Amplitude-Integrated Electroencephalography for Early Recognition of Brain Injury in Neonates with Critical Congenital Heart Disease

• Published in: The Journal of pediatrics Vol. 202; pp. 199 - 205.e1
• Main Authors: Claessens, Nathalie H.P., Noorlag, Lotte, Weeke, Lauren C., Toet, Mona C., Breur, Johannes M.P.J., Algra, Selma O., Schouten, Antonius N.J., Haas, Felix, Groenendaal, Floris, Benders, Manon J.N.L., Jansen, Nicolaas J.G., de Vries, Linda S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2018
• Subjects: brain abnormalities; brain activity; brain function; cardiac surgery; heart defect; MRI; newborns; MRI; EEG; SAT; brain function; newborns; BGP; CNV; aEEG; SVP; heart defect; DNV; FT; BS; CPB; cardiac surgery; brain activity; BVP; CHD; ISI; SWC; brain abnormalities; BVP-AO
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2018.06.048

To study perioperative amplitude-integrated electroencephalography (aEEG) as an early marker for new brain injury in neonates requiring cardiac surgery for critical congenital heart disease (CHD).
This retrospective observational cohort study investigated 76 neonates with critical CHD who underwent neonatal surgery. Perioperative aEEG recordings were evaluated for background pattern (BGP), sleep-wake cycling (SWC), and ictal discharges. Spontaneous activity transient (SAT) rate, inter-SAT interval (ISI), and percentage of time with an amplitude <5 µV were calculated. Routinely obtained preoperative and postoperative magnetic resonance imaging of the brain were reviewed for brain injury (moderate-severe white matter injury, stroke, intraparenchymal hemorrhage, or cerebral sinovenous thrombosis).
Preoperatively, none of the neonates showed an abnormal BGP (burst suppression or worse) or ictal discharges. Postoperatively, abnormal BGP was seen in 18 neonates (24%; 95% CI, 14%-33%) and ictal discharges was seen in 13 neonates (17%; 95% CI, 8%-26%). Abnormal BGP and ictal discharges were more frequent in neonates with new postoperative brain injury (P = .08 and .01, respectively). Abnormal brain activity (ie, abnormal BGP or ictal discharges) was the single risk factor associated with new postoperative brain injury in multivariable logistic regression analysis (OR, 4.0; 95% CI, 1.3-12.3; P = .02). Postoperative SAT rate, ISI, or time <5 µV were not associated with new brain injury.
Abnormal brain activity is an early, bedside marker of new brain injury in neonates undergoing cardiac surgery. Not only ictal discharges, but also abnormal BGP, should be considered a clear sign of underlying brain pathology.