Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Boston Circulatory Arrest Study Group.
BACKGROUND
The outcome of infants who have transient seizures after open heart surgery has not been studied. Using the database of the Boston Circulatory Arrest Study involving 171 children with D-transposition of the great arteries, we explored the relationship between early postoperative clinical and EEG seizures and neurodevelopmental outcomes at ages 1 and 2 1/2 years.


RESULTS
At 1 year, children returned for developmental and neurological evaluations and MRI. Parent-completed developmental questionnaires were collected at 2 1/2 years of age. At 1 year, children with early postoperative seizures had lower Psychomotor Development Index (motor function) scores (clinical seizures: 12.9 mean difference [MD]; 95% confidence interval [CI], 2.2 to 23.6; P=.02; EEG seizures: 13.3 MD; 95% CI, 6.8 to 19.7; P<.001). Mental Developmental Index scores of children with clinical or EEG seizures were also lower, but the differences were not statistically significant. Infants with seizures were more likely to have an abnormal neurological examination (clinical seizures: 78% versus 31%; P=.008; EEG seizures: 58% versus 34%; P=.04). Children with EEG seizures were more likely to have MRI abnormalities (43% versus 13%, P=.002). At age 2 1/2, children with EEG seizures had lower scores in several areas of function.


CONCLUSIONS
In infants undergoing the arterial switch operation for correction of D-transposition of the great arteries, transient postoperative clinical and EEG seizures were associated with worse neurodevelopmental outcomes at ages 1 and 2 1/2 years as well as neurological and MRI abnormalities at 1 year of age. The occurrence of such seizures may provide an early sign of brain injury with neurological and developmental sequelae.
Rappaport
L A
LA
Department of Medicine, Children's Hospital, Boston, MA 02115, USA. Rappaport@A1.tch.harvard.edu
Wypij
D
D
Bellinger
D C
DC
Helmers
S L
SL
Holmes
G L
GL
Barnes
P D
PD
Wernovsky
G
G
Kuban
K C
KC
Jonas
R A
RA
Newburger
J W
JW
D000367:Age Factors; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000150:complications / Q000209:etiology* / Q000473:pathology; D004569:Electroencephalography; D006323:Heart Arrest / Q000473:pathology; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000150:complications / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009420:Nervous System / Q000254:growth & development / Q000473:pathology*; D009460:Neurologic Examination / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011597:Psychomotor Performance; D012640:Seizures / Q000150:complications / Q000209:etiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome