The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery.
OBJECTIVE
The occurrence of a seizure after the arterial switch operation is associated with a worse long-term neurodevelopmental outcome. The significance of seizures after neonatal and infant repair of other congenital heart defects is not known.


METHODS
A recent study at our institution demonstrated seizures documented by 48-hour electroencephalographic monitoring in 20 (11%) of 178 neonates and infants after surgery for complex congenital heart defects, including hypoplastic left heart syndrome or variants. The developmental outcomes of this cohort were evaluated at 1 year of age by using the Bayley Scales of Infant Development II, which yields 2 scores: the Mental Developmental Index and the Psychomotor Developmental Index.


RESULTS
Developmental evaluations were performed in 114 (70%) of 164 survivors, including 36 with hypoplastic left heart syndrome. Postoperative electroencephalographic seizures had occurred in 15 (13%) of 114 of the entire group and in 8 (22%) of 36 of those with hypoplastic left heart syndrome. For the entire cohort, the Mental Developmental Index was 92.3 +/- 13.5, and the Psychomotor Developmental Index was 79.9 +/- 18.8 for patients without seizures, compared with 90.3 +/- 10.7 and 74.4 +/- 19.3 for those with seizures (both P > .5). For the hypoplastic left heart syndrome subgroup, the Mental Developmental Index was 92.3 +/- 14.9, and the Psychomotor Developmental Index was 74.8 +/- 19.3 for patients with seizures, compared with 91.9 +/- 12.4 and 73.9 +/- 18.3 for those without seizures (both P > .5). A frontal onset of seizures was predictive of a lower score on the Psychomotor Developmental Index, but not on the Mental Developmental Index.


CONCLUSIONS
The occurrence of a seizure after cardiac operation is a marker of central nervous system injury. However, in this cohort of neonates and infants with complex congenital heart defects, the occurrence of a seizure was not predictive of a worse developmental outcome at 1 year of age as assessed by the Bayley Scales of Infant Development II.
Gaynor
J William
JW
Division of Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. gaynor@email.chop.edu
Jarvik
Gail P
GP
Bernbaum
Judy
J
Gerdes
Marsha
M
Wernovsky
Gil
G
Burnham
Nancy B
NB
D'Agostino
Jo Ann
JA
Zackai
Elaine
E
McDonald-McGinn
Donna M
DM
Nicolson
Susan C
SC
Spray
Thomas L
TL
Clancy
Robert R
RR
D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004569:Electroencephalography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011596:Psychomotor Disorders / Q000209:etiology*; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors