Neurologic events in neonates treated surgically for congenital heart disease.
OBJECTIVE
The incidence of acute neurologic events prior to discharge in neonates with congenital heart disease (CHD) was determined and peri-operative characteristics predictive of a neurologic event were identified.


METHODS
A retrospective chart review over 1 year was conducted of infants <1 month of age with a diagnosis of CHD. Outcomes were measured by the occurrence of an acute neurologic event defined as electroencephalogram (EEG)-proven seizure activity, significant hypertonia or hypotonia, or choreoathetosis prior to hospital discharge. Stepwise logistic regression identified variables most likely to be associated with an acute neurologic event.


RESULTS
Surgical intervention occurred in 95 infants who were admitted with a diagnosis of CHD. The survival rate was 92%. Of the survivors, 16 (17%) had an acute neurologic event, with 19% of events occurring preoperatively. Factors associated with neurologic events included an elevated nucleated red blood cell (NRBC) count, an abnormal preoperative brain imaging study, and a 5-min Apgar score <7 (P<0.05).


CONCLUSIONS
Neonates with CHD have a significant risk of neurologic events. Preoperative brain imaging, the 5-min Apgar score, and initial serum NRBC counts may identify infants at highest risk for central nervous system injury.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA.
V Y
VY
Chock
V M
VM
Reddy
D
D
Bernstein
A
A
Madan
D000208:Acute Disease; D001264:Athetosis / Q000209:etiology* / Q000401:mortality; D002819:Chorea / Q000209:etiology* / Q000401:mortality; D004569:Electroencephalography; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009122:Muscle Hypertonia / Q000209:etiology* / Q000401:mortality; D009123:Muscle Hypotonia / Q000209:etiology* / Q000401:mortality; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate