title: Amplitude-integrated EEG in newborns with critical congenital heart disease predicts preoperative brain magnetic resonance imaging findings.
abstract: OBJECTIVE
  The study aims are to evaluate cerebral background patterns using amplitude-integrated electroencephalography in newborns with critical congenital heart disease, determine if amplitude-integrated electroencephalography is predictive of preoperative brain injury, and assess the incidence of preoperative seizures. We hypothesize that amplitude-integrated electroencephalography will show abnormal background patterns in the early preoperative period in infants with congenital heart disease that have preoperative brain injury on magnetic resonance imaging.
  
  
  METHODS
  Twenty-four newborns with congenital heart disease requiring surgery at younger than 30 days of age were prospectively enrolled within the first 3 days of age at a tertiary care pediatric hospital. Infants had amplitude-integrated electroencephalography for 24 hours beginning close to birth and preoperative brain magnetic resonance imaging. The amplitude-integrated electroencephalographies were read to determine if the background pattern was normal, mildly abnormal, or severely abnormal. The presence of seizures and sleep-wake cycling were noted. The preoperative brain magnetic resonance imaging scans were used for brain injury and brain atrophy assessment.
  
  
  RESULTS
  Fifteen of 24 infants had abnormal amplitude-integrated electroencephalography at 0.71 (0-2) (mean [range]) days of age. In five infants, the background pattern was severely abnormal. (burst suppression and/or continuous low voltage). Of the 15 infants with abnormal amplitude-integrated electroencephalography, 9 (60%) had brain injury. One infant with brain injury had a seizure on amplitude-integrated electroencephalography. A severely abnormal background pattern on amplitude-integrated electroencephalography was associated with brain atrophy (P = 0.03) and absent sleep-wake cycling (P = 0.022).
  
  
  CONCLUSIONS
  Background cerebral activity is abnormal on amplitude-integrated electroencephalography following birth in newborns with congenital heart disease who have findings of brain injury and/or brain atrophy on preoperative brain magnetic resonance imaging.
authors.affiliation: Department of Pediatrics, Section of Pediatric Neurology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. Electronic address: mulkeysarah@uams.edu.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Mulkey
authors.affiliation: Department of Pediatrics, Section of Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Vivien L
authors.initials: VL
authors.lastname: Yap
authors.affiliation: Department of Pediatrics, Section of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Shasha
authors.initials: S
authors.lastname: Bai
authors.affiliation: Department of Radiology, Section of Pediatric Neuroradiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Raghu H
authors.initials: RH
authors.lastname: Ramakrishnaiah
authors.affiliation: Department of Radiology, Section of Pediatric Neuroradiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Glasier
authors.affiliation: Department of Pediatrics, Section of Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Renee A
authors.initials: RA
authors.lastname: Bornemeier
authors.affiliation: Department of Anesthesiology, Section of Pediatric Cardiothoracic Anesthesia, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schmitz
authors.affiliation: Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001930:Brain Injuries / Q000473:pathology / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006330:Heart Defects, Congenital / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000473:pathology* / Q000503:physiopathology; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care
keywords: brain injury; congenital heart disease; electroencephalography; neuromonitoring; newborn; seizures
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