title: Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity.
abstract: OBJECTIVE
  Neonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes.
  
  
  METHODS
  Neonates requiring surgery had continuous intraoperative EEG and hemodynamic monitoring. The level of EEG suppression was classified as either: slow and continuous; moderate burst suppression; severe burst suppression; or isoelectric (no brain activity for >3 minutes). Follow-up neurodevelopmental outcomes were assessed using the Vineland Adaptive Behavior Scale II (Vineland-II).
  
  
  RESULTS
  Twenty-one neonates requiring cardiac surgery developed a slow and continuous EEG pattern after general anesthesia. Ten neonates (48%) maintained continuous brain electrical activity with moderate burst suppression as the maximum level of EEG suppression. Eleven neonates (52%) developed severe burst suppression that progressed into an isoelectric state during the deep hypothermic period required for circulatory arrest. However, the duration of this state was significantly longer than circulatory arrest times (111.1 ± 50 vs 22.3 ± 17 minutes; P < .001). At a mean follow-up at 5.6 ± 1.0 years, compared with neonates with continuous brain electrical activity, neonates who developed an isoelectric state had lower Vineland-II scores in communication. There was an inverse relationship between composite Vineland-II scores and duration of isoelectric activity (R = -0.75, P = .01). Of neonates who experienced an isoelectric state, durations of >90 minutes were associated with the lowest Vineland-II scores (125.0 ± 2.6 vs 81.1 ± 12.7; P < .01).
  
  
  CONCLUSIONS
  The duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.
authors.affiliation: Department of Neurology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Laurie
authors.initials: L
authors.lastname: Seltzer
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: Michael_Swartz@urmc.rochester.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.affiliation: Department of Neurology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Department of Neurology, University of Rochester Medical Center, Rochester, NY.
authors.forename: James
authors.initials: J
authors.lastname: Burchfiel
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.affiliation: Department of Statistics, University of Rochester Medical Center, Rochester, NY.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, NY; Department of Anesthesia, University of Rochester Medical Center, Rochester, NY.
authors.forename: Dawn
authors.initials: D
authors.lastname: Sweeney
authors.affiliation: Department of Neurology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Adams
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Meagher
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Ron
authors.initials: R
authors.lastname: Angona
authors.affiliation: Department of Neonatology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Guillet
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002540:Cerebral Cortex / Q000254:growth & development*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: EEG; deep hypothermic circulatory arrest; neurodevelopmental outcomes