title: Postoperative Amplitude-Integrated Electroencephalography Predicts Four-Year Neurodevelopmental Outcome in Children with Complex Congenital Heart Disease.
abstract: OBJECTIVE
  To evaluate the predictive value of pre- and postoperative amplitude-integrated electroencephalography (aEEG) on neurodevelopmental outcomes in children operated for congenital heart disease (CHD).
  
  
  METHODS
  Prospectively enrolled cohort of 60 infants with CHD who underwent cardiac surgery with cardiopulmonary bypass in the first 3 months of life. Infants with a genetic comorbidity were excluded. aEEG was assessed for 12 hours pre- and 48 hours postoperatively. Background pattern was classified by the use of standard categories, and the presence of seizures and sleep-wake cycles (SWCs) was noted. Outcome at 1 and 4 years of age was assessed with standardized developmental tests.
  
  
  RESULTS
  Preoperatively, infants either showed continuous normal voltage (n = 56) or discontinuous normal voltage (n = 4). Postoperatively, abnormal background pattern (flat trace, burst suppression, or continuous low voltage) was detected in 7 (12%), discontinuous normal voltage in 37 (61%), and continuous normal voltage in 16 (27%) infants. Nineteen infants (32%) did not return to normal SWCs within the recording period. Seizures were detected in 4 infants preoperatively and in another 4 postoperatively. After we controlled for surgical and postoperative risk factors, abnormal postoperative background pattern and lack of return to SWCs independently predicted poorer intelligence quotient at 4 years (P = .03 and P = .04 respectively) but was not related to motor outcome.
  
  
  CONCLUSIONS
  aEEG is a useful bedside tool that helps to predict outcome in infants undergoing open-heart surgery for CHD. Abnormal postoperative background pattern and lack of return to SWCs are markers for subsequent impaired cognitive development.
authors.affiliation: Child Development Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland. Electronic address: bea.latal@kispi.uzh.ch.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
authors.affiliation: Department of Pediatric Neurology and Neurophysiology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wohlrab
authors.affiliation: Department of Pediatric Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Brotschi
authors.affiliation: Child Development Center, University Children's Hospital, Zurich, Switzerland.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Beck
authors.affiliation: Children's Research Center, University Children's Hospital, Zurich, Switzerland; Division of Cardiology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
authors.affiliation: Children's Research Center, University Children's Hospital, Zurich, Switzerland; Department of Pediatric Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Vera
authors.initials: V
authors.lastname: Bernet
mesh_terms: D001921:Brain / Q000254:growth & development*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies
keywords: background pattern; cardiopulmonary bypass