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Continuous electroencephalography (cEEG) in infants with congenital heart disease (CHD)

  • Clinical Research Article
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Abstract

Background

Neonates with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) surgery have increased risk of impaired neurodevelopmental outcomes secondary to brain injury. This study aims to characterize pre- and post-operative continuous EEG (cEEG) patterns to detect abnormal cerebral activity in infants with CHD and investigate whether an association exists between the degree of encephalopathy in pre- and post-operative cEEG.

Methods

This retrospective cohort study conducted between 2010 and 2018 at a tertiary hospital in Cleveland, OH included infants with CHD with cEEG monitoring, who underwent CPB surgery within first 6 months of life.

Results

Study included 77 patients, of which 61% were males who were operated at median age 6 days. Pre-operatively, 69% and 87% had normal cEEG and sleep–wake cycles, respectively. Post-operatively, 80% had abnormal cEEG. Longer circulatory arrest time and CPB were associated with lack of continuity (p 0.011), excessive discontinuity (p 0.007) and prolonged inter-burst interval (IBI) duration (p value < 0.001). A significant association existed between severity of encephalopathy in immediate and 24-h post-operative period (p value < 0.001).

Conclusions

More than 80% of neonates with CHD have abnormal post-operative EEG. Longer circulatory arrest time and CPB were associated with lack of continuity, excessive discontinuity, and prolonged IBI duration on post-operative EEG.

Impact

  • This study shows that majority of neonates with congenital heart disease (CHD) have normal pre-operative EEG with a continuous background and normal sleep–wake cycles. Also, 80% of neonates had abnormal post-operative EEG.

  • Longer duration of arrest time and bypass time was associated with lack of continuity, excessive discontinuity, and prolonged IBI duration during post-operative EEG monitoring.

  • These findings will help clinicians when counseling parents in the intensive care unit, risk stratification, and long-term neurodevelopmental monitoring in these high-risk patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No financial assistance was received in support of this study.

Author information

Authors and Affiliations

  1. Department of Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Swetha Padiyar & Hany Aly

  2. Department of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, USA

    Neil Friedman

  3. Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA

    Elia Pestana-Knight, Ahsan Mossa-Naduvil & Linda Franic

  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Sarah Worley

Authors
  1. Swetha Padiyar
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  2. Neil Friedman
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Contributions

S.P. helped design the study, designed data collection instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. N.F. conceptualized and designed the study and reviewed the manuscript. E.P.-K. and A.M.-N. helped design the study and reviewed and revised the manuscript for important intellectual content. L.F. helped design data collection instruments and collected data. S.W. helped with data stratification and statistical analysis. H.A. coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content.

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Correspondence to Swetha Padiyar.

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The authors declare no competing interests.

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No patient consent was required for this retrospective cohort study.

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Padiyar, S., Friedman, N., Pestana-Knight, E. et al. Continuous electroencephalography (cEEG) in infants with congenital heart disease (CHD). Pediatr Res 94, 715–723 (2023). https://doi.org/10.1038/s41390-023-02520-6

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  • DOI: https://doi.org/10.1038/s41390-023-02520-6

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