Gagandeep Singh, MD
Loma Linda University Children's Hospital
Loma Linda, California
Disclosure information not submitted.
Andrew Hopper, MD
Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Christopher WIlson, PhD
Associate Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Pilar Pichon, MD
Assistant Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Anees Razzouk, MD
Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Timothy Martens, MD, PhD
Associate Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
John Tan, PhD
Assistant Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Harmony Carter, MD
Associate Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Larry Tinsley, MD
Associate Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Harsha Chandnani, MBA, MD, MPH
Assistant Professor of Pediatrics
Loma Linda University, United States
Disclosure information not submitted.
Title: Perioperative Non-Invasive Neuromonitoring in Infants with Congenital Heart Disease
Introduction: Neurodevelopmental impairment is prevalent in infants born with congenital heart disease (CHD) undergoing corrective/palliative surgeries. Hypoxic-ischemic insult and impaired cerebral autoregulation play a key role in brain injury. Bedside non-invasive neuromonitoring techniques like near-infrared regional spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG) can help identify at-risk patients.
Methods: Thirty-one neonates/infants undergoing cardiac surgery were enrolled from Sept 2019-Dec 2020. Patients were classified in 4 groups per their CHD diagnosis: (Group 1)single ventricle with aortic arch obstruction, (Group 2)single ventricle without aortic arch obstruction, (Group 3)two ventricles with aortic arch obstruction, and (Group 4)two ventricle without aortic arch obstruction. All subjects underwent vital signs, pulse oximetry, aEEG, and NIRS monitoring in the preoperative, intraoperative, and postoperative periods. A blinded pediatric neurologist reviewed aEEG tracings for seizure activity, dominant background pattern, and presence of sleep-wake cycles.
Results: Infants in Group 1 had lower birth weight, required surgical palliation at a younger age(5.5 days), with prolonged cardiopulmonary bypass(175.2 min) and circulatory arrest times(54.2 min). In the operative phase, the median cerebral saturations decreased with compensatory increase in fractional tissue oxygen extraction of the brain in all subjects. Preoperative electroencephalographic background was continuous in 25 infants; intraoperatively, 5 infants had discontinuous backgrounds, 10 were in burst suppression. Background pattern recovery to preoperative pattern occurred at a median of 1 hour after surgery. Electroencephalographic seizures were recorded in 22 infants; 87.5% of Group 1 had electroencephalographic seizure activity during the postoperative period.
Conclusions: Infants with complex CHD undergoing surgery had increased periods of abnormal electroencephalographic background activity and electrographic seizure activity during the intraoperative period. Infants in Group 1 had higher incidence of seizures during the postoperative period. Further clinical research is required in developing tools to detect impaired cerebral hemodynamics and to optimize long-term neurodevelopmental outcomes in infants with CHD.