From the Departments of Medicine (L.A.R.), Neurology (D.C.B., S.L.H.,
G.L.H., K.C.K.K.), Radiology (P.D.B.), Cardiology (G.W., J.W.N.), and
Cardiovascular Surgery (R.A.J.), Children's Hospital, and the Department
of Biostatistics, Harvard School of Public Health, Boston, Mass (D.W.). Dr
Wernovsky is currently at the Department of Cardiology, Children's
Hospital, Philadelphia, Pa.
Correspondence to Leonard A. Rappaport, MD, Department of Medicine, Fegan 10, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail Rappaport{at}A1.tch.harvard.edu
Background—The outcome of infants
who have transient seizures after open heart surgery has not been
studied. Using the database of the Boston Circulatory Arrest Study
involving 171 children with D-transposition of the great arteries, we
explored the relationship between early postoperative clinical and EEG
seizures and neurodevelopmental outcomes at ages 1 and 21/2
years.
Methods and Results—At 1 year, children returned for
developmental and neurological evaluations and MRI. Parent-completed
developmental questionnaires were collected at 2 1/2 years of
age. At 1 year, children with early postoperative seizures had lower
Psychomotor Development Index (motor function) scores (clinical
seizures: 12.9 mean difference [MD]; 95% confidence interval [CI],
2.2 to 23.6; P=.02; EEG seizures: 13.3 MD; 95% CI, 6.8
to 19.7; P<.001). Mental Developmental Index scores of
children with clinical or EEG seizures were also lower, but the
differences were not statistically significant. Infants with seizures
were more likely to have an abnormal neurological examination (clinical
seizures: 78% versus 31%; P=.008; EEG seizures: 58%
versus 34%; P=.04). Children with EEG seizures were
more likely to have MRI abnormalities (43% versus 13%,
P=.002). At age 21/2, children with EEG seizures
had lower scores in several areas of function.
Conclusions—In infants undergoing the arterial switch
operation for correction of D-transposition of the great arteries,
transient postoperative clinical and EEG seizures were associated with
worse neurodevelopmental outcomes at ages 1 and 2 1/2 years as
well as neurological and MRI abnormalities at 1 year of age. The
occurrence of such seizures may provide an early sign of brain injury
with neurological and developmental sequelae.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Relation of Seizures After Cardiac Surgery in Early Infancy to Neurodevelopmental Outcome
Key Words: surgery • seizures • circulation • child development
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