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
This article has been cited by other articles:
 |
|
 |
|
  A. J. Shillingford, M. M. Glanzman, R. F. Ittenbach, R. R. Clancy, J. W. Gaynor, and G. Wernovsky Inattention, Hyperactivity, and School Performance in a Population of School-Age Children With Complex Congenital Heart Disease Pediatrics, April 1, 2008; 121(4): e759 - e767. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Wernovsky Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 240 - 242. [Full Text] [PDF]
|
|
|
|
 |
|
 M. V. Johnston Congenital Heart Disease and Brain Injury N. Engl. J. Med., November 8, 2007; 357(19): 1971 - 1973. [Full Text] [PDF]
|
|
|
|
 |
|
 S. P Miller and P. S McQuillen Neurology of congenital heart disease: insight from brain imaging Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F435 - F437. [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Hannan, M. A. Ybarra, J. W. Ojito, F. A. Alonso, A. F. Rossi, and R. P. Burke Complex Neonatal Single Ventricle Palliation Using Antegrade Cerebral Perfusion. Ann. Thorac. Surg., October 1, 2006; 82(4): 1278 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Duara, S. Shekhar Padhi, A. Padmanabhan Iyer, C. Parija, and S. Rema Krishna Manohar Convulsive syncope after bidirectional Glenn shunts: physiological implications for a neurological event Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 594 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Padula and A. M. Ades Neurodevelopmental Implications of Congenital Heart Disease NeoReviews, July 1, 2006; 7(7): e363 - e369. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gaynor, G. P. Jarvik, J. Bernbaum, M. Gerdes, G. Wernovsky, N. B. Burnham, J. A. D'Agostino, E. Zackai, D. M. McDonald-McGinn, S. C. Nicolson, et al. The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 181 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. L. Hanley Religion, politics...deep hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1236 - 1236. [Full Text] [PDF]
|
|
|
|
|
|
T. R. Karl, S. Hall, G. Ford, E. A. Kelly, C. P. R. Brizard, R. B. B. Mee, R. G. Weintraub, A. D. Cochrane, and D. Glidden Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: Neurodevelopmental outcome J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 213 - 222. [Abstract] [Full Text]
|
|
|
|
|
|
D. C. Bellinger, D. Wypij, A. J. duPlessis, L. A. Rappaport, R. A. Jonas, G. Wernovsky, and J. W. Newburger Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1385 - 1396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. Clancy, S. A. McGaurn, G. Wernovsky, J. W. Gaynor, T. L. Spray, W. I. Norwood, M. L. Jacobs, and J. E. Goin Risk of Seizures in Survivors of Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest Pediatrics, March 1, 2003; 111(3): 592 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. Mahle, F. Tavani, R. A. Zimmerman, S. C. Nicolson, K. K. Galli, J. W. Gaynor, R. R. Clancy, L. M. Montenegro, T. L. Spray, R. M. Chiavacci, et al. An MRI Study of Neurological Injury Before and After Congenital Heart Surgery Circulation, September 24, 2002; 106(12_suppl_1): I-109 - I-114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Hovels-Gurich, M.-C. Seghaye, R. Schnitker, M. Wiesner, W. Huber, R. Minkenberg, F. Kotlarek, B. J. Messmer, and G. von Bernuth Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 448 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, N. A. Tatton, N. Khaladj, N. Zhang, S. Nandor, S. Insolia, D. J. Weisz, D. Spielvogel, and R. B. Griepp Involvement of apoptosis in neurological injury after hypothermic circulatory arrest: a new target for therapeutic intervention? Ann. Thorac. Surg., November 1, 2001; 72(5): 1457 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ueno, Y. Sawa, S. Kitagawa-Sakakida, M. Nishimura, R. Morishita, Y. Kaneda, E. Kohmura, T. Yoshimine, and H. Matsuda Nuclear factor-{kappa}B decoy attenuates neuronal damage after global brain ischemia: A future strategy for brain protection during circulatory arrest J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 720 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Hovels-Gurich, M.-C. Seghaye, M. Sigler, F. Kotlarek, A. Bartl, J. Neuser, R. Minkenberg, B. J. Messmer, and G. von Bernuth Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation Ann. Thorac. Surg., March 1, 2001; 71(3): 881 - 888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Dyamenahalli, B. W. McCrindle, G. A. Barker, W. G. Williams, R. M. Freedom, and D. J. Bohn Influence of perioperative factors on outcomes in children younger than 18 months after repair of tetralogy of Fallot Ann. Thorac. Surg., April 1, 2000; 69(4): 1236 - 1242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Abdul-Khaliq, V. Alexi-Meskhishvili, and P. E. Lange Serum S-100 protein levels after pediatric cardiac surgery: A possible new marker for postperfusion cerebral injury J. Thorac. Cardiovasc. Surg., April 1, 1999; 117(4): 843 - 844. [Full Text]
|
|