200 Abnormal Preoperative Eeg's In Newborn Infants with Congenital Heart Disease

Introduction: Abnormal preoperative neurological symptoms in infants with congenital heart disease (CHD) may be more common than previously recognised. The aim of the present study was to investigate if EEG correlates with preoperative morbidity. Method: We investigated EEG and cranial ultrasound/CT/MRI in 28 newborn infants with CHD. Inclusion criteria were gest. age 36 weeks or more, postnatal age <14 days, no other major malformations, parental consent and no language barrier. Standard EEG's were recorded within 24 hours of arrival and evaluated according to predefined criteria. Seven EEG categories were evaluated: background, assymetry, spikes/sharp waves, seizure activity, sleep-wake cycling, reactivity and a total evaluation of normality/degree of abnormality. Results: Twenty-eight infants with CHD were included, their median (range) gestational age was 39 (36– 41) weeks. The EEG was performed at median 4 (1–14) postnatal days. Twenty-five of the 28 infants received infusion with prostaglandin E1 (PGE1). Six infants (21.4%) had suspected or clear clinical seizures, four infants (15.4%) hade abnormal cranial ultrasound/CT/MRI. Six of the infants died, one due to preoperative hypoxic-ischemic brain injury, and the other five later due to heart failure. Results: The preoperative total EEG evaluation was normal in 12 infants, slightly abnormal in 4, moderately abnormal in 10, and severely abnormal in 2 infants. The EEG background correlated significantly with lowest preoperative pH (p=0.026, rs= −0.429) and base deficit (p=0.030, rs = −0.426, and also correlated with the amount of PGE1 (0.022, rs = 0.438. Presence of seizure activity was negatively associated with lowest preoperative oxygen saturation (p=0.019, rs =−0.448). Increasing degree of intracranial abnormality correlated with increasingly abnormal EEG background (p=0.005, rs = 0.532) and sleep-wake cycling in EEG (p=0.023, rs = −0.452), and the total evaluation of the EEG (p=0.017, rs = 0.463). Infants with hypoplastic left heart syndrome (HLHS)/single ventricle had significantly more often a moderately or severely abnormal EEG (p=0.044). Mortality was associated with intracranial morphological abnormality (p=0.012) but not abnormal EEG. Conclusion: Abnormal preoperative neurology and EEG is probably uncommon in infants with CHD. Possible effects on EEG from PGE1 should be further investigated.