Role of Conventional EEG in Infants with Congenital Heart Disease and Its Correlation with Long Term Neurodevelopmental Outcomes

Background: Newborns with congenital heart disease (CHD) requiring surgery during the neonatal period are at increased risk for early brain injury. Neurodevelopmental disability after congenital cardiac surgery is a common squeal of CHD; however there is an ongoing need to identify and stratify patients at risk. Methods to identify brain injury and predict neurodevelopmental outcomes using non-invasive neuro-diagnostic tests such as electroencephalography (EEG) could improve critical care of these newborns. Recent guidelines by the American Clinical Neurophysiology Society recommends long term EEG monitoring in neonates with CHD that require early surgery.

Objective:
To evaluate the role of conventional EEG in infants with CHD undergoing surgical repair and its correlation with long term neurodevelopmental outcomes.

Methods: This is a retrospective study of infants who underwent congenital cardiac surgery at < 6 months of age using cardiopulmonary bypass from 2010-2018. Infants transferred to other institutes for care or who underwent cardiac transplantation < 30 months of age were excluded.

Results: A total of 98 patient records were included. Interim results for 19 patients who had pre-operative and post-operative EEGs were analyzed, that showed median age at surgery was 6 days of which 74% were male patients (Table 1). Pre-op EEGs were normal in 76% whereas 29% had mild encephalopathy. Immediate post-op EEGs were abnormal in 89% of cases. Bayley Scale of Infant Development (BSID) was performed at median age of 15 months (Table 2). An EEG finding of lack of Sleep- wake cycling at 24-hour post- op EEG was associated with significantly lower cognitive (CCS), language (LCS) and motor (MCS) composite scales (Table 3).

Conclusion: Sleep- wake cycle abnormalities at 24- hour post- op EEG were significantly associated with lower scores on the Bayley Scales in all three domains.