| Background&Objective:Congenital heart disease(CHD)is the most common birth defect.Due to an increasing absolute and relative survival in children and young adults with CHD,brain injury,as a potentially devastating complication of CHD,has attracted increasing attention from neurologists and parents.So far,cardiologists and pediatrics have not got a clearly conclusion on the early predictive examination of neurodevelopmental disorders in children with congenital heart disease.Amplitude-integrated electroencephalography(aEEG)is used to identify seizures and abnormalities in the background cerebral activity of infants in Neonatal Intensive Care Units(NICU).This study is to explore the correlation between aEEG results and clinical characteristics and to investigate the perioperative cortical activity in infants with CHD and its risk factors.It is to analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 12 months of age and to analyze the association between the perioperative aEEG of infants with CHD and their neurodevelopmental outcome at 18 months of age.Methods:Newborns and infants with CHD who were admitted to the Department of Neonatal Cardiology at our hospital were included.Preoperative and postoperative aEEG was underwent and its correlation with clinical characteristics was analyzed.Twelve-month-old infants with CHD undergoing follow-up at the outpatient clinic were enrolled.The Bay ley scales of infant development(BSID)were used to evaluate the levels of mental development(MDI)and psychomotor development(PDI).The clinical characteristics of the surgery and perioperative manage during hospitalization were reviewed,and the risk factors of MDI and PDI were analyzedChildren with CHD who were admitted to the NICU were enrolled.All patients had undergone cardiac surgery before 3 months of age and had pre-or postoperative aEEG monitoring.The background pattern,sleep-wake cycle(SWC)and seizure(include electrographic activity(EA))were used to quantify cerebral activity related to brain function.Infants with CHD were followed up at 18 months.Participants were assessed at 18 months via the use of the BSID.Results:A total of 295 patients were enrolled.Preoperative aEEG monitoring was performed in 167 patients.19.17%(32/167)infants showed mild abnormal background patterns and 34.73%(58/167)infants showed immature sleep-wake cycling(SWC),and 1.8%(3/167)infants showed absent SWC.The older the gestational age was,the higher the likelihood of a normal background pattern(OR=0.220,95%CI:0.072-0.675);the higher likelihood of abnormal SWC(OR=6.595)in patients with mild hypoxia at birth.Five infant patients had preoperative seizures and were all diagnosed with cyanotic CHD.226 patients who underwent postoperative aEEG monitoring,approximately 5.75%(13/226)showed mild abnormal background patterns,0.88%(2/226)showed severe abnormalities,27.43%(62/226)demonstrated an immature SWC,and 3.54%(8/226)showed absent SWC.The patients who had a history of hypoxia at birth(OR:14.647,95%CI:2.590-82.822)or delayed sternal closure(OR:5.197,95%CI:1,659-16.285)or severe postoperative neurological symptoms(OR:5.145,95%CI:1.044-25.348)had higher probabilities of abnormal postoperative SWC.Both preoperative and postoperative aEEG were performed in 103 patients.The patients with postoperative septicemia were more likely to have a worsened SWC.A total of 116 children with CHD underwent BSID evaluation at 12 months of age.Both the MDI(95.38±22.98)and PDI(87.84±22.57)of the cohort were significantly lower than the average value of the normal population(100)(p<0.05).There was a positive correlation between MDI and PDI(?:0.835,95%CI:0.429-1.241).The higher MDI,the higher PDI(?:0.497,95%CI:0.342-0.652);the infants who underwent surgery with CPB got higher PDI compared those who underwent surgery without CPB(?:11.956,95%CI:0.845-23.068).The longer the length was of the hospital stay,the lower the PDI(?:-0.577,95%CI:-0.874?-0.279).Inpatients undergoing cardiopulmonary bypass surgery,the PDI was higher(?=11.956).Compared to infants with relatively normal behavior,the PDI of infants with mild behavioral problems was lower(p:-10.605,95%CI:-18.546?-2.664).A total of 93 children with CHD were included in the current study.Participants got MDI(96.483 ±21.997)and PDI(87.763±21.584)at 18 months of age.Compared with the average value(100)of general population,the PDI of infants in this study was lower(t=-5.467,P<0.001).The infants who showed absent SWC in postoperative aEEG exhibited a significantly lower MDI(P=0.09).The infants who showed mild abnormal preoperative background pattern exhibited a significantly lower PDI(P=0.0064).The infants who showed immature preoperative SWC exhibited a significantly lower PDI(P=0.03 7).The preoperative background pattern and SWC maybe can predict the motor function in infants with CHD.Conclusion:1.most of the patients' cortical activity were normal.SWC could be a better predictor of brain damage than background and seizure.Gestational age and hypoxia at birth were the risk factors of preoperative brain injury.Delayed sternal closure,postoperative septicemia,and postoperative neurological symptoms were risk factors for postoperative brain injury.Several infants who had perioperative seizures were all with complex CHD.Brain function improvement was more difficult in patients with postoperative septicemia.2.The children with CHD have delayed neurodevelopmental outcomes compared with those of healthy children.The outcomes of infants who underwent surgery with CPB were better than others.Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes.3.aEEG is a useful bedside tool that helps to predict outcomes in infants undergoing heart surgery at 18 months of age.The perioperative background pattern and SWC could be predict markers for motor development. |
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