Factors Associated with Seizures after Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest.
Abstract number :
1.146
Submission category :
Year :
2001
Submission ID :
1675
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
R.R. Clancy, M.D., Neurology, The Children[ssquote]s Hospital of Philadelphia, Philadelphia, PA; J.W. Gaynor, M.D., Cardiothoracic Surgery, The Children[ssquote]s Hospital of Philadelphia, Philadelphia, PA; T. Spray, M.D., Cardiothoracic Surgery, The Chil
RATIONALE: The signs of an acute neonatal encephalopathy (ANE): seizures and/or coma are relatively common after newborn heart surgery but the factors that influence their occurrence are incompletely understood. This study conducted an exploratory analysis of pre- and intra-operative variables associated with seizures in survivors of newborn heart surgery under deep hypothermic circulatory arrest (DHCA).
METHODS: We previously reported the results of a pharmacologic protection trial in two strata of congenital heart disease (CHD): (i) hypoplastic left heart syndrome (HLHS) and (ii) all other form of CHD (non-HLHS). The subjects of this analysis were survivors of the non-HLHS strata, in whom study drug did not provide neuroprotection. Multiple pre- and intra-operative variables were examined to identify factors significantly associated with ANE.
RESULTS: The neuroprotection trial conducted at CHOP between 1992 and 1997 included 170 non-HLHS infants who were enrolled, underwent surgery using DHCA and survived. Aortic arch obstruction was present in 63 (37%). ANE occurred in 32 (19%) including seizures alone (n=29), coma alone (n=1) or seizures and coma (n=2). The infants were term (EGA=38.6+/12.19 wks) and surgery occurred at 12.5+/-13.5 days of life. Microcephaly was present in 13 (8%) and 52 (31%) harbored a suspected or definite genetic syndrome. In the pre-operative analysis, the presence of a genetic syndrome and aortic arch obstruction each had odds ratio (OR) estimates for seizures of ~2.0. The next iteration included the addition of the intra-operative variable [dsquote]DHCA time [gt] 60 mins[dsquote], resulting in these ORs (Table).The proportion of seizures in survivors with genetic syndromes and arch obstruction (47.8%) was significantly higher than those without (14.3%) (p=.001). Furthermore, the proportion of seizures in survivors with genetic syndromes and either arch obstruction or long DHCA times (50%) was significantly higher than those without (12.7%) (p[lt].0001).
CONCLUSIONS: Survivors of newborn heart surgery experience a substantial burden of post-operative seizures. Pre-operative variables (genetics and cardiac anatomy) are significantly associated with this risk, independent of the stress imposed by prolonged DHCA. Recognition of the influence of pre-operative factors on seizures is essential in the design of future neuroprotection trials in the CHD population.[table]
Support: NINDS, NIH Contract NO1-NS-1-2315