Neurologic events in neonates treated surgically for congenital heart disease
Journal of Perinatology (2006) 26, 237–242. doi:10.1038/sj.jp.7211459; published online 23 February 2006
V Y Chock(1), V M Reddy(2), D Bernstein(1) and A Madan(1)P>
1 (1)Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
2 (2)Cardiovascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
Correspondence: Dr A Madan, Department of Pediatrics, Division of Neonatal and Developmental Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA. E-mail: ashima@stanford.edu
Received 7 September 2005; Revised 9 January 2006; Accepted 17 January 2006; Published online 23 February 2006.
Abstract
Objective:
The incidence of acute neurologic events prior to discharge in neonates with congenital heart disease (CHD) was determined and peri-operative characteristics predictive of a neurologic event were identified.
Study design:
A retrospective chart review over 1 year was conducted of infants <1 month of age with a diagnosis of CHD. Outcomes were measured by the occurrence of an acute neurologic event defined as electroencephalogram (EEG)-proven seizure activity, significant hypertonia or hypotonia, or choreoathetosis prior to hospital discharge. Stepwise logistic regression identified variables most likely to be associated with an acute neurologic event.
Results:
Surgical intervention occurred in 95 infants who were admitted with a diagnosis of CHD. The survival rate was 92%. Of the survivors, 16 (17%) had an acute neurologic event, with 19% of events occurring preoperatively. Factors associated with neurologic events included an elevated nucleated red blood cell (NRBC) count, an abnormal preoperative brain imaging study, and a 5-min Apgar score <7 (P<0.05).
Conclusions:
Neonates with CHD have a significant risk of neurologic events. Preoperative brain imaging, the 5-min Apgar score, and initial serum NRBC counts may identify infants at highest risk for central nervous system injury.
Keywords:
cardiac surgery, neurologic injury, risk factors
Reprinted with Permission
Brain Disorders/Neurological Index
