Article Text

CEREBRAL FUNCTION MONITORING (CFM) IN NEWBORNS WITH SURGERY FOR CONGENITAL HEART DISEASE: PRELIMINARY RESULTS
  1. V Bernet1,
  2. G Wohlrab2,
  3. C Doell1,
  4. I Beck3,
  5. B Schmitt2,
  6. O Baenziger1,
  7. B Latal3
  1. 1Department of Neonatology and Pediatric Intensive Care, University Children’s Hospital Zurich, Zurich, Switzerland
  2. 2Department of Neuropaediatrics and Neurophysiology, University Children’s Hospital Zurich, Zurich, Switzerland
  3. 3Child Development Centre, University Children’s Hospital Zurich, Zurich, Switzerland

Abstract

Background Timing of cerebral injury remains unclear in newborns with congenital heart disease. CFM is routinely used in neonates with perinatal asphyxia, but not in a similar manner in infants with congenital heart disease (CHD) undergoing bypass surgery.

Aims To describe CFM abnormalities in infants undergoing bypass surgery for CHD and to relate those findings to perioperative outcome.

Methods Prospective cohort study on infants with CHD requiring cardio-pulmonary bypass (CPB) surgery. Newborns with cerebral anomalies and with chromosomal disorders were excluded. CFM was performed 12–24 hours preoperatively and within 6 hours after surgery for 48 hours. Amplitude integrated electroencephalogram (aEEG) was classified into continuous normal voltage (CNV), discontinuous normal voltage (DNV), burst-suppression (BS), continuous low voltage (CLV) and flat tracing (FT). Epileptic activity was classified.

Results 33 newborns were enrolled of whom 28 (85%) had a cyanotic CHD. One child died postoperatively. Median gestational age was 39.9 weeks with a median birth weight of 3250 grams. CFM abnormalities were detected in 2 of 33 neonates (6%) preoperatively and in 7 of 32 (21%) infants postoperatively. Median cardiopulmonary bypass time was 208 minutes (74–489). Postoperative CFM abnormalities were correlated with the hospitalisation time in ICU (p = 0.013). Duration on CPB, RACH-score, lactate, blood sugar and total hospitalisation time were not significantly correlated.

Conclusion In infants undergoing heart surgery on CPB for CHD preoperative CFM abnormalities are rare. However, postoperative CFM abnormalities occur in a large number of infants and are associated with longer duration of intensive care stay.

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