Abstract

Background: Newborns with congenital heart disease have a high risk of seizures, associated to developmental delay, cerebral palsy, and epilepsy.

In this study we analyzed the etiology of seizures, electroencephalographic findings and outcome of newborns with congenital heart disease and seizures.

Methods: We retrospectively identified 29 newborns with congenital heart disease, who presented with at least one seizure during their admission to the Neonatal Intensive Care Unit of the Hospital Italiano.

Results: All newborns had structural/metabolic seizures. Median gestational age was 38 weeks (30-40 weeks, four pre-term) and median birth weight was 3100 g. (range: 1200-4375). Neurological exam was normal in seven neonates (24%), fourteen had only one seizure and four developed status epilepticus.  The EEGs were abnormal in 21 newborns (72%). Ten showed focal paroxysms, ten showed minimal alterations with low amplitude and one had a  burst-suppression pattern.

Nine newborns (31%) died, due to hemodynamic decompensation.  They all had an abnormal EEG (p=0.027), an abnormal neurological exam (p: 0.05) and four presented status epilepticus. (p=0.0053).

At six months, two more newborns died and two had refractory epilepsy. Of the 18 patients, six had a normal neurological exam. These 6 patients, had had a normal neonatal neurological exam before hospital discharge and four had had only one seizure. Of the six newborns, five had a normal EEG (p= 0.03).

Conclusions: In this population we observed a high mortality and an adverse neurological outcome. Abnormal EEG, abnormal neurological exam and status epilepticus were significantly related to mortality.