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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.
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References
1. Glass HC, Wirrell E (2009) Controversies in neonatal seizure management. J Child Neurol 24 (5):591-9. DOI: 10.1177/0883073808327832 PMID: 19218527
2. Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J et al. (2006) The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics 117 (4):1270-80. DOI: 10.1542/peds.2005-1178 PMID: 16585324
3. Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39 (12):1890-900. PMID: 12084585
4. Samánek M (2000) Congenital heart malformations: prevalence, severity, survival, and quality of life. Cardiol Young 10 (3):179-85. PMID: 10824896
5. Massaro AN, El-Dib M, Glass P, Aly H (2008) Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev 30 (7):437-46. DOI: 10.1016/j.braindev.2007.12.013 PMID: 18249516
6. Volpe JJ. Neonatal Seizures. In: Neurology of the newborn.5th edition.Saunders/Elsevier Academic Press Philadelphia; 2008
7. Holmes GL, Lombroso CT (1993) Prognostic value of background patterns in the neonatal EEG. J Clin Neurophysiol 10 (3):323-52. PMID: 8408599
8. Clancy RR, Legido A (1987) The exact ictal and interictal duration of electroencephalographic neonatal seizures. Epilepsia 28 (5):537-41. PMID: 3653058
9. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P et al. (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46 (4):470-2. DOI: 10.1111/j.0013-9580.2005.66104.x PMID: 15816939
10. Newburger JW, Jonas RA, Wernovsky G, Wypij D, Hickey PR, Kuban KC et al. (1993) A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 329 (15):1057-64. DOI: 10.1056/NEJM199310073291501 PMID: 8371727
11. Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C (2000) Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 137 (5):638-45. DOI: 10.1067/mpd.2000.109152 PMID: 11060529
12. Mahle WT, Tavani F, Zimmerman RA, Nicolson SC, Galli KK, Gaynor JW et al. (2002) An MRI study of neurological injury before and after congenital heart surgery. Circulation 106 (12 Suppl 1):I109-14. PMID: 12354718
13. Licht DJ, Wang J, Silvestre DW, Nicolson SC, Montenegro LM, Wernovsky G et al. (2004) Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. J Thorac Cardiovasc Surg 128 (6):841-9. DOI: 10.1016/j.jtcvs.2004.07.022 PMID: 15573068
14. Sherlock RL, McQuillen PS, Miller SP, aCCENT (2009) Preventing brain injury in newborns with congenital heart disease: brain imaging and innovative trial designs. Stroke 40 (1):327-32. DOI: 10.1161/STROKEAHA.108.522664 PMID: 18988911
15. Clancy RR, Sharif U, Ichord R, Spray TL, Nicolson S, Tabbutt S et al. (2005) Electrographic neonatal seizures after infant heart surgery. Epilepsia 46 (1):84-90. DOI: 10.1111/j.0013-9580.2005.22504.x PMID: 15660772
16. Pisani F, Copioli C, Di Gioia C, Turco E, Sisti L (2008) Neonatal seizures: relation of ictal video-electroencephalography (EEG) findings with neurodevelopmental outcome. J Child Neurol 23 (4):394-8. DOI: 10.1177/0883073807309253 PMID: 18192647
17. Legido A, Clancy RR, Berman PH (1991) Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics 88 (3):583-96. PMID: 1881741
18. Garfinkle J, Shevell MI (2011) Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol 15 (3):222-9. DOI: 10.1016/j.ejpn.2010.11.002 PMID: 21146431
19. Holden KR, Mellits ED, Freeman JM (1982) Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics 70 (2):165-76. PMID: 7099782
References
1. Glass HC, Wirrell E (2009) Controversies in neonatal seizure management. J Child Neurol 24 (5):591-9. DOI: 10.1177/0883073808327832 PMID: 19218527
2. Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J et al. (2006) The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics 117 (4):1270-80. DOI: 10.1542/peds.2005-1178 PMID: 16585324
3. Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39 (12):1890-900. PMID: 12084585
4. Samánek M (2000) Congenital heart malformations: prevalence, severity, survival, and quality of life. Cardiol Young 10 (3):179-85. PMID: 10824896
5. Massaro AN, El-Dib M, Glass P, Aly H (2008) Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev 30 (7):437-46. DOI: 10.1016/j.braindev.2007.12.013 PMID: 18249516
6. Volpe JJ. Neonatal Seizures. In: Neurology of the newborn.5th edition.Saunders/Elsevier Academic Press Philadelphia; 2008
7. Holmes GL, Lombroso CT (1993) Prognostic value of background patterns in the neonatal EEG. J Clin Neurophysiol 10 (3):323-52. PMID: 8408599
8. Clancy RR, Legido A (1987) The exact ictal and interictal duration of electroencephalographic neonatal seizures. Epilepsia 28 (5):537-41. PMID: 3653058
9. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P et al. (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46 (4):470-2. DOI: 10.1111/j.0013-9580.2005.66104.x PMID: 15816939
10. Newburger JW, Jonas RA, Wernovsky G, Wypij D, Hickey PR, Kuban KC et al. (1993) A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 329 (15):1057-64. DOI: 10.1056/NEJM199310073291501 PMID: 8371727
11. Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C (2000) Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 137 (5):638-45. DOI: 10.1067/mpd.2000.109152 PMID: 11060529
12. Mahle WT, Tavani F, Zimmerman RA, Nicolson SC, Galli KK, Gaynor JW et al. (2002) An MRI study of neurological injury before and after congenital heart surgery. Circulation 106 (12 Suppl 1):I109-14. PMID: 12354718
13. Licht DJ, Wang J, Silvestre DW, Nicolson SC, Montenegro LM, Wernovsky G et al. (2004) Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. J Thorac Cardiovasc Surg 128 (6):841-9. DOI: 10.1016/j.jtcvs.2004.07.022 PMID: 15573068
14. Sherlock RL, McQuillen PS, Miller SP, aCCENT (2009) Preventing brain injury in newborns with congenital heart disease: brain imaging and innovative trial designs. Stroke 40 (1):327-32. DOI: 10.1161/STROKEAHA.108.522664 PMID: 18988911
15. Clancy RR, Sharif U, Ichord R, Spray TL, Nicolson S, Tabbutt S et al. (2005) Electrographic neonatal seizures after infant heart surgery. Epilepsia 46 (1):84-90. DOI: 10.1111/j.0013-9580.2005.22504.x PMID: 15660772
16. Pisani F, Copioli C, Di Gioia C, Turco E, Sisti L (2008) Neonatal seizures: relation of ictal video-electroencephalography (EEG) findings with neurodevelopmental outcome. J Child Neurol 23 (4):394-8. DOI: 10.1177/0883073807309253 PMID: 18192647
17. Legido A, Clancy RR, Berman PH (1991) Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics 88 (3):583-96. PMID: 1881741
18. Garfinkle J, Shevell MI (2011) Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol 15 (3):222-9. DOI: 10.1016/j.ejpn.2010.11.002 PMID: 21146431
19. Holden KR, Mellits ED, Freeman JM (1982) Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics 70 (2):165-76. PMID: 7099782