Abstract Details

Title Continuous EEG for Seizure Detection in Neonates after Cardiac Bypass without Deep Hypothermic Cardiac Arrest

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-012

Objective The American Clinical Neurophysiology Society suggests continuous EEG (cEEG) for seizure detection after neonatal surgery involving cardiopulmonary bypass (CPB). This study characterizes seizure prevalence in a neonatal cohort after CPB without standard deep hypothermic cardiac arrest (DHCA).

Background Early reports described seizures in >20% of children after CPB, with recent estimates ranging 3-12%. Seizures have been associated with DHCA, bypass duration, and age. Seizures are associated with worse neurocognitive outcomes later in life.

Design/Methods Single-center chart review of all infants <3 months old from July 2017 through February 2019 monitored with cEEG after CPB. Clinical and EEG variables were recorded for univariate and multivariate analyses (Wilcoxon rank sum test, Fisher's exact test).

Results 93 infants were monitored for 4135 hours. 10 patients (10.8%) had seizures. Only 2 patients had DHCA, neither had seizures. Time to first seizure ranged from 8-52 hours after end of CPB. Median time from end of bypass to EEG was 7.8 hours; median time to first seizure was 30.9 hours. All patients with seizures had subclinical seizures. Bypass time trended to be higher in patients with seizures (median 178.5 vs 148 minutes, p=0.06). Cross clamp time was not significantly different. Delayed sternal closure was associated with increased seizure risk (p=0.007).

Conclusions Seizure prevalence of 10.8% in our cohort was analogous to other reports, despite minimal DHCA. Time to first seizure was 8-52 hours after end of CBP, suggesting a window of highest yield for cEEG. Longer bypass and cross clamp time was not significantly associated, but delayed sternal closure was associated with increased risk. Since our sample is small, we may not have enough data points to detect the same risk differences other studies found for bypass time. Analysis is ongoing to better predict which patients are at higher risk for seizure via pre-, intra-, and post-operative risk factors.

Authors/Disclosures
Rebecca J. Levy, MD (Stanford LPCH Child Neurology) PRESENTER	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. An immediate family member of Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for SRB Hawaii Law LLC. An immediate family member of Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Wisner Baum LLP. The institution of Dr. Levy has received research support from CNCDP-K12. The institution of Dr. Levy has received research support from NINDS.
Amanda Sandoval Karamian, MD (The University of Utah, Department of Pediatrics)	The institution of Dr. Sandoval Karamian has received research support from Pediatric Epilepsy Research Foundation.
Elizabeth Mayne, MD (Stanford Child Neurology)	Dr. Mayne has received research support from NINDS-CNCDP K12.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Courtney Wusthoff, MD, F�鶹��ýӳ�� (UC Davis Neurology)	Dr. Wusthoff has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for ICON. Dr. Wusthoff has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Wusthoff has received research support from NIH. Dr. Wusthoff has received publishing royalties from a publication relating to health care.

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