Current incidence of acute neurologic complications after open-heart operations in children.

BACKGROUND: Previously, neurologic dysfunction was estimated to complicate 25% or less of pediatric open-heart operations. We sought to determine the current incidence and spectrum of early postoperative neurologic complications. METHODS: We undertook a retrospective review of all patients undergoing open heart operations in 1 year at our institution with the goal to identify all neurologic complications occurring in the early postoperative period. RESULTS: Open-heart operations were performed in 706 children. Sixteen children (2.3%) had neurologic complications develop, including 9 (1.3%) with definite clinical seizures, 1 with suspected seizures and bilateral subdural hemorrhage, 2 with coma after cardiac arrest, 2 with transient mild choreoathetosis, 1 with facial palsy, and 1 with persistent irritability. Causes of seizure were cyclosporin A toxicity posttransplant (4), cerebral ischemia post cardiac arrest (3), and unknown (2). In infants less than 1 year of age, the incidence of seizures was 1.2%. CONCLUSIONS: This review suggests a decrease in acute neurologic morbidity after pediatric open heart operation. Clinical seizures remain the most common complication. Posttransplant, cyclosporin-associated seizures have emerged as an important etiologic category, coincident with an increase in cardiac transplantation in children.

Prognostic value of neonatal discontinuous EEG.

The burst suppression pattern on the neonatal electroencephalogram (EEG) is associated with a poor outcome. However, this serious abnormality constitutes only a small proportion of discontinuous neonatal EEGs. We sought to establish whether any easily measurable parameters among the broad range of excessively discontinuous neonatal EEGs are predictive of outcome. We retrospectively reviewed the EEGs and medical records of 43 term infants with excessively discontinuous EEGs. We quantitated 10 parameters in the bursts and interburst intervals, among them the predominant interburst interval duration (defined as the duration of more than 50% of all interburst intervals of an EEG). Univariate and multivariate analyses were performed on the 10 EEG variables in relation to neurologic outcome and subsequent epilepsy. Based on multivariate analysis, a single easily measurable EEG parameter related significantly to outcome. A predominant interburst interval duration of more than 30 seconds correlated with the occurrence of both unfavorable neurologic outcome and subsequent epilepsy (P = 0.040 and P = 0.033, respectively). In conclusion, a infant whose EEG contains a predominant interburst interval duration of more than 30 seconds has a 100% probability of experiencing severe neurologic disabilities or death and an 86% chance of developing subsequent epilepsy. This easily quantitated EEG parameter could be valuable for the early estimation of neurologic prognosis.

Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children.

High-dose suppressive therapy (HDST) is used to treat refractory status epilepticus (RSE). Prolonged therapy is required in some cases, and prognosis is important in making therapeutic decisions. The authors therefore studied the long-term outcome in previously normal children who survived prolonged HDST for acute symptomatic RSE. All have intractable epilepsy, and none returned to baseline.