Neonatal Surgery for Congenital Heart Disease and 2-Year Neurodevelopmental Outcomes: Single-Center, Retrospective Study of Postoperative Electroencephalography and Medications, 2013-2020

Abstract

Objectives: To first evaluate the association between postoperative electroencephalography findings and 24-month neurodevelopmental outcomes in neonates with congenital heart disease (CHD) undergoing cardiac surgery. Secondarily to explore the association between perioperative medication exposure and outcome.

Design: Single-center retrospective cohort study in a University-affiliated tertiary pediatric center, between February 2013 and September 2020.

Patients: Neonates (postmenstrual age [PMA] > 36 wk) with CHD requiring cardiopulmonary bypass surgery at PMA younger than 44 weeks who had neurodevelopmental assessments at 24 months using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III).

Interventions: None.

Measurements and main results: Out of 345 neonates with complex CHD, there were 68 neonates in our clinical outcome cohort, and 32 of 68 (47%) in the postoperative electroencephalography cohort. In the electroencephalography group, a quantitative electroencephalography index of discontinuity index was calculated and averaged from postoperative recordings between 15 and 24 hours. Here, adjusted analyses showed greater postoperative electroencephalography discontinuity index was associated with lower BSID-III motor scores at 24 months (-0.48 [95% CI, -2.31 to -0.51]; p = 0.009). In the complete clinical cohort, linear regression models were used to explore the association between medication dosing (intraoperative, 24-hr postoperative, and cumulative doses) with BSID-III scores at 24 months. Higher early postoperative opioid doses were associated with better motor outcomes, as represented by the standardized coefficient, B, and its 95% CI, including: global motor composite scores (complete cohort, 0.33 [95% CI, 0.77-5.41]; p = 0.010 and d-transposition of the great arteries subgroup, 0.37 [95% CI, 0.67-5.41]; p = 0.013); fine motor scaled scores (complete cohort, 0.26 [95% CI, 0.01-0.97]; p = 0.049); and gross motor scaled scores (complete cohort, 0.26 [95% CI, 0.01-0.94]; p = 0.047).

Conclusions: Our single-center retrospective study shows an association between early postoperative electroencephalography findings and outcomes after neonatal cardiac surgery. Electroencephalography discontinuity may be a potential biomarker of later adverse motor outcomes. Future evaluations are needed to clarify the interaction between postoperative electroencephalography monitoring, pharmacologic exposures and later neurodevelopment.

Keywords: cardiac surgery; congenital heart disease; neurodevelopmental outcomes; pediatric critical care; pharmacological agents; quantitative electroencephalography analysis.