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23. The Relationship of Postoperative Electrographic Seizures to Neurodevelopmental Outcome at One Year of Age Following Neonatal and Infant Cardiac Surgery
J W Gaynor, Gail P Jarvik, Judy Bernbaum, Marsha Gerdes, Gil Wernovsky, Nancy Burnham, Joann D'agostino, Susan C Nicolson, Thomas L Spray, Robert R Clancy; Philadelphia, PA; Seattle, WA; , PA

Objective:
Postoperative seizures have been implicated as a risk factor for worse short and long-term neurodevelopmental outcomes. In the Boston Circulatory Arrest Study, occurrence of a seizure after the arterial switch operation was associated with an 11.2 point decrease for the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development (BSID) at 1 year of age. The significance of seizures after neonatal and infant repair of other congenital heart defects (CHD) is not known.
Methods:
A recent study at our institution demonstrated seizures documented by 48-hour electroencephalographic (EEG) monitoring in 11% of 178 neonates and infants after repair of complex CHD, including hypoplastic left heart syndrome (HLHS) or variant. Developmental outcomes for this cohort were evaluated at 1-year of age using the PDI and the Mental Developmental Index (MDI) of the BSID .
Results:
Developmental evaluations were performed in 114/164 survivors (70%), including 36 with HLHS. Postoperative EEG seizures had occurred in 15/114 (13%) of the entire group and in 8/36 (22%) of those with HLHS. For the entire cohort, the MDI was 92.3±13.5 and the PDI was 79.2±18.9 for patients without seizures compared to 90.3±10.7 and 74.4±19.3 for those with seizures, both p > 0.3. For the HLHS subgroup, the MDI was 92.3±14.9 and the PDI was 74.8±19.3 for patients without seizures compared to 91.9±12.4 and 73.9±18.3 for those with seizures, both p > 0.5.
Conclusions:
Occurrence of a seizure following cardiac surgery is a marker of central nervous system injury. However, in this cohort of neonates and infants with complex CHD, the magnitude of the adverse effect of a seizure on short-term neurodevelopmental outcome, even in patients with HLHS, was less than previously reported. Occurrence of a seizure was not predictive of worse developmental outcome at 1-year of age.

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