Intermediate-term Neuro- Developmental Outcomes after Neonatal Cardiac Surgery: Role of Cortical Iso-Electric Activity Pediatric Cardiac Consortium of Upstate New York University of Rochester Medical Center

Disclosures None

Objective Neurodevelopmental delay diagnosed 5-7 years following neonatal cardiac surgery Thought to arise from multiple factors – Pre-natal hypoxia – Operative Hypoxia Hypothermia Low flow

Objective Continuous intra-operative EEG Hypothermia  Iso-electric activity Recovery from iso-electric activity  seizures – Rhythmic Burst Pattern – Sharp Components – Asynchronous between hemispheres

Hypothesis We hypothesized that the duration of iso-electric cortical brain activity would be related to neuro-developmental outcomes

Methods Neonates requiring surgery EEG leads placed – Standard Baseline EEG prior to anesthesia Continuous Intra-operative EEG monitoring Lead Placement

Methods EEG activity classified as 1.Normal for Age 2.Slow and Continuous Slower frequencies but continuous 3.Moderate Burst Suppression < 30 second intervals between bursts 4.Severe Burst Suppression > 30 second intervals between bursts 5.Iso-Electric Activity Absence of brain activity

Methods F7-T7 T7-P7 P7-O1 F3-C3 C3-P3 P3-O1 F2-C2 C2-P2 F4-C4 C4-P4 P4-O2 F8-T8 T8-P8 P8-O2 Normal for Age

Methods F7-T7 T7-P7 P7-O1 F3-C3 C3-P3 P3-O1 F2-C2 C2-P2 F4-C4 C4-P4 P4-O2 F8-T8 T8-P8 P8-O2 Moderate Burst Suppression

Methods F7-T7 T7-P7 P7-O1 F3-C3 C3-P3 P3-O1 F2-C2 C2-P2 F4-C4 C4-P4 P4-O2 F8-T8 T8-P8 P8-O2 Iso-Electric Activity

Methods-VABS-II Parents of neonates with prior EEG recordings contacted Parents completed VABS-II questionnaire at a follow-up of 5.6 ± 1.0 years Investigator trained in the VABS-II validated the parental responses

Methods-VABS-II Numeric and percentile scores of overall performance – Communication – AODL – Socialization – Motor skills Scores classified according to percentiles – Low – Moderately low – Adequate – Moderately high – High

Original Cohort (n=32) Died during the follow-up (n=6) Did not complete survey correctly (n=3) Lost to Follow-up (n=2) Results EEG’s and ND outcomes (n=21) IE Activity (n=11) Non-IE Activity (n=10)

IE (n=11)Non IE (n=10)p value Age at operation (days)7.0 ± ± Weight (kg)3.1 ± ± HLHS or variant D-TGA TOF011.0 CoA/Arch Hypoplasia DHCA Time (min)24.1 ± Regional Perfusion36% (4)0 Results

Non IE (n=10) IE (n=11)

Results Non IE (n=10) IE (n=11)

Results Non IE (n=10) IE (n=11)

Results

IE (n=11)Non IE (n=10)P value Communication Score43.1± ± Receptive14.2 ± ± Expressive14.5 ± ± Written14.5 ± ± Daily Living40.5 ± ± Personal12.8 ± ± Domestic13.9 ± ± Community13.8 ± ± Socialization43.2 ± ± Interpersonal Relations14.9 ± ± Play/Leisure12.3 ± ± Coping skills16.0 ± ± Motor Skills26.5 ± ± Gross Motor Skills13.1 ± ± Fine Motor Skills13.2 ± ± Adaptive Behavior351.1± ± Adequate79 Maladaptive Behavior Index17.5 ± ±

Results

R = 0.1 p = 0.7

Results IE Time DHCA Time

Conclusions Cortical IE is strongly associated with hypothermia < 25 °C Duration of IE activity correlates with neuro- developmental outcomes at an intermediate- term follow-up Intra-operative EEG may be a useful tool to assess neurologic injury Limited hypothermia may improve neuro- developmental outcomes

Thank you

Results

DHCA-Neonates cooled to °C Absence of DHCA-Neonates cooled to °C Glucose levels maintained g/dl PO 2 > 100 PCO 2 < 30 Hemoglobin > 7.0 g/dl Methods-Operative