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Changes in Neonatal Intraoperative Electroencephalogram Alpha: Delta Ratios Precede Neurologic Injury.
Swartz, Michael F; Lansinger, Justin; Scheffler, Emelie-Jo; Duncan, Aubrey; Cholette, Jill M; Yoshitake, Shuichi; Alfieris, George M.
Afiliación
  • Swartz MF; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
  • Lansinger J; Department of Internal Medicine-Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
  • Scheffler EJ; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
  • Duncan A; Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
  • Cholette JM; Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
  • Yoshitake S; Department of Internal Medicine-Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
  • Alfieris GM; Department of Internal Medicine-Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
World J Pediatr Congenit Heart Surg ; : 21501351241269963, 2024 Sep 12.
Article en En | MEDLINE | ID: mdl-39267395
ABSTRACT

Background:

Unrecognized intraoperative cerebral ischemia during neonatal aortic arch reconstruction may precede neurologic injury. Electroencephalogram (EEG) alphadelta ratio (AD) changes predict cerebral ischemia; however, if AD differences can identify ischemia during neonatal antegrade cerebral perfusion (ACP) and aortic arch reconstruction is unknown. We hypothesized that AD changes would precede neurologic injury.

Methods:

Simultaneous EEG derived left versus right hemispheric and anterior cerebral ADs were retrospectively measured at baseline and every 5 min during arterial cannulation, cooling, ACP, and the rewarming phases of the operation. A paired left versus right AD difference >25% was considered significant for ischemia, and the duration of a significant and continuous AD difference was quantified in minutes. Neonates were divided into two groups (1) new neurologic injury (stroke or seizure) and (2) no known neurologic injury.

Results:

From 72 neonates, there were no significant differences in the baseline ADs. Seven neonates (9.7%) developed a new neurologic injury (seizure = 3, stroke = 2, seizure and stroke = 2). Male gender and longer ACP times were significantly associated with neurologic injury. In neonates with a neurologic injury, the duration of a significant and continuous AD difference was longer within the hemispheric and anterior regions. Multivariable analysis demonstrated that a significant and continuous anterior AD difference (odds ratio 1.345, 95% CI 1.058-1.712; P = .01) was independently associated with neurologic injury.

Conclusions:

A longer continuous anterior AD difference > 25% was independently associated with neurologic injury. Intraoperative EEG monitoring could be considered during neonatal arch reconstruction.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: World J Pediatr Congenit Heart Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: World J Pediatr Congenit Heart Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos