Aug 19, 2015 -- AMERICAN ASSOCIATION FOR THORACIC SURGERY -- Summary: In 2011, the American Clinical Neurophysiology Society issued a guideline recommending that neonates undergoing cardiac surgery for repair of congenital heart disease be placed on continuous encephalographic (EEG) monitoring after surgery to detect seizures. These recommendations followed reports that seizures are common in this population, may not be detected clinically, and are associated with adverse neurocognitive outcomes. Yet, in a discussion at the 2014 Annual Meeting of The American Association for Thoracic Surgery, 80% to 90% of the audience was not following these recommendations. In this report from The Children's Hospital of Philadelphia, investigators present the results of implementing these recommendations. They found that seizures were not uncommon, would not have been detected without EEG monitoring, and that neonates who had seizures faced a significantly higher risk of death.

Beverly, MA, August 19, 2015 - With mounting concerns about postoperative seizures, doctors at The Children's Hospital of Philadelphia placed 161 neonates who had undergone cardiac surgery on continuous EEG monitoring. They found that 8% of the neonates experienced EEG seizures and 85% of these were unrecognized clinically. Many of the seizures were severe, and the seizure group faced a higher risk of death, according to a report in The Journal of Thoracic and Cardiovascular Surgery, the official publication of the American Association for Thoracic Surgery (AATS).

"In their article, Naim and colleagues have clearly pointed out that if we don't carefully assess for seizure activity with EEG monitoring, we will not identify these at-risk neonates," stated Carl L. Backer, MD, Division of Cardiovascular-Thoracic Surgery, and Bradley S. Marino, MD, MPP, MSCE, Division of Cardiology, both at the Ann & Robert H. Lurie Children's Hospital of Chicago, in an accompanying editorial. "It is clearly no longer adequate for investigators reporting outcomes after neonatal cardiac surgery to state that neonates did not have postoperative neurologic complications if they do not use continuous EEG monitoring."
Conducting a quality improvement project, the team at The Children's Hospital of Philadelphia implemented continuous EEG monitoring in neonates (? 30 days corrected gestational age) following cardiac surgery for repair of congenital heart disease. During an 18-month period from June 15, 2012 to December 31, 2013, records of continuous EEG (CEEG) were obtained from 94% (161) of 172 surgeries.

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