Risk of seizures in survivors of newborn heart surgery using deep hypothermic circulatory arrest
Risk of seizures in survivors of newborn heart surgery using deep hypothermic circulatory arrest
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DOI：
10.1542/peds.111.3.592
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发表时间：
2003-03-01
期刊：
影响因子：
8
通讯作者：
Goin, JE
中科院分区：
文献类型：
--
作者：
Clancy, RR;McGaurn, SA;Goin, JE
目标。识别先天性心脏手术后发生深度低温循环骤停（DHCA）的新生儿术后急性神经系统事件（ANEs）相关的术前和术中变量，包括癫痫发作和昏迷，并在术前风险变量的基础上对该人群进行风险分层，以设计未来的神经保护试验。参加神经保护试验的新生儿心脏手术幸存者提供了一个综合数据库，用于评估术前和术中影响ANEs（癫痫发作或昏迷）术后发生的变量。排除患有心脏发育不全综合征的患者。在对研究人群进行特征描述后，逐步逻辑回归结合临床判断，用于确定研究样本中最有可能与癫痫发作风险增加相关的变量，以及最有可能推广到其他人群的变量。164名接受新生儿心脏手术的非发育不良左心综合征幸存者使用了DHCA。31例（18.9%）发生ANEs，包括“单纯癫痫发作”（n = 28）、“单纯昏迷”（n = 2）或“癫痫发作并昏迷”（n = 1）。构建的术前风险模型显示，遗传疾病和主动脉弓梗阻的婴儿发生ANEs的风险为47.8%，而其他所有婴儿的风险为9.9%。研究还发现，延长DHCA时间（60分钟）对先前存在遗传疾病的婴儿可能有重大风险；然而，有遗传病的婴儿，没有延长DHCA时间或有主动脉弓阻塞的婴儿，没有增加anes的风险。本研究为新生儿心脏手术后发生ANEs提供了新的信息。癫痫发作或昏迷出现在约19%的非发育不良左心综合征幸存者中，这不是随机事件，而是与特定类型的先天性心脏病、遗传条件的存在和DHCA时间延长显著相关。这3个确定的变量允许将个别病例划分为低、中、高风险类别。由于新生儿癫痫发作是长期神经系统预后的一个很好的替代标志物，这些模型为将来的神经保护试验中对个体患者的癫痫发作风险进行分层提供了有用的信息。
Objective. To identify pre- and intraoperative variables associated with postoperative acute neurologic events (ANEs), including seizures and coma, in newborn survivors of congenital heart surgery undergoing deep hypothermic circulatory arrest (DHCA), and to risk-stratify this population on the basis of preoperative risk variables for the purpose of designing future neuroprotection trials.Methods. Survivors of newborn heart surgery who were enrolled in a neuroprotection trial provided a comprehensive database for the evaluation of pre- and intraoperative variables that influence the postoperative occurrence of ANEs (seizures or coma). Patients with hypoplastic heart syndrome were excluded. After characterization of the study population, stepwise logistic regression, combined with clinical judgment, was used to identify variables that were most likely to be associated with an increased risk of seizures in the study sample and that were most likely to be generalized to other populations.Results. Data were available on 164 nonhypoplastic left heart syndrome survivors who underwent newborn heart surgery using DHCA. ANEs occurred in 31 (18.9%) including "seizures alone" (n = 28), "coma alone" (n = 2) or "seizures and coma" (n = 1). A preoperative risk model was constructed demonstrating that infants with a genetic condition and aortic arch obstruction had a 47.8% risk of ANEs compared with all other remaining infants, who had a 9.9% risk. It was also found that prolonged DHCA time ( 60 minutes) can be a significant risk for infants who have a preexisting genetic condition; however, infants who have genetic conditions and do not undergo prolonged DHCA time or have an aortic arch obstruction are not at increased risk of ANEs.Conclusions. This study provides new information about the occurrence of ANEs after newborn heart surgery. Seizures or coma, which appeared in approximately 19% of all non-hypoplastic left heart syndrome survivors, were not random events but were significantly associated with specific types of congenital heart disease, the presence of genetic conditions, and prolonged DHCA time. The 3 identified variables permitted individual cases to be assigned to low-, intermediate-, or high-risk categories. Because neonatal seizures are a good surrogate marker of long-term neurologic outcome, these models provide useful information to stratify individual patients for risk of seizures in future neuroprotection trials.