Background Neonates undergoing cardiac surgery are at risk for neurologic injury, but seizure incidence under current practices is unclear. Continuous electroencephalography (cEEG) enables real-time monitoring, yet its prognostic role remains understudied. This study examines seizure incidence and the relationship between cEEG background features, perioperative factors, and neurobehavioral outcomes. Methods We conducted a retrospective single-center cohort study of 104 term and late-preterm neonates who underwent cardiac surgery with cardiopulmonary bypass. All patients received 48 h of postoperative cEEG. Interburst interval (IBI) severity was assessed at 24 and 48 h. Outcomes included complications, mortality, and attention scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Results Seizure incidence was 1.9% (2/104). Excessive discontinuity was common: 52% showed moderate or severe IBI prolongation at 24 h. At 48 h, severe IBI was associated with increased risk of major complications (RR 6.1, 95% CI 2.7–14.2), mortality (RR 5.4, 95% CI 2.4–11.9), and abnormal attention scores (RR = 3.8, 95% CI 1.7–8.3). Conclusion Seizures were rare, but excessive discontinuity was common and correlated with adverse outcomes. These findings highlight the prognostic value of cEEG background features beyond seizure detection and support routine postoperative monitoring in neonates undergoing cardiac surgery. Impact <UnorderedList Mark="Bullet"> <ItemContent> Despite rare seizures, moderate to severe EEG discontinuity was prevalent following neonatal cardiac surgery. </ItemContent> <ItemContent> Prolonged interburst intervals postoperatively were associated with a higher incidence of complications and mortality. </ItemContent> <ItemContent> Severity of discontinuity also correlated with lower attention scores on standardized neurobehavioral assessment. </ItemContent> <ItemContent> This study highlights the prognostic utility of postoperative continuous EEG background features, reinforcing its value beyond seizure detection. </ItemContent> <ItemContent> Incorporating these EEG markers could improve early risk stratification and guide targeted neuroprotective interventions in this high-risk population. </ItemContent> </UnorderedList>

Continuous EEG monitoring after neonatal cardiac surgery: seizure incidence and prognostic background abnormalities

期刊论文
发表日期：

2026年5月7日

查看全文

Reilly Philliben,
Jennifer Keene,
Kathleen Campbell,
Amanda Sandoval Karamian,
Betsy Ostrander,
Reilly Hobbs,
Chanelle Stidham,
Brent Kay,
Kristi Glotzbach

摘要

Background

Neonates undergoing cardiac surgery are at risk for neurologic injury, but seizure incidence under current practices is unclear. Continuous electroencephalography (cEEG) enables real-time monitoring, yet its prognostic role remains understudied. This study examines seizure incidence and the relationship between cEEG background features, perioperative factors, and neurobehavioral outcomes.

Methods

We conducted a retrospective single-center cohort study of 104 term and late-preterm neonates who underwent cardiac surgery with cardiopulmonary bypass. All patients received 48 h of postoperative cEEG. Interburst interval (IBI) severity was assessed at 24 and 48 h. Outcomes included complications, mortality, and attention scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS).

Results

Seizure incidence was 1.9% (2/104). Excessive discontinuity was common: 52% showed moderate or severe IBI prolongation at 24 h. At 48 h, severe IBI was associated with increased risk of major complications (RR 6.1, 95% CI 2.7–14.2), mortality (RR 5.4, 95% CI 2.4–11.9), and abnormal attention scores (RR = 3.8, 95% CI 1.7–8.3).

Conclusion

Seizures were rare, but excessive discontinuity was common and correlated with adverse outcomes. These findings highlight the prognostic value of cEEG background features beyond seizure detection and support routine postoperative monitoring in neonates undergoing cardiac surgery.

Impact

Despite rare seizures, moderate to severe EEG discontinuity was prevalent following neonatal cardiac surgery.

Prolonged interburst intervals postoperatively were associated with a higher incidence of complications and mortality.

Severity of discontinuity also correlated with lower attention scores on standardized neurobehavioral assessment.

This study highlights the prognostic utility of postoperative continuous EEG background features, reinforcing its value beyond seizure detection.

Incorporating these EEG markers could improve early risk stratification and guide targeted neuroprotective interventions in this high-risk population.