Use of AEEG as Predictor of Long-term Motor Outcome in Neonates With Congenital Heart Disease

• Performance on neurologic screening tools [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]
• Head ultrasound abnormalities [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]
• Seizures [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]
• Death [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]
• Inability to feed orally [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]
• Respiratory support requirement [ Time Frame: from 24 hours of life to time of discharge home from the neonatal intensive care unit which is on average about four weeks ] [ Designated as safety issue: No ]

This study aims to examine performance on a neurological screening test, the Dubowitz, and sleep wake cycles on amplitude integrated electroencephalogram (AEEG) in neonates with congenital heart disease (CHD) as a way to potentially predict longterm motor outcome. It will compare the results of these studies to neonates without CHD.

Neonates with congenital heart disease are at increased risk of adverse long term neurodevelopmental outcomes, including lower mean intelligent quotients (IQs). However, it is difficult to predict with neonates are most likely to be affected and a cost effective method is needed. AEEG has been used in neonates with hypoxic-ischemic encephalopathy and abnormal sleep wake cycles have been proposed to predict poorer long term outcomes. We thus hypothesize that abnormal sleep wake cycles in neonates with congenital heart disease will correlate with poorer outcomes. In our study, we will examine the relationship between performance on a neurodevelopmental screening tool, the Dubowitz neonatal neurological screening tool, and the sleep wake cycles on AEEG both before and after cardiac repair to try and predict which neonates are at increased risk of adverse long term outcomes. We will also compare the findings of the AEEG and performance on the neurodevelopmental tool to the data gathered from neonates without cardiac disease.

Anticipated, 65 newborns with congenital heart disease and 20 newborns without congenital heart disease

• Massaro AN, El-Dib M, Glass P, Aly H. Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev. 2008 Aug;30(7):437-46. Epub 2008 Feb 4. Review.
• Brown MD, Wernovsky G, Mussatto KA, Berger S. Long-term and developmental outcomes of children with complex congenital heart disease. Clin Perinatol. 2005 Dec;32(4):1043-57, xi. Review.
• Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr. 2000 Nov;137(5):638-45.
• Shalak LF, Laptook AR, Velaphi SC, Perlman JM. Amplitude-integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy. Pediatrics. 2003 Feb;111(2):351-7.

Inclusion Criteria:

• Newborn with cardiac anomaly requiring surgical intervention or a newborn that is in NICU for at least 24 hours for monitoring
• If newborn has congenital cardiac anomaly, cardiac repair must be performed at Mount Sinai Hospital
• If newborn has congenital cardiac anomaly, he/she must be managed pre-operatively for at least 24 hours at Mount Sinai Hospital
• If newborn has congenital cardiac anomaly, he/she must be managed post-operatively at Mount Sinai Hospital for at least 72 hours

Exclusion Criteria:

• Newborns with previously known anomalies other than cardiac
• Chromosomal abnormalities other than 22Q, that might have long-term neurodevelopmental implications
• Diagnosis of hypoxic-ischemic encephalopathy
• Metabolic disorder
• Other genetic disorders