癫痫发作是常见的，但往往不明显的新生儿心脏手术后

对心脏外科手术的新生儿有一个潜在的严重发作，这可能不是很明显的常规临床评估的重大风险。儿科研究者目前专业指南推荐脑电图（EEG）监测的连续报道，谁经历了手术后癫痫发作的婴儿有较高的死亡率比那些没有发作。

“我们发现连续脑电图监测发现新生儿癫痫发作，这表明潜在的脑损伤，也坏的神经发育预后和死亡率的一个危险因素，”该研究的领导者Maryam Y。 Naim，医学博士，心脏重症监护医生在费城儿童医院（CHOP）。“承认这些癫痫发作早期是至关重要的实施治疗，以防止其复发。”

纳和他的同事们从印章和宾夕法尼亚大学医学院将他们的研究发表在七月出版的胸与心血管外科杂志。

大多数癫痫发作的临床照顾者是不可见的

The researchers studied 161 newborns who underwent open heart surgery at CHOP over an 18-month period and received continuous EEG monitoring as part of routine postoperative monitoring。 The team found seizures in 13 of the infants (8 percent)。 Of those 13 infants, 11 (85 percent) had subclinical seizures, detectable only by EEG。 Eight of the 13 infants had status epilepticus seizures, which are particularly dangerous。 The majority of the seizures found using EEG would not have been visible to clinical caregivers, said Naim。 The seizures occurred in newborns with all types of congenital heart disease (CHD)。

The study team found a mortality rate of 38 percent (five deaths) among the 13 infants with seizures, compared to 3 percent (four deaths) among the 148 infants who did not have seizures。 “Seizures are a marker of brain injury, but their recurrence may independently cause brain injury, making it all the more important to detect and potentially treat seizures as soon as possible,” said Naim。

This single-center study was the first to report on the implementation of guidelines issued in 2011 by the American Clinical Neurophysiology Society recommending continuous EEG monitoring of neonates undergoing cardiac surgery for congenital heart disease。 CHOP implemented routine postoperative EEG monitoring in 2012。 Many centers do not currently follow these recommendations, possibly because of the resource commitment necessary to perform continuous EEG monitoring for these patients。

早期识别癫痫发作的关键，干预和改善长期结果

Identifying seizure occurrence allows clinicians to use antiseizure drugs or other therapies to decrease seizure recurrence。 Naim acknowledged that investigators have not yet demonstrated that treating seizures will improve long-term outcomes in high-risk pediatric heart patients。

However, previous studies in animals and humans have shown a link between seizures and long-term neurodevelopmental outcomes。 The Boston Circulatory Arrest Study, for instance, showed that postoperative seizures were the most important predictor of poor neurological outcomes, such as memory and executive function, when pediatric heart patients were followed 16 years later。 More recently, a CHOP co-author of the current paper, J。 William Gaynor, MD, found that a genetic subset of CHD patients treated as infants with antiseizure medication had better neurological outcomes compared to patients in the Boston study。

“Our surgeons are excellent at what they do, with exceptional survival rates following cardiac surgery in this high-risk population,” said Naim。 “Our focus has now moved from survival to improving long-term neurodevelopmental outcomes for CHD patients。 With that said, I expect that investigations of seizures and seizure prevention may become more prominent,” she added。

An editorial commentary on the current study in the same journal calls for a larger, multicenter study to analyze continuous EEG monitoring following infant heart surgery, and to investigate seizure prevention and treatment。 The commenters also advocate for a less expensive, and less labor-intensive screening tool than continuous EEG monitoring。

（注：转载时请注明复诊网）