2013, Number 6
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Gac Med Mex 2013; 149 (6)
Electroencephalographic and neurodevelopmental disorders in toddlers with severe congenital heart diseases. Preliminary study
Esquivel-Hernández FJ, Pliego-Rivero FB, Mendieta-Alcántara GG, Ricardo-Garcell J, Otero-Ojeda GA
Language: Spanish
References: 41
Page: 605-612
PDF size: 279.80 Kb.
ABSTRACT
Within the field of pediatric heart disease, congenital cardiopathology is the most important issue due to the fact that in
these patients a delay of neurodevelopment is the most frequent morbidity. The major aim of this work was to determine
the impact of severe congenital cardiopathology (SCC) on the central nervous system (CNS) through the study of the
electroencephalogram (EEG) and the assessment of neurodevelopment.
Population and methods: Children under
3 years old, 41 of them presenting SCC and 15 healthy controls (C) were studied. Conventional EEG recording and
assessment of neurodevelopment were performed.
Results: In twenty children presenting SCC (48.8%) the EEG was
found abnormal (paroxysmal of spikes and sharp waves). Forty of them (97.6%) presented neurodevelopmental
alterations, including hypotonia and a delay in gross motor skills. When comparing EEG between SCC and C children,
odds ratio was 13.33 (1.602-111) and comparing neurodevelopment delay, it was 35 (3.769-235). Both were statistically
significant (p ≤ 0.00039 and p ≤ 0.00038, respectively).
Conclusions: A high percentage of children suffering from SCC
exhibited EEG patterns with abnormal epileptic-like activity although without clinical manifestation of seizures. These children also showed delay features in different areas of neurodevelopmental. The assessment of new born carrying some
type of severe cardiopathology indicated that they were under high risk of suffering from CNS altered development.
REFERENCES
Heusser F, Urcelay G, Arnaiz P, et al. Enfermedades del aparato cardiovascular. Parte XV. Pediatría Meneghello. 5.a ed. Editorial Médica Panamericana; Bogotá, 1997.
Buendía A. A propósito de las cardiopatías congénitas. Arch Cardiol Mex. 2005;75:387-8.
Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890-00.
Daliento L, Mazzotti E, Mongillo E, Rotundo M, Dalla Volta S. Life expectancy and quality of life in adult patients with congenital heart disease. Ital Heart J. 2002;3:339-47.
Wren C, O’Sullivan JJ. Survival with congenital heart disease and need for follow-up in adult life. Heart. 2001;85:438-43.
Wray J, Sensky T. Congenital heart disease and cardiac surgery in childhood: effects on cognitive function and academic ability. Heart. 2001;85:687-91.
Mahle WT, Wernovsky G. Long-term developmental outcome of children with complex congenital heart disease. Clin Perinatol. 2001;28:235-47.
Wernovsky G, Stiles KM, Grauvreau K, et al. Cognitive development after the Fontan operation. Circulation. 2000;102:883-9.
Wernovsky G, Shillingford AJ, Gaynor JW. Central nervous system outcomes in children with complex congenital heart disease. Curr Opin Cardiol. 2005;20:94-9.
Sharma R, Choudary SK, Mohan MR, et al. Neurological evaluation and intelligence testing in the child with operated congenital heart disease. Ann Thorac Surg. 2000;70:575-81.
Hövels-Gurich HH, Konrad K, Skorzenski D, Herpertz-Dahlmann B, Messmer BJ, Seghaye MC. Attentional dysfunction in children after corrective cardiac surgery in infancy. Ann Thorac Surg. 2007;83:1425-30.
Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121:759-67.
Villasís-Keever MA, Aquiles-Pineda R, Halley-Castillo E, Alva-Espinosa C. Frecuencia y factores de riesgo asociados a desnutrición de niños con cardiopatía congénita. Salud Pública Mex. 2001;43:313-23.
Torres-Salas JC. Nutrición en niños con cardiopatía congénita. Pediatrica. 2007;9:77-88.
Licht DJ, Agner S, Montenegro LM, et al. Preoperative MRI abnormalities are common in full-term infants with severe CHD and resemble lesions in pre-term infants. Abstracts of the 10th International Child Neurology Congress; 2006; Montreal, Canada. Neuropediatrics. 2006;37 Suppl 1:1-183.
Licht DJ, Shera DM, Clancy RR, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg. 2009;137:529-37.
Miller SP, McQuillen PS, Hamrick S, et al. Abnormal brain development in newborns with congenital heart disease. N Engl J Med. 2007;357: 1928-38.
Palencia R. Complicaciones neurológicas del paciente con cardiopatía. Rev Neurol. 2002;35:279-85.
Mendieta Alcántara GG, Otero Ojeda GA, Colmenero M, et al. Alteraciones electroencefalográficas en niños con cardiopatías congénitas severas. Rev Ecuat Neurol. 2011;20:60-7.
Sotaniemi KA. Five-year neurological and EEG outcome after open-heart surgery. J Neurol Neurosurg Psychiatry. 1985;48:569-75.
Pressler RM, Boylan GB, Morton M, Binnie CD, Rennie JM. Early serial EEG in hypoxic ischaemic encephalopaty. Clin Neurophysiol. 2001;112: 31-7.
González de Dios J, Moya M, Vioque J. Factores de riesgo predictivos de secuelas neurológicas en recién nacidos a término con asfixia perinatal. Rev Neurol. 2001;32:210-6.
Sinclair DB, Campbell M, Byrne P, Prasertsom W, Robertson CM. EEG and long-term outcome of term infants with neonatal hypoxic-ischemic encephalopathy. Clin Neurophysiol. 1999;110:655-9.
Marret S, Parain D, Menard JF, et al. Prognostic value of neonatal electroencephalography in premature newborn less the 33 weeks of gestational age. Electroenceph Clin Neurophysiol. 1997;102:178-85.
Legido A, Clancy RR, Berman PH. Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics. 1991;88: 583-96.
Jiménez R, Figueras J, Cañadel D, Bostet F, Cruz M. Factores pronósticos en la encefalopatía hipoxicoisquémica del recién nacido a término. Ann Esp Pediatr. 1989;31:189-95.
Alvarado RG, Sánchez PC, Mandujano VM. EVANENE. Evaluación del neurodesarrollo del neonato. Manual 32 CBS. México: UAM Xochimilco; 2010.
Rodríguez Hernández M. Pediatría. 2.a ed. Madrid: Díaz Santos; 1986.
Feiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76:378-83.
Miatton M, De Wolf D, François K, Thiery E, Vingerhoets G. Intellectual, neuropsychological, and behavioral functioning in children with tetralogy of Fallot. J Thorac Cardiovasc Surg. 2007;133:449-55.
Miatton M, De Wolf D, Francois K, Thiery E, Vingerhoets G. Neurocognitive consequences of surgically corrected congenital heart defects: a review. Neuropsychol Rev. 2006;16:65-85.
Miatton M, De Wolf D, François K, Thiery E, Vingerhoets G. Neuropsychological performance in school-aged children with surgically corrected congenital heart disease. J Pediatr. 2007;151:73-8.
Karsdorp PA, Everaerd W, Kindt M, Mulder BJM. Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis. J Pediatr Psychol. 2007;32:527-41.
Van der Rijken R, Hulstijn-Dirkmaat G, Kraaimaat F, Nabuurs-Kohrman L, Daniëls O, Maassen B. Evidence of impaired neurocognitive functioning in school-age children awaiting cardiac surgery. Dev Med Child Neurol. 2010;52:552-8.
Kohner EM, Allen EM, Saunders KB, Emery VM, Pallis C. Electroencephalogram and retinal vessels in congenital cyanotic heart disease before and after surgery. Brit Med J. 1967;4:207-10.
Limperopoulos C, Majnemer A, Shellell I, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics. 1999;103:402-8.
Ter Horst HJ, Mud M, Roofthooft MT, Bos AF. Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery. Early Hum Dev. 2010;86:759-64.
Mahle WT, Tavani F, Zimmerman RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation. 2002;106: 109-14.
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;137:638-45.
Dittrich H, Bührer C, Grimmer I, Dittrich S, Abdul-Khaliq H, Lange PE. Neurodevelopmental 1 year old age in infants with congenital heart disease. Heart. 2003;89:436-41.
Donofrio MT, Massaro AN. Impact of congenital heart disease on brain development and neurodevelopmental outcome. Int J Pediatr. 2010. Article ID 359390. doi: 10.1155/2010/359390. Publicado en línea agosto 24 2010. Disponible en http://www.nbci.nlm.nih.gov/pmc/articles/PMC29 38447/?tool=pmcentrez.