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After correcting for the CHD subtype, the severity of developmental impairment is dependent on multiple factors, including intraoperative brain injury, which is more frequent and more severe in those undergoing aortic arch repair with deep hypothermic circulatory arrest (DHCA). It is proposed that brain injury may be reduced if cooling is stopped at the point of electrocerebral inactivity (ECI) on electroencephalogram (EEG), but there is limited evidence to support this as few centres perform perioperative EEG routinely. This study aims to assess the feasibility of EEG monitoring during neonatal aortic arch repair and investigate the relationship between temperature and EEG to inform the design of a future clinical trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>Single-centre prospective observational cohort study in a UK specialist children\u2019s hospital, aiming to recruit 74 neonates (\u22644 weeks corrected age) undergoing aortic arch repair with DHCA. EEG will be acquired at least 1\u20133\u2009hours before surgery, and brain activity will be monitored continuously until 24 hours following admission to intensive care. Demographic, clinical, surgical and outcome variables will be collected. Feasibility will be measured by the number of patients recruited, data collection procedures, technically successful EEG recordings and adverse events. The main outcomes are the temperature at which ECI is achieved and its duration, EEG patterns at key perioperative steps and neurodevelopmental outcomes at 24 months postsurgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The study was approved by the Yorkshire and The Humber Sheffield National Health Service Research Ethics Committee (20\/YH\/0192) on 18 June 2020. Written informed consent will be obtained from the participant\u2019s parent\/guardian prior to surgery. Findings will be disseminated to the academic community through peer-reviewed publications and presentations at conferences. Parents\/guardians will be informed of the results through a newsletter in conjunction with local charities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106423","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:35:26Z","timestamp":1752154526000},"page":"e106423","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Surgery on the aortic arch and feasibility of electroencephalography (SAFE) monitoring in neonates: protocol for a prospective observational cohort study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1547-5052","authenticated-orcid":false,"given":"William M","family":"McDevitt","sequence":"first","affiliation":[{"name":"Neurophysiology, Birmingham Children\u2019s Hospital NHS Foundation Trust, Birmingham, UK"},{"name":"Cardiovascular Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J","family":"Jones","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, University of Birmingham, Birmingham, UK"},{"name":"Paediatric Cardiac Surgery, Birmingham Children\u2019s Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9660-4631","authenticated-orcid":false,"given":"Laura","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-1421","authenticated-orcid":false,"given":"Christina L","family":"Easter","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Brandon","family":"Westover","sequence":"additional","affiliation":[{"name":"Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6198-4985","authenticated-orcid":false,"given":"Barnaby R","family":"Scholefield","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Seri","sequence":"additional","affiliation":[{"name":"Neurophysiology, Birmingham Children\u2019s Hospital NHS Foundation Trust, Birmingham, UK"},{"name":"Cardiovascular Sciences, University of Birmingham, Birmingham, UK"},{"name":"Institute of Health and Neurodevelopment, Aston University, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9012-6683","authenticated-orcid":false,"given":"Nigel E","family":"Drury","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, University of Birmingham, Birmingham, UK"},{"name":"Paediatric Cardiac Surgery, Birmingham Children\u2019s Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"2025101813424425000_15.7.e106423.1","unstructured":"National institute for Cardiovascular Outcomes Research . 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