{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:25:58Z","timestamp":1787675158861,"version":"build-2784847793"},"reference-count":15,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,3,1]]},"abstract":"<jats:p>Objective. To identify pre- and intraoperative variables associated with postoperative acute neurologic events (ANEs), including seizures and coma, in newborn survivors of congenital heart surgery undergoing deep hypothermic circulatory arrest (DHCA), and to risk-stratify this population on the basis of preoperative risk variables for the purpose of designing future neuroprotection trials.<\/jats:p>\n               <jats:p>Methods. Survivors of newborn heart surgery who were enrolled in a neuroprotection trial provided a comprehensive database for the evaluation of pre- and intraoperative variables that influence the postoperative occurrence of ANEs (seizures or coma). Patients with hypoplastic heart syndrome were excluded. After characterization of the study population, stepwise logistic regression, combined with clinical judgment, was used to identify variables that were most likely to be associated with an increased risk of seizures in the study sample and that were most likely to be generalized to other populations.<\/jats:p>\n               <jats:p>Results. Data were available on 164 nonhypoplastic left heart syndrome survivors who underwent newborn heart surgery using DHCA. ANEs occurred in 31 (18.9%) including \u201cseizures alone\u201d (n = 28), \u201ccoma alone\u201d (n = 2) or \u201cseizures and coma\u201d (n = 1). A preoperative risk model was constructed demonstrating that infants with a genetic condition and aortic arch obstruction had a 47.8% risk of ANEs compared with all other remaining infants, who had a 9.9% risk. It was also found that prolonged DHCA time (\u226560 minutes) can be a significant risk for infants who have a preexisting genetic condition; however, infants who have genetic conditions and do not undergo prolonged DHCA time or have an aortic arch obstruction are not at increased risk of ANEs.<\/jats:p>\n               <jats:p>Conclusions. This study provides new information about the occurrence of ANEs after newborn heart surgery. Seizures or coma, which appeared in approximately 19% of all non\u2013hypoplastic left heart syndrome survivors, were not random events but were significantly associated with specific types of congenital heart disease, the presence of genetic conditions, and prolonged DHCA time. The 3 identified variables permitted individual cases to be assigned to low-, intermediate-, or high-risk categories. Because neonatal seizures are a good surrogate marker of long-term neurologic outcome, these models provide useful information to stratify individual patients for risk of seizures in future neuroprotection trials.<\/jats:p>","DOI":"10.1542\/peds.111.3.592","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"592-601","source":"Crossref","is-referenced-by-count":101,"title":["Risk of Seizures in Survivors of Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest"],"prefix":"10.1542","volume":"111","author":[{"given":"Robert R.","family":"Clancy","sequence":"first","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"McGaurn","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Wernovsky","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Spray","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William I.","family":"Norwood","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall L.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Goin","sequence":"additional","affiliation":[{"name":"From the Division of Neurology and the Cardiac Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2003,3,1]]},"reference":[{"key":"2021121114061471000_R1","doi-asserted-by":"crossref","unstructured":"Ferry P. Neurologic sequelae of open-heart surgery in children: an irritating question. Am J Dis Child.1990;144:369\u2013373","DOI":"10.1001\/archpedi.1990.02150270119040"},{"key":"2021121114061471000_R2","doi-asserted-by":"crossref","unstructured":"Miller G, Eggli K, Contant C, Baylen B, Myers J. Postoperative neurologic complications after open heart surgery on young infants. Arch Pediatr Adolesc Med.1995;149:764\u2013768","DOI":"10.1001\/archpedi.1995.02170200054008"},{"key":"2021121114061471000_R3","doi-asserted-by":"crossref","unstructured":"Newburger J, Jonas R, Wernovsky G. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med.1993;329:1057\u20131064","DOI":"10.1056\/NEJM199310073291501"},{"key":"2021121114061471000_R4","doi-asserted-by":"crossref","unstructured":"Clancy RR, McGaurn SA, Goin JE, et al. Allopurinol neuro-cardiac protection trial in infants undergoing heart surgery utilizing deep hypothermic circulatory arrest. Pediatrics.2001;107:61\u201370","DOI":"10.1542\/peds.108.1.61"},{"key":"2021121114061471000_R5","unstructured":"Hollingshead A. Four Factor Index of Social Status. New Haven, CT: Department of Sociology, Yale University; 1975"},{"key":"2021121114061471000_R6","doi-asserted-by":"crossref","unstructured":"Hosmer D, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley; 1989","DOI":"10.2307\/2531779"},{"key":"2021121114061471000_R7","doi-asserted-by":"crossref","unstructured":"Hosmer D, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley; 1989:135\u2013173","DOI":"10.2307\/2531779"},{"key":"2021121114061471000_R8","unstructured":"SAS II. SAS\/STAT Software: Changes and Enhancements Through Release 6.12. Cary, NC: SAS Institute; 1997:461"},{"key":"2021121114061471000_R9","unstructured":"Mizrahi E, Clancy R, Dunn J, et al. Neurologic impairment, developmental delay and post-natal seizures two-years after video-EEG documented seizures in near-term and full-term neonates: report of the Clinical Research Centers for Neonatal Seizures. Epilepsia.2001;42(suppl 7):102\u2013103"},{"key":"2021121114061471000_R10","doi-asserted-by":"crossref","unstructured":"Mizrahi E, Clancy R. Neonatal seizures: early-onset seizure syndromes and their consequences for development. Ment Retard Dev Disabil Res Rev.2000;6:229\u2013241","DOI":"10.1002\/1098-2779(2000)6:4<229::AID-MRDD2>3.0.CO;2-Y"},{"key":"2021121114061471000_R11","doi-asserted-by":"crossref","unstructured":"Nelson K, Broman S. Perinatal risk factors in children with serious motor and mental handicaps. Ann Neurol.1977;2:371\u2013377","DOI":"10.1002\/ana.410020505"},{"key":"2021121114061471000_R12","doi-asserted-by":"crossref","unstructured":"Ellenberg J, Nelson K. Cluster of perinatal events identifying infants at high risk for death or disability. J Pediatr.1988;113:546\u2013552","DOI":"10.1016\/S0022-3476(88)80649-8"},{"key":"2021121114061471000_R13","doi-asserted-by":"crossref","unstructured":"Rappaport LA, Wypij D, Bellinger DC, et al. Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Boston Circulatory Arrest Study Group. Circulation.1998;97:773\u2013779","DOI":"10.1161\/01.CIR.97.8.773"},{"key":"2021121114061471000_R14","doi-asserted-by":"crossref","unstructured":"Bove E. Current status of staged reconstruction for hypoplastic left heart syndrome. Pediatr Cardiol.1998;19:308\u2013315","DOI":"10.1007\/s002469900314"},{"key":"2021121114061471000_R15","doi-asserted-by":"crossref","unstructured":"Clancy R, McGaurn S, Wernovsky G, et al. Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate. 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