Post-Emergency Seizures in Infants After Heart Surgery

Seizures following infant resuscitation?

Hello doctor, my baby is three months old and underwent a cardiac catheterization due to a heart defect.
However, the procedure was not smooth, as her heart rate dropped, and it took 50 minutes of resuscitation to stabilize her.
She was saved, but she developed seizures, occurring twice a day.
The doctor prescribed antiepileptic medication, which has improved her condition, and she has not had any more seizures.
However, during each visit, I notice that her gaze is vacant, and she does not seem to respond to moving objects.
Before the surgery, her eyes would look around, but now she does not react when called, as if she cannot see or hear.
I would like to ask if this is normal.
A brain ultrasound showed normal results, and we are still waiting for the EEG report.
I have inquired with the hospital, and they responded that she is just sleepy after eating and taking medication, but I hope that is all it is.

Xin Tong de Fu Mu, 20~29 year old female. Ask Date: 2017/11/09

Dr. Xiao Kaiwen reply Pediatrics

Infants who cannot undergo standard vision and hearing tests can have their visual and auditory functions assessed through visual evoked potential testing and hearing screening, which can help identify any abnormalities.
Early detection of epilepsy and timely medication can significantly reduce subsequent neurological developmental sequelae, which is a positive outcome.

Reply Date: 2017/11/09

More Info

Post-emergency seizures in infants, particularly following heart surgery, can be a concerning issue for parents. In your case, your three-month-old baby underwent a catheterization procedure due to a congenital heart defect, and the surgery was complicated by a significant drop in heart rate that required resuscitation. This situation can lead to various neurological outcomes, including seizures.

Seizures in infants can occur for several reasons, especially after a stressful event like surgery. In your baby's case, the seizures may be a result of several factors, including:
1. Hypoxia: The prolonged period of low heart rate could have led to decreased oxygen supply to the brain, which can result in seizures. Hypoxic-ischemic injury is a known risk in cases where there is a significant drop in cardiac output.

2. Metabolic Imbalances: Surgery and the stress associated with it can lead to metabolic disturbances, such as electrolyte imbalances, which can also trigger seizures.

3. Neurological Impact of Surgery: Any major surgery, especially on the heart, can have secondary effects on the brain. The stress of surgery, anesthesia, and the recovery process can all contribute to neurological symptoms.

4. Medication Effects: The anti-seizure medications prescribed may have side effects that include sedation or altered responsiveness. It’s not uncommon for infants on these medications to appear drowsy or less responsive.

Regarding your observations about your baby's behavior post-surgery, such as appearing "dazed" or unresponsive, it is essential to consider the following:
- Postictal State: After a seizure, infants may experience a postictal state, where they are lethargic or less responsive. This can last for a variable amount of time.

- Medication Side Effects: As mentioned, the medications used to control seizures can cause sedation, which might explain the lack of responsiveness.
- Developmental Impact: It’s crucial to monitor your baby's overall development. If the lack of responsiveness persists, it may warrant further evaluation by a pediatric neurologist.

- Hearing and Vision: The concerns about your baby not responding to visual or auditory stimuli should be taken seriously. While it could be related to medication or the post-surgical state, it is essential to rule out any neurological deficits.
Given that the brain ultrasound was normal and you are awaiting EEG results, it is a positive sign that there may not be any structural abnormalities. However, the EEG will provide more information regarding the electrical activity in the brain and help determine if there are ongoing seizure activities or other concerns.

In conclusion, while some degree of lethargy and altered responsiveness can be expected after such a significant medical event, persistent or worsening symptoms should be evaluated further. It is essential to maintain open communication with your healthcare team, and if you have concerns about your baby's responsiveness or development, do not hesitate to seek a second opinion or further evaluation. Early intervention can be crucial in addressing any potential developmental delays or neurological issues.

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