Seizures in congenital heart disease: risks, outcomes, and birth cohort data from China.

OBJECTIVE: Congenital heart disease is the most common birth defect and carries a high risk of seizures; however, specific risk factors and long-term neurodevelopmental outcomes remain poorly defined. We aimed to identify factors associated with seizure occurrence and evaluate neurodevelopmental outcomes in children with congenital heart disease. METHODS: This prospective cohort study included 31,734 singleton live births in Lanzhou, China (2018-2023) followed for 18 months. Maternal, demographic, and clinical data were prospectively collected. Congenital heart disease phenotypes were classified as left-to-right shunt, cyanotic, left-sided, or single-ventricle lesions. Univariate logistic regression was conducted to identify factors associated with clinical seizures, and electroclinical and neurodevelopmental profiles were systematically evaluated. RESULTS: Congenital heart disease was diagnosed in 392 infants (1.2%), of whom 23 (5.9%) experienced clinical seizures. Lower birthweight, prolonged hospitalization, and extracorporeal membrane oxygenation support were significantly associated with seizure occurrence (all P < 0.001). Among congenital heart disease phenotypes, single-ventricle physiology had the highest seizure incidence (5.8%, P < 0.001). Electroencephalography identified focal impaired awareness seizures (n = 13), electrographic-only seizures (n = 2), and diverse interictal abnormalities. At 18 months, children with seizures demonstrated significantly lower motor scores (P = 0.038) and higher rates of global developmental delay/intellectual disability (P < 0.001). CONCLUSIONS: Seizures represent a critical complication in infants with congenital heart disease, particularly those with single-ventricle physiology or requiring prolonged hospitalization or mechanical circulatory support. Seizure development was associated with poorer 18-month neurodevelopmental outcomes, underscoring the need for proactive neurological surveillance and larger multicenter studies to identify independent risk pathways.