Long-term outcome in children with neonatal seizures: A tertiary center experience in cohort of 168 patients
Introduction
Neonatal seizures (NS) are the most common neurological disorder in newborns, and often the first sign of neurological dysfunction. The seizures in neonatal period are the topic of many scientific and clinical investigations due to their powerful predictor value of long-term cognitive and developmental impairment. The etiology of NS is very heterogeneous, mostly acute symptomatic. It is very important to determine causes of NS, since etiology has significant impact on prognosis and outcome and influences further therapeutic strategies [1], [2], [3].
Neonatal seizures are mostly focal, though generalized seizures have also been described in rare instances, and their clinical presentation highly variable. One particular type of NS are so-called “subtle seizures”, which are clinically manifested as chewing, pedaling, and/or ocular movements, that are more common in full-term than in premature infants [2], [4]. The scoring system for an early prognostic assessment after NS was devised by Pisani et al. identifying independent risk factors for adverse outcome as follows: (1) weight at birth, (2) Apgar score at first minute, (3) neurological status at the seizure onset, (4) cerebral ultrasound findings, (5) efficacy of anticonvulsant therapy, and (6) the presence of neonatal status epilepticus [5].
The aims of this study were to evaluate the long-term outcome and to identify predictors of lethal outcome, neurological and intellectual disabilities and epilepsy in children with NS treated in tertiary hospital.
Section snippets
Methods
The retrospective study included children with NS treated at the Intensive Care Unit (ICU) and/or Department of Neurology at the Institute for Mother and Child Healthcare of Serbia during the period from January the 1st 2005 to December the 31st 2015.
The inclusion criteria are as follows: (1) full-term and preterm newborns with seizures clinically observed by a physician in our hospital within the neonatal period, (2) newborns without clinically manifested seizures, but with an ictal
Stasistical analysis
Categorical variables were described by counts or percentages. The assumption of normality was tested by Kolmogorov–Smirnov test for continuous variable birth body weight and follow-up period). Test results showed normal distribution for birth body weight and the skewed distribution for follow-up period. Continuous variables were described by mean and standard deviation or median and interquartile range.
For logistic regression four dependent variables were observed: neurological abnormalities
Results
The retrospective study included 168 children with NS treated at the Institute during a period of 11 years. Most of our cohort are full-term newborns with body weight (BW) at birth higher than 2500 g. The average body weight at birth was 3285.7 g (min: 1750, max: 5450, SD: 597.787, med: 3300, iqr: 700), and in the group with body weight below 2500 g, the mean weight was 2149.3 g (min: 1750, max: 2430, SD: 225.541, med: 2160, iqr: 432.5). Neonatal seizures are more frequent in males than
Discussion
The incidence of seizures is highest during the neonatal period [1], [14]. Neonatal seizures have particular features in clinical presentation, response to the treatment, etiology, and impact to the morbidity and mortality [15], and are associated with adverse neurodevelopmental outcomes, including epilepsy, cerebral palsy, developmental delay, and psychomotor deficits [16], [17], [18].
Pisani et al. devised a scoring system and identified 6 independent risk factors for adverse outcome: (1)
Conclusion
The long-term outcome in children with NS could be favorable in most patients, and the major determinants for outcome are the EEG background activity, the response to AEDs, and the Apgar scores. Since electroencephalographic background activity has the main predictive value in all aspects of outcome, it is very important to introduce and perform this procedure in all newborns with NS. The long-term EEG monitoring in newborn at risk is important to assess the background activity and to the early
Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgments
We would like to thank to Dr. Bojana Radojicic for her contribution to collecting the data for this study. We thank Institute for Mother and Child Healthcare of Serbia for financial support. B.V.T. would like to thank Marin Tadić and Prof. Dr. V. Dmitrašinović for correcting our English.
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