Elsevier

Epilepsy & Behavior

Volume 84, July 2018, Pages 107-113
Epilepsy & Behavior

Long-term outcome in children with neonatal seizures: A tertiary center experience in cohort of 168 patients

https://doi.org/10.1016/j.yebeh.2018.05.002Get rights and content

Highlights

  • Neonatal seizures are associated with increased risk of death and long-term morbidity in survivors.

  • Neonatal EEG is useful to the clinicians in assessing prognosis of cerebral function.

  • Abnormal background activities in neonatal EEG correlate with poor outcome.

  • We identify predictors of neurological and intellectual disabilities and epilepsy in children with neonatal seizures.

Abstract

Purpose

The purpose of this study was to evaluate long-term outcome and assess predictors of prognosis in children with neonatal seizures (NS).

Method

This retrospective study includes children with NS treated at our Institute from January the 1st 2005 until December the 31st 2015. The data were collected from medical charts and the electroencephalogram (EEG) database at the Institute. The predictive value was evaluated for following parameters: (1) characteristics of the patients, such as gender, gestational age, birth body weight, Apgar score, artificial ventilation; (2) etiology; (3) characteristics of seizures such as type, time of onset, resistance to treatment; and (4) EEG background activity and paroxysmal discharges. The outcome of NS was assessed at the end of the follow-up period and was categorized as one of the following: (1) lethal outcome, (2) neurological abnormalities, (3) intellectual disability, and (4) epilepsy. Univariate and multivariate logistic regression analyses were used to assess predictors of NS outcome.

Results

The study included 168 children with NS (of which 109 are males, and 59 are females), mean aged 5.6 (SD 3.5) years at the end of the follow-up (with a range of 1 to 12 years). There was normal neurological development without epilepsy in 131 patients (78%), neurological abnormality in 31 (19.0%), intellectual disability in 28 (17.2%), epilepsy in 12 (7.4%), and lethal outcome in 7 patients (4.17%).

Conclusions

Long-term outcome in children with NS could be favorable in most patients, and it appears to be related to specific early clinical and paraclinical variables. Newborns with an abnormal background EEG activity, with seizures resistant to antiepileptic drugs and/or low Apgar score are at a higher risk of a poor outcome. Females are at a much higher risk of lethal outcome than males.

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.

References (35)

  • F. Pisani et al.

    Neonatal status epilepticus vs recurrent neonatal seizures: clinical findings and outcome

    Neurology

    (2007)
  • L. Dubowitz et al.

    The Dubowitz neurological examination of the full-term newborn

    Ment Retard Dev Disabil Res Rev

    (2005)
  • J.J. Volpe

    Neonatal seizures: current concepts and revised classification

    Pediatrics

    (1989)
  • P. Kwan et al.

    Definition of drug-resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies

    Epilepsia

    (2010)
  • C.T. Lombroso

    Neonatal EEG poligraphy in normal and abnormal newborns

  • J. Gosselin et al.

    The Amiel-Tison neurological assessment at term: conceptual and methodological continuity in the course of follow-up

    Ment Retard Dev Disabil Res Rev

    (2005)
  • S.R. Fisher et al.

    A practical clinical definition of epilepsy

    Epilepsia

    (2014)
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