In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns.

The presence, time of onset, and quality of SWC reflected the severity of the hypoxic-ischemic insult to which newborns were exposed. The time of onset of SWC has a predictive value for neurodevelopmental outcome.

Objective: To assess the time course of recovery of severely abnormal initial amplitude integrated electroencephalographic (aEEG) patterns (flat trace (FT), continuous low voltage (CLV), or burst suppression (BS)) in full term asphyxiated neonates, in relation to other neurophysiological and neuroimaging findings and neurodevelopmental outcome. Methods: A total of 190 aEEGs of full term infants were reviewed. The neonates were admitted within 6 hours of birth to the neonatal intensive care unit because of perinatal asphyxia, and aEEG recording was started immediately. In all, 160 infants were included; 65 of these had an initial FT or CLV pattern and 25 an initial BS pattern. Neurodevelopmental outcome was assessed using a full neurological examination and the Griffiths' mental developmental scale. Results: In the FT/CLV group, the background pattern recovered to continuous normal voltage within 24 hours in six of the 65 infants (9%). All six infants survived the neonatal period; one had a severe disability, and five were normal at follow up. In the BS group, the background pattern improved to normal voltage in 12 of the 25 infants (48%) within 24 hours. Of these infants, one died, five survived with moderate to severe disability, two with mild disability, and four were normal. The patients who did not recover within 24 hours either died in the neonatal period or survived with a severe disability. Conclusion: In this study there was a small group of infants who presented with a severely abnormal aEEG background pattern within six hours of birth, but who achieved recovery to a continuous normal background pattern within the first 24 hours. Sixty one percent of these infants survived without, or with a mild, disability.

A new lidocaine dosing schedule was developed. This new regimen should have a lower risk of cardiac arrhythmias and appears to be as effective in term infants. For preterm infants the optimal regimen needs to be determined.

No abstract

SUMMARYObjective: To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second-or third-line antiepileptic drug (AED) for neonatal seizures. Methods: Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed <2 h). Results: Lidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p < 0.001). In full-term infants the response to lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p < 0.001). Factors associated with a good response to lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second-or third-line AED and seizure etiology. Significance: Seizure response to lidocaine was seen in~70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs.

RESULTS An underlying aetiology was identified in 354 infants (93.7%). The most commonaetiologies identified were hypoxic-ischaemic encephalopathy (46%), intracranial haemorrhage (12.2%), and perinatal arterial ischaemic stroke (10.6%). When comparing MRI with cUS in these 354 infants MRI showed new findings which did not become apparent on cUS, contributing to a diagnosis in 42 (11.9%) infants and providing additional information to cUS, contributing to a diagnosis in 141 (39.8%). cUS alone would have allowed a diagnosis in only 37.9% of infants (134/354).INTERPRETATION Cerebral MRI contributed to making a diagnosis in the majority of infants.In 11.9% of infants the diagnosis would have been missed if only cUS were used and cerebral MRI added significantly to the information obtained in 39.8% of infants. These data suggest that cerebral MRI should be performed in all newborn infants presenting with EEGor aEEG-confirmed seizures.Neonatal seizures are associated with high mortality (21-24%) 1,2 and morbidity rates (25-35%). 3 No evidence-based guidelines for the evaluation of neonatal seizures exist, 4 but it is likely that magnetic resonance imaging (MRI) would provide the most useful information. 5,6 MRI is now considered the criterion standard for diagnosing brain injury and developmental disorders and for determining the prognosis in neonates presenting with seizures. 4 Many studies have reported on brain imaging and neonatal seizures, but most focused on MRI data in small groups of infants with a specific underlying problem. Only a few studies have reported on neuroimaging findings in infants with neonatal seizures. 3,[7][8][9] The aim of this study was to assess the aetiologies and additional value of MRI compared with cranial ultrasonography (cUS) in a retrospective study of a large cohort of term-born and near-term-born infants with neonatal seizures. Our hypothesis was that MRI would make an important contribution to the diagnostic process. METHOD PatientsIn this retrospective study, infants were included if they had a gestational age of 35 weeks or more and clinical and/or subclinical neonatal seizures, confirmed by amplitude-integrated electroencephalography (aEEG) or (March 1999-October 2013. Infants were excluded if they had clinical seizures without confirmation by either aEEG or standard EEG. Infants were identified using a local database on discharge diagnoses using 'seizures' and 'convulsions' as search terms. These data were compared with a local neuroimaging database to identify those who underwent cUS and MRI during the same admission period. Subsequently, the medical records and discharge summaries were used to check whether or not seizures had been confirmed by EEG or aEEG.No permission was required from the hospital's medical ethics committee for this retrospective anonymous data analysis. Amplitude-integrated electroencephalographyContinuous aEEG recordings were routinely used in infants at risk of or with suspected neonatal seizures. Standard EEG was performed when aEEG was inconclusive,...

The present study demonstrates that continuous cardiac monitoring of neonates who receive lidocaine for neonatal seizures is indicated, as there is a risk to develop cardiac arrhythmias. Lidocaine should be discontinued immediately when a cardiac arrhythmia occurs. Lidocaine should not be given to patients with a congenital heart disease and to infants who have already been treated with diphantoine.