Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

Abstract

-Objective: To describe the neurological outcome of newborns with seizures. Method: Cohort study with newborns prospectively followed. Perinatal characteristics and etiological screening were related to outcome in a regression model. Results: During the study 3659 newborns were admitted and 2.7% were diagnosed as having seizures. Hypoxic ischemic encephalopathy (51%) was the etiology more frequently associated to seizures and also to postneonatal epilepsy (53%). In the follow up 25 died during the acute neonatal illness and 9 during the first years of life, 19 were diagnosed as having post neonatal epilepsy, 35 had developmental delay and 11 an association among this two comorbidities. A significant association between abnormal postnatal EEG and neuroimaging to developmental delay (p=0.014, p=0.026) was observed. The group of newborns that had seizures presented an increased risk of developing epilepsy compared to newborns from the same cohort without seizures (19.3/100 vs. 1.8/100, p<0.001). Conclusion: In this study neonatal seizures predominated in term newborns with perinatal asphyxia an elevated perinatal mortality and post neonatal morbidity was observed.The follow up showed an increased risk for developing postnatal epilepsy and developmental delay.KEy worDs: neonatal seizures, follow up, epilepsy, neonatal EEG, preterm newborn. Prognóstico neurológico de recém nascidos com crises convulsivas: estudo de coorte em hospital terciárioResumo -Objetivo: Avaliar o prognóstico neurológico de neonatos com crises convulsivas. Método: Estudo prospectivo, realizado em coorte de neonatos provenientes de hospital terciário. As características clínicas perinatais e os resultados de exames complementares foram correlacionados com prognóstico através de modelo de regressão logística. Resultados: Durante o estudo 3659 neonatos foram internados, sendo que 101 apresentaram crises convulsivas (2,7%). A encefalopatia hipóxico-isquêmica foi a etiologia mais frequentemente associada às crises (51%). o seguimento evidenciou 25 óbitos no período neonatal e 9 durante os primeiros anos de vida, 19 lactentes desenvolveram epilepsia, 35 atraso no desenvolvimento e 11 associação entre os dois desfechos. o modelo de regressão logística aplicado mostrou associação significativa entre EEG pós neonatal anormal e neuroimagem anormal com atraso no desenvolvimento (p=0,014, p=0,026). os neonatos em estudo, quando comparados aos demais da mesma coorte, que não apresentaram crises convulsivas tiveram maior probabilidade de desenvolver epilepsia (19,3/100 vs. 1,8/100, p<0,001). Conclusão: Neste estudo em que ocorreu predomínio de crises neonatais em neonatos a termo com asfixia perinatal, foi observada alta mortalidade perinatal e morbidade. o seguimento neurológico evidenciou elevado risco de desenvolvimento de epilepsia e/ou atraso no desenvolvimento neuropsicomotor.

Factors associated with clinical seizures in high-risk neonates at the Wesley Guild hospital, Ilesa, Nigeria

“…Many studies reported male preponderance among babies with seizures [5][6][7][8][9][10][11]. This is in keeping with male to female ratio of 2.9:1 reported in the present study.…”

“…Reports from developing countries though mostly hospital based [4][5][6][7][8] signify a high incidence of neonatal morbidity including seizures compared to that from developed countries [9][10][11]. Unfortunately, in most centers in developing countries where neonatal seizures as well as newborn morbidity and mortality are high, facilities to fully investigate, monitor and manage neonatal seizures are often inadequate [4][5][6][7][8].…”

Birth asphyxia as the major complication in newborns: moving towards improved individual outcomes by prediction, targeted prevention and tailored medical care

“…11. Hypoxic-ischaemic encephalopathy [55–57], CNS damage [58, 59], epilepsy [60, 61], nephropathy [43], cardiomyopathy [62, 63], vascular pathologies [64], senescence [32, 65], diabetes mellitus [66, 67], cancer [68], neurodegenerative diseases [58], morbidity and mortality [69] and tissue remodelling [70] all belong to individual short- and long-term outcomes of birth asphyxia. Specialised issue of The EPMA Journal , further treat the major related topics, namely “PPPM in Diabetes”, “PPPM in Neurodegenerative Diseases”, “PPPM in Cancer”, “PPPM in Cardiovascular Diseases”, “PPPM in Body Culture and Sport Medicine”, “Healthcare Overview”, where the articles overview the innovative technologies of predictive diagnostics, targeted prevention measures and desirable personalisation of medical care [71–80].…”

Early onset epilepsy is associated with increased mortality: A population-based study

“…Although some epilepsy syndromes affecting children less than one of year of age can have favorable prognoses, others result in medically refractory seizures, developmental delay/intellectual disability, and other neurologic handicaps (Nunes, et al 2008, Yamamoto, et al 2011, van der Heide, et al 2012). While the increased morbidity of early onset epilepsy is known, its mortality has not been robustly explored.…”