Electrographic Seizures in Preterm Infants During the First Week of Life Are Associated With Cerebral Injury

Abstract

ABSTRACT:The aim of the study was to determine the incidence of electrographic seizure activity in a prospective cohort of preterm infants and relate it to the presence of cerebral injury. Infants born Ͻ30-wk gestation received a median 74 h of continuous 2-channel EEG with amplitude-integrated EEG monitoring in the first week of life. Infants were classified in the abnormal outcome group if they died in the neonatal period and/or had grades 3-4 intraventricular hemorrhage and/or moderate or severe abnormalities on cerebral MRI. Seizures were defined as rhythmic spike and/or wave activity lasting at least 10 s on the raw EEG trace. Eleven of 51 infants monitored had electrographic seizures. These infants were more premature had lower birth weights and a greater proportion had abnormal outcomes. In four infants, seizures preceded ultrasound findings of grades 3-4 intraventricular hemorrhage. Three of the four infants with seizures and concurrent physiologic recordings displayed concurrent rises in heart rate and one showed a fall in respiratory rate. In conclusion, electrographic seizures were more likely to occur in the sicker and more premature infants with abnormal outcomes. Seizures detected on continuous amplitude-integrated EEG monitoring with the raw EEG were associated with poor outcome. (Pediatr Res 67: 102-106, 2010)

Gray Matter Volume Decrements in Preterm Children With Periventricular Leukomalacia

“…Neonatal periventricular WM injury in preterm samples might lead to damage of subplate neurons, crucial in thalamocortical and corticocortical connections (25), and this could result in cortical and subcortical GM reductions. These GM reductions present in preterm samples with WM injury might be also related with the high incidence of seizures reported in preterms with brain injury (26,27) as is the case for the abnormal cortical reorganization of some GM nuclei after cystic WM injury (28). Several GM regions in which preterms with PVL showed volume decrements were only correlated with the BW neonatal variable.…”

Enteral Supplements of a Carbon Monoxide Donor CORM-A1 Protect against Cerebrovascular Dysfunction Caused by Neonatal Seizures

“…8 Alternatively, one may hypothesize that CO-derived CORM-A1 has anticonvulsant effects. However, CORM-A1 did not affect the dynamics of ictal tachycardia, a reliable and sensitive indicator of status epilepticus in patients, [20][21][22][23][24] of the EEG suggested that CO has proconvulsant, rather than anticonvulsant action. 16 Importantly, CORM-A1 (2 mg/kg), administered via enteral or parenteral routes, provides a safe and effective pharmacological option for prevention of oxidative stress-induced cerebral vascular disease.…”

Using amplitude-integrated EEG in neonatal intensive care

“…Data from premature infants continue to evolve, especially in terms of prognosis. 3 More recently, the establishment of aEEG as inclusion criteria for neuroprotective strategies has emerged, 4,5 and its application in newborns with both pulmonary hypertension and congenital heart disease is increasing. 6 Whatever the case, newer monitoring devices incorporating both aEEG and the raw EEG trace continue to develop and are beginning to be integrated into the routine care of the critically ill infant in the NICU.…”

“…A recent study has shown that electrographic seizures in the first week of life correlate with adverse outcomes. 3 Intraventricular hemorrhage (IVH) and its subsequent effects, specifically, influence a number of aEEG characteristics. When compared with agematched controls, premature infants <30 weeks of GA with IVH show increased discontinuity, seizures and decreased amount of SWC.…”