HHS Public Access Author manuscript Author Manuscript

J Pediatr. Author manuscript; available in PMC 2017 July 01. Published in final edited form as: J Pediatr. 2016 July ; 174: 98–103.e1. doi:10.1016/j.jpeds.2016.03.035.

Contemporary profile of seizures in neonates: a prospective cohort study

Author Manuscript

Hannah C. Glass, MDCM, MAS1,2, Renée A. Shellhaas, MD, MS3, Courtney J. Wusthoff, MD4, Taeun Chang, MD5, Nicholas S. Abend, MD6, Catherine J. Chu, MD7, M. Roberta Cilio, MD, PhD1, David V. Glidden, PhD2, Sonia L. Bonifacio, MD, MAS8, Shavonne Massey, MD6, Tammy N. Tsuchida, MD, PhD5, Faye S. Silverstein, MD3, and Janet S. Soul, MDCM9 on behalf of the Neonatal Seizure Registry Study Group* 1Departments

of Neurology & Pediatrics; UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA 2Department

of Epidemiology & Biostatistics; University of California San Francisco, San Francisco, CA

3Department

of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI

4Departments

of Neurology & Pediatrics, Stanford University, Palo Alto, CA

5Department

of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC

Author Manuscript

6Departments

of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

7Department

of Neurology, Massachusetts General Hospital, Boston, MA

8Division

of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA

9Department

of Neurology, Boston Children’s Hospital, Boston, MA

Abstract Objective—To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG).

Author Manuscript

Study design—We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks postmenstrual age with clinically suspected seizures and/or electrographic *

Corresponding author: Janet S. Soul, MDCM, Boston Children’s Hospital, Department of Neurology, 300 Longwood Avenue, Boston, MA 02115. Phone: 617-355-7176. Fax: 617-730-0366. [email protected] *List of additional members of Neonatal Seizure Registry Study Group is available at www.jpeds.com (Appendix). No reprints requested The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors declare no conflicts of interest. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Glass et al.

Page 2

Author Manuscript

seizures. Subjects were assessed between January 2013 and April 2015 at seven U.S. tertiary care pediatric centers following American Clinical Neurophysiology Society (ACNS) guidelines for cEEG for at risk neonates. Seizure etiology, burden, management and outcome were determined by chart review using a case report form designed at study onset. Results—The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received ≥2 anti-seizure medications. During the neonatal admission, 17% died; 49% of survivors had abnormal neurological examination at hospital discharge. In an adjusted analysis, high seizure burden was a significant risk factor for mortality, length of hospital stay, and abnormal neurological examination at discharge.

Author Manuscript

Conclusions—In this large contemporary profile of consecutively enrolled newborns with seizures treated at centers using cEEG per ACNS guidelines, about half had high seizure burden, received ≥2 anti-seizure medications, and/or died or had abnormal examination at discharge. Higher seizure burden was associated with increased morbidity and mortality. These findings underscore the importance of accurate determination of neonatal seizure frequency and etiology, and a potential for improved outcome if seizure burden is reduced. Keywords Neonatal seizures; EEG; Electroencephalogram; Epilepsy; Neurocritical Care; Infant; Critical care; Neonatal Encephalopathy; Hypoxic-Ischemic Encephalopathy

Author Manuscript

Seizures are a common manifestation of neurological disorders in neonates and are associated with unfavorable short- and long-term developmental outcomes. More than 50% of survivors experience considerable disability across a range of developmental domains, most frequently cerebral palsy, post-neonatal epilepsy, and/or intellectual disability,, requiring costly, lifelong therapies and social and academic support. Advances in the accurate diagnosis and management of seizures in neonates have been limited by several important factors: (1) seizures are difficult to diagnose as almost any abnormal movement can be due to seizures, yet electrographic seizures frequently do not have a clinical correlate;, (2) commonly used medications have limited efficacy; and (3) the relatively rare occurrence of seizures (1–4/1000 live term births) requires multicenter collaborative efforts.– Most studies of neonatal seizures have used either single-center data or population-based information that relied primarily on observation of clinical seizures rather than seizures identified by electroencphalography (EEG)..

Author Manuscript

To address these limitations, we developed the Neonatal Seizure Registry, a multicenter collaboration of tertiary centers across the United States that follow the American Clinical Neurophysiology Society (ACNS) guidelines for continuous video-EEG (cEEG) monitoring for at-risk neonates. The aim of this study was to use registry data to identify the contemporary profile of seizure etiologies and characteristics of seizures in a large, prospective, consecutive cohort.

J Pediatr. Author manuscript; available in PMC 2017 July 01.

Glass et al.

Page 3

Author Manuscript

METHODS

Author Manuscript

Subjects were consecutive neonates (

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study.

To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (...
216KB Sizes 4 Downloads 10 Views

Recommend Documents


Cohort profile: golestan hepatitis B cohort study- a prospective long term study in northern iran ​.
Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand

Urine neutrophil gelatinase-associated lipocalin in asphyxiated neonates: a prospective cohort study.
Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term

Survival of neonates and predictors of their mortality in Tigray region, Northern Ethiopia: prospective cohort study.
Neonatal mortality accounts for an estimated 2.8 million deaths worldwide, which constitutes 44 % of under-5-mortality and 60 % of infant mortality. Neonatal mortality predictors vary by country with the availability and quality of health care. There

To study the incidence, etiology and EEG profile of neonatal seizures: a prospective observational study from India.
To study the incidence, etiology and electroencephalography (EEG) profile of neonatal seizures and also to study the correlation between clinical picture and EEG appearance.

Cohort Profile: Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) prospective cohort study.
Adapting to an over-demanding stressful urban environment may exhaust the psychophysiological resources to cope with these demands, and lead to sympathetic nervous system dysfunction. The evidence that an urban-dwelling lifestyle may be detrimental t

Cohort Profile: The Malaysian Cohort (TMC) project: a prospective study of non-communicable diseases in a multi-ethnic population.
The Malaysian Cohort study was initiated in 2005 by the Malaysian government. The top-down approach to this population-based cohort study ensured the allocation of sufficient funding for the project which aimed to recruit 100,000 individuals aged 35-

COHORT PROFILE: The Complications of Long-Term Antiretroviral Therapy study in Uganda (CoLTART), a prospective clinical cohort.
Antiretroviral therapy (ART) improves the survival and quality of life of HIV-positive individuals, but the effects of long-term ART use do eventually manifest. The Complications of Long-Term Antiretroviral Therapy cohort study in Uganda (CoLTART) wa

Adverse drug reactions in neonates: a prospective study.
To investigate the frequency and characteristics of adverse drug reactions (ADRs) in hospitalised neonates to obtain a better understanding of and improvement in neonatal healthcare.

Oxygen saturation profile in late-preterm and term infants: a prospective cohort study.
To determine oxygen saturation profile over 6 h monitoring period in healthy late-preterm and term neonates during the first 48 h of age, and to assess the impact of gestational age, birth weight and method of delivery on this profile.