Seizures in preterm neonates

Hannah C. Glass, MDCM, Renée A. Shellhaas, MD, MS, Tammy N. Tsuchida, MD, PhD, Taeun Chang, MD, Courtney J. Wusthoff, MD, Catherine J. Chu, MD, M. Roberta Cilio, MD, PhD, Sonia L. Bonifacio, MD, MAS, Shavonne L. Massey, MD, Nicholas S. Abend, MD, Janet S. Soul, MDCM On behalf of the Neonatal Seizure Registry study group.  Seizures in Preterm Neonates: A Multicenter Observational Cohort Study. Pediatric Neurology.  In press.

Abstract

Objective

The purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society’s neonatal electorencephalogram monitoring guideline.

Study Design

Of 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extremely preterm (<28 weeks, N=18), very preterm (28 to <32 weeks, N=18), and moderate/late preterm (32 to <37 weeks, N=56) and compared to term neonates.

Result

Hypoxic-ischemic encephalopathy (33%) and intracranial hemorrhage (27%) accounted for etiology in >50% of preterm neonates. Hypothermia therapy was administered in 15 moderate/late preterm subjects with encephalopathy. The presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) were similar when comparing preterm and term neonates. However, exclusively subclinical seizures were more common in preterm than term neonates (24% versus 14%). Phenobarbital was the most common initial medication for all gestational age groups and failure to respond to an initial loading dose was 63% in both preterm and term neonates. Mortality was similar among the three preterm gestational age groups; however, preterm mortality was more than twice that of term infants (35% versus 15%).

Conclusion

Subclinical seizures were more common and mortality was higher for preterm than term neonates. These data underscore the importance of electroencephalographic monitoring and the potential for improved management in preterm neonates.

_______________________________________________________________________

This study's goal was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society’s neonatal electorencephalogram monitoring guideline. For preterm, subclinical seizures were more common and mortality was higher than term neonates. In preterm neonates, these data emphasize the importance of electroencephalographic monitoring and the potential for improved management.

Methods

The clinicians enrolled 611 neonates with seizures (92 (15%) were born preterm).

They evaluated seizure characteristics by gestational age at birth for extremely preterm (<28 weeks, N=18), very preterm (28 to <32 weeks, N=18), and moderate/late preterm (32 to <37 weeks, N=56) and compared to term neonates.

Results

In >50% of preterm neonates, hypoxic-ischemic encephalopathy (33%) and intracranial hemorrhage (27%) accounted for etiology.

The clinicians administered hypothermia therapy in 15 moderate/late preterm subjects with encephalopathy.

When comparing preterm and term neonates, the presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) was similar.

However, in preterm, exclusively subclinical seizures were more common than term neonates (24% vs. 14%).

The most common initial medication for all gestational age groups was phenobarbital and failure to respond to an initial loading dose was 63% in both preterm and term neonates.

Among the 3 preterm gestational age groups, mortality was similar.

However, preterm mortality was more than twice that of term infants (35% vs. 15%).

https://www.mdlinx.com/neurology/medical-news-article/2017/04/24/infant-preterm-neonatal-seizures-eeg-electroencephalogram/7143960/?category=latest&page_id=1