Neonatal seizures in preterm newborns: A predictive model for outcome

• Published in: European journal of paediatric neurology Vol. 20; no. 2; pp. 243 - 251
• Main Authors: Pisani, Francesco, Facini, Carlotta, Pelosi, Annalisa, Mazzotta, Silvia, Spagnoli, Carlotta, Pavlidis, Elena
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2016
• Subjects: Birth Weight; Electroencephalography; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Premature; Male; Models, Statistical; Neonatal seizures; Neonatal status epilepticus; Neurology; Outcome; Pediatrics; Preterm newborns; Recovery of Function; Seizures - complications; Seizures - epidemiology; Status Epilepticus - complications; Status Epilepticus - epidemiology; Preterm newborns; CUS; Neonatal seizures; v-EEG; HIE; Outcome; PVL; NICU; IVH; Neonatal status epilepticus; hypoxic–ischemic encephalopathy; cerebral ultrasound; periventricular leukomalacia; intraventricular hemorrhage; video-EEG; neonatal intensive care unit
• ISSN: 1090-3798; 1532-2130; 1532-2130
• DOI: 10.1016/j.ejpn.2015.12.007

With a reported prevalence of 22.2%, seizures in preterm newborns represent an emergent challenge, because they are often related to adverse outcome. The electroclinical features of preterm infants with neonatal seizures were evaluated in order to predict outcome. From 154 newborns with video-EEG confirmed neonatal seizures admitted to Parma University Hospital between January 1999 and December 2012, we collected 76 preterm newborns with neonatal seizures. Outcome was assessed at least at one year. Student t-test for unpaired data was used to compare means of continuous variables. We applied the χ2 test to compare nominal data between preterm newborns with favorable versus adverse outcome, and between those with seizures versus those with status epilepticus. Then we determined the independent risk factors for adverse outcome with multivariate logistic regression analysis. Birth weight, Apgar at 1st minute, neurologic examination, EEG, US brain scans and the presence of neonatal status epilepticus were different between preterm newborns with favorable and adverse outcome (p ≤ .049). Furthermore, birth weight, seizure onset, neurologic examination and EEG were different between the group with or without status (p ≤ .031). None of the infants with status epilepticus had a favorable outcome compared to 22.3% of those with neonatal seizures (p = .004). We also identified a predictive model that correctly classified outcome in 85.5% of subjects, with a high sensitivity for adverse outcome (>91.5%). The presence of neonatal seizures in preterm newborns is highly related to an adverse outcome that can be predicted since the first days of life. •Seizures in preterm newborns represent an emergent challenge.•Indeed, adverse outcome is still high in these infants (77.6%).•We reported the electroclinical features of preterm newborns with neonatal seizures.•A predictive model was developed, that correctly classified outcome in 85.5% of these infants.•Our model showed a high sensitivity for the adverse one (>91.5%).