Outcomes after Neonatal Seizures in Infants Less Than 29 Weeks' Gestation: A Population-Based Cohort Study

Neurogenetic and Metabolic Mimics of Common Neonatal Neurological Disorders

Neurogenetic and metabolic diseases often present in the neonatal period, masquerading as other disorders, most commonly as neonatal encephalopathy and seizures. Advancements in our understanding of inborn errors of metabolism are leading to an increasing number of therapeutic options. Many of these treatments can improve long-term neurodevelopment and seizure control. However, the treatments are frequently condition-specific. A high index of suspicion is required for prompt identification and treatment. When suspected, simultaneous metabolic and molecular testing are recommended along with concurrent treatment.

The developmental origins of health and chronic kidney disease: Current status and practices in Japan

The concept of the developmental origins of health and disease (DOHaD) views unfavorable perinatal circumstances as contributing to the development of diseases in later life. It is well known that such unfavorable circumstances play an important role as a risk factor for chronic kidney disease (CKD) in infants born with prematurity. Low birthweight (LBW) is believed to be a potential contributor to CKD in adulthood. Preterm and/or LBW infants are born with incomplete nephrogenesis. As a result, the number of nephrons is low. The poor intrauterine environment also causes epigenetic changes that adversely affect postnatal renal function. After birth, hyperfiltration of individual nephrons due to low nephron numbers causes proteinuria and secondary glomerulosclerosis. Furthermore, the risk of CKD increases as renal damage takes a second hit from exposure to nephrotoxic substances and acquired insults such as acute kidney injury after birth among infants in neonatal intensive care. Meanwhile, unfortunately, recent studies have shown that the number of nephrons in healthy Japanese individuals is approximately two-thirds lower than that in previous reports. This means that Japanese premature infants are clearly at a high risk of developing CKD in later life. Recently, several DOHaD-related CKD studies from Japanese researchers have been reported. Here, we summarize the relevance of CKD in conjunction with DOHaD and review recent studies that have examined the impact of the upward LBW trend in Japan on renal health.

Linking acute symptomatic neonatal seizures, brain injury and outcome in preterm infants

Neonatal seizures (NS) are the most frequent sign of neurological dysfunction in newborn infants. With increased survival of preterm neonates, the current clinical focus has shifted from preventing death to improving long-term neurological outcome. In the context of acute symptomatic NS, the main negative prognostic factors include etiology, and severity of brain injury, but also prolonged seizures and especially status epilepticus. However, the reasons for the detrimental contribution of seizures to outcome are still unclear, and evidence has been collected both in favor of seizures being an epiphenomenon of brain injury and of independently contributing to further damage. In this narrative focused review, we will discuss both hypotheses, with special emphasis on data relating to preterm infants. We will also identify present controversies and possible future lines of research.

Neonatal seizures in the U.S. National Inpatient Population: Prevalence and outcomes

BACKGROUND

Seizures are the most frequent neurological manifestation in neonates. Prevalence of neonatal seizures has not been well described in relationship with gestational age (GA). Also, the impact of seizures on neonatal mortality has not been quantified. This study aims to determine 1) prevalence of neonatal seizures in all GA groups, 2) associated mortality in each GA group and 3) impact of seizures on length of stay (LOS) of survivors in each GA group.

METHODS

Data from the national Kids' Inpatient Database (KID) for the years 2006, 2009 and 2012 was used in the study. All admitted infants with a documented GA were included in the study. All categorical variables were analyzed using Chi-square test, continuous variables were analyzed using t-test, and logistic regression analysis used to calculate odds ratio (OR) and 95% confidence intervals (CI).

RESULTS

A total of 10, 572,209 infants were included, of whom 4400 infants (0.04%) had seizures. The highest prevalence was at 24 weeks (0.12%). Overall mortality rate of patients with seizures was 4% with OR = 2.24 (95% CI = 1.90-2.65, p < 0.001). The correlation of seizure with mortality was significant after 33 weeks GA with greatest impact at 33-36 weeks GA (OR = 46.38 (95% CI = 26.86-80.08, p < 0.001). Seizures were associated with increased median LOS from 2 to 4 days (p < 0.001).

CONCLUSION

The prevalence of seizures varies according to gestational age ranging from 0.02% to 0.12%. The highest prevalence is at 24 weeks GA. The greatest impact for seizures on mortality is at 33-36 weeks GA.

Neonatal seizures in preterm infants: A systematic review of mortality risk and neurological outcomes from studies in the 2000's

INTRODUCTION

Neonatal seizures (NS) are associated with increased mortality and risk of cerebral palsy, epilepsy and intellectual disability. We performed a systematic review with the primary objective to delineate the rate of these outcomes following NS in preterm infants from studies published in the 2000's and the secondary objective to identify risk factors.

METHODS

Inclusion criteria: original articles published between 1/1/2000 and 12/31/2018, written in English, evaluating newborns ≤37 weeks of gestational age and suffering from NS, in which at least one of these was evaluated: epilepsy, cerebral palsy, intellectual disability/developmental delay, normal outcome, death.

RESULTS

Twenty-two papers were selected and all were observational, with a retrospective design in 15. Three were population-based and twenty-one have a comparison. It has been found a 22-80 % of mortality, 11.3-38.9 % of epilepsy, 12-84.6 % of cerebral palsy, and 20-42.7 % of intellectual disability/developmental delay rate. An increased risk for all outcomes considered was reported. Risk factors for specific outcomes were provided by a minority of studies. However, inclusion criteria, definition of NS and measured outcomes, follow-up lengths differed considerably between studies.

DISCUSSION

Results of the selected studies are only partially comparable or generalizable because of differences in study design. They have a risk for potential biases, although they provide (if analyzed) readily available prognostic factors, easy to apply in clinical practice. Prospective, population-based studies with EEG-defined NS are warranted in order to produce evidence-based guidance for management of preterm newborns with seizures.