Neonatal seizures in preterm infants: clinical outcome and relationship with subsequent epilepsy

Rhythmic EEG patterns in extremely preterm infants: Classification and association with brain injury and outcome

•

Most rhythmic EEG patterns in extremely preterm infants related to head position.

•

Clear ictal discharges were only observed in one out of 77 infants (1.3%).

•

PEDs were prevalent, but their significance is not known.

•

PEDs were not related to brain injury or poor cognition.

Objective

Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome.

Methods

Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72 h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years).

Results

Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p < 0.05), but not PEDs (p = 0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years.

Conclusions

Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts.

Significance

Rhythmic EEG patterns may have a different significance in extremely preterm infants.

Neonatal seizures: Predictors of adverse outcome

Context:

Early detection of predictors of adverse outcome will be helpful for neonatologists to plan management, follow up and rehabilitation in advance so that neurological disability can be minimised.

Aims:

The purpose of this study was to determine the factors affecting the adverse outcome of neonatal seizures.

Settings and Design:

This is a prospective study conducted in the neonatal unit of a tertiary care hospital. One hundred and eight newborns consecutively admitted with seizures were included in this study.

Materials and Methods:

Data was collected regarding perinatal history and seizure and evaluated for etiology. We conducted a retrospective analysis to identify the factors associated with adverse outcome after neonatal seizures.

Statistical Analysis Used:

Chi-square test with degree of freedom = 1 was used to find the variables significantly associated with adverse outcome (P < 0.05).

Results:

Gestational age, birth weight, Apgar score at 5 min, seizure onset <24 hrs, status epilepticus, radiological findings and EEG findings were significantly associated with outcome.

Conclusion:

Mortality and severe neurological impairment after neonatal seizure is associated with prematurity, LBW, low Apgar score at 5 min, etiologies like meningitis, sepsis, severe HIE, brain malformations, grade 3 or 4 IVH or intracranial haemorrhage, seizure onset <24 hours, presence of status epilepticus, severely abnormal radiological and EEG findings.