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Sandoval Karamian AG, DiGiovine MP, Massey SL. Neonatal Seizures. Pediatr Rev 2024; 45:381-393. [PMID: 38945992 DOI: 10.1542/pir.2023-006016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Amanda G Sandoval Karamian
- Division of Neurology, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT
| | - Marissa P DiGiovine
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Shavonne L Massey
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Li H, Chen X, Chen L, Li J, Liu X, Chen C, Xie D, Yuan J, Tao E. Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review. Front Pharmacol 2024; 15:1391024. [PMID: 38957388 PMCID: PMC11218545 DOI: 10.3389/fphar.2024.1391024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate's condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.
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Affiliation(s)
- Haiting Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xiyang Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Linlin Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Jie Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xixi Liu
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Caie Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Dengpan Xie
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Junhui Yuan
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
- Department of Science and Education, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
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Altınbezer P, Çolak R, Çalkavur Ş, Yılmaz Ü. Epilepsy Frequency and Risk Factors Three Years After Neonatal Seizures. Pediatr Neurol 2023; 149:120-126. [PMID: 37866139 DOI: 10.1016/j.pediatrneurol.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Neonatal seizures, one of the main risk factors for the development of epilepsy, remain a clinical concern. In children with neonatal seizures, early recognition of risk factors is important for the early diagnosis and appropriate treatment of epilepsy and for improving prognosis. In this study, we aimed to determine the frequency of and the risk factors for the development of epilepsy in patients with neonatal seizures. METHODS The hospital files of 228 children who experienced seizures in the neonatal period were reviewed. The frequency of epilepsy and risk factors for the development of epilepsy were determined at age 36 months. RESULTS Epilepsy was diagnosed in 40.8% of the cases. Univariate analysis revealed family history of epilepsy, parental consanguinity, abnormal neurological examination findings, microcephaly, unresponsiveness to antiepileptic drugs or antiseizure medication, use of more than one antiepileptic drugs to antiseizure medication at discharge, status epilepticus, electroencephalography abnormalities, abnormal neuroimaging findings, invasive ventilation requirement, myoclonic seizures, central nervous system malformation, and congenital metabolic disease as risk factors for the development of epilepsy. Of these, a family history of epilepsy, abnormal neurological examination findings at discharge, and use of at least two antiepileptic drugs to antiseizure medication at discharge were found as independent risk factors in multivariate analysis. CONCLUSIONS Neonatal seizures appear to be associated with epilepsy in more than one-third of the patients. Of the newborns with seizures, those with a family history of epilepsy, abnormal neurological examination findings at discharge, and those using at least two antiepileptic drugs to antiseizure medication at discharge should be monitored more carefully for the development of epilepsy.
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Affiliation(s)
- Pelin Altınbezer
- Department of Pediatrics, Dr. Behçet Uz Children's Education and Research Hospital, University of Health Sciences Turkey, Izmir, Turkey.
| | - Rüya Çolak
- Division of Neonatalogy, Department of Pediatrics, Dr. Behçet Uz Children's Education and Research Hospital, University of Health Sciences Turkey, Izmir, Turkey
| | - Şebnem Çalkavur
- Division of Neonatalogy, Department of Pediatrics, Dr. Behçet Uz Children's Education and Research Hospital, University of Health Sciences Turkey, Izmir, Turkey
| | - Ünsal Yılmaz
- İzmir Faculty of Medicine, Division of Pediatric Neurology, Department of Pediatrics, Dr. Behçet Uz Children's Education and Research Hospital, University of Health Sciences Turkey, Izmir, Turkey
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Pijpers JA, Au PYB, Weeke LC, Vein AA, Smit LS, Vilan A, Jacobs E, de Vries LS, Steggerda SJ, Cilio MR, Carapancea E, Cornet MC, Appendino JP, Peeters-Scholte CMPCD. Early recognition of characteristic conventional and amplitude-integrated EEG patterns of seizures in SCN2A and KCNQ3-related epilepsy in neonates. Seizure 2023; 110:212-219. [PMID: 37429183 DOI: 10.1016/j.seizure.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Early recognition of seizures in neonates secondary to pathogenic variants in potassium or sodium channel coding genes is crucial, as these seizures are often resistant to commonly used anti-seizure medications but respond well to sodium channel blockers. Recently, a characteristic ictal amplitude-integrated electroencephalogram (aEEG) pattern was described in neonates with KCNQ2-related epilepsy. We report a similar aEEG pattern in seizures caused by SCN2A- and KCNQ3-pathogenic variants, as well as conventional EEG (cEEG) descriptions. METHODS International multicentre descriptive study, reporting clinical characteristics, aEEG and cEEG findings of 13 neonates with seizures due to pathogenic SCN2A- and KCNQ3-variants. As a comparison group, aEEGs and cEEGs of neonates with seizures due to hypoxic-ischemic encephalopathy (n = 117) and other confirmed genetic causes affecting channel function (n = 55) were reviewed. RESULTS In 12 out of 13 patients, the aEEG showed a characteristic sequence of brief onset with a decrease, followed by a quick rise, and then postictal amplitude attenuation. This pattern correlated with bilateral EEG onset attenuation, followed by rhythmic discharges ending in several seconds of post-ictal amplitude suppression. Apart from patients with KCNQ2-related epilepsy, none of the patients in the comparison groups had a similar aEEG or cEEG pattern. DISCUSSION Seizures in SCN2A- and KCNQ3-related epilepsy in neonates can usually be recognized by a characteristic ictal aEEG pattern, previously reported only in KCNQ2-related epilepsy, extending this unique feature to other channelopathies. Awareness of this pattern facilitates the prompt initiation of precision treatment with sodium channel blockers even before genetic results are available.
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Affiliation(s)
- Judith A Pijpers
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands.
| | - Ping Yee Billie Au
- Departments of Medical Genetics, Cumming School of Medicine, University of Calgary, Canada
| | - Lauren C Weeke
- Departments of Neonatology, Erasmus Medical Center, the Netherlands
| | - Alla A Vein
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands
| | - Liesbeth S Smit
- Departments of Neonatology, Erasmus Medical Center, the Netherlands; Departments of Neurology, Erasmus Medical Center, the Netherlands
| | - Ana Vilan
- Department of Neonatology, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Portugal
| | - Elke Jacobs
- Departments of Neurology, Erasmus Medical Center, the Netherlands
| | - Linda S de Vries
- Departments of Neonatology, Leiden University Medical Center, the Netherlands
| | - Sylke J Steggerda
- Departments of Neonatology, Leiden University Medical Center, the Netherlands
| | - Maria Roberta Cilio
- Division of Pediatric Neurology, Department of Pediatrics, Catholic University of Louvain, Brussels, Belgium
| | - Evelina Carapancea
- Division of Pediatric Neurology, Department of Pediatrics, Catholic University of Louvain, Brussels, Belgium
| | - Marie-Coralie Cornet
- Division of Neonatology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Juan P Appendino
- Departments of Pediatric Neurology, Cumming School of Medicine, University of Calgary, Canada
| | - Cacha M P C D Peeters-Scholte
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands
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Affiliation(s)
- Elissa Yozawitz
- From the Isabelle Rapin Division of Child Neurology of the Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Kim EH, Shin J, Lee BK. Neonatal seizures: diagnostic updates based on new definition and classification. Clin Exp Pediatr 2022; 65:387-397. [PMID: 35381171 PMCID: PMC9348949 DOI: 10.3345/cep.2021.01361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Neonatal seizures are the most common neurological symptoms caused by various etiologies in the neonatal period, but their diagnosis and treatment are challenging because their pathophysiology and electroclinical manifestations differ from those of patients in older age groups. Many seizures present as electrographic-only events without clinical signs or as obscure clinical manifestations that are difficult to distinguish from other neonatal behaviors. Accordingly, a new definition and classification of neonatal seizures was recently proposed by the International League Against Epilepsy Task Force on neonatal seizures, highlighting the role of electroencephalography in diagnosing and treating neonatal seizures. Neonatal seizures are defined as electrographic events with sudden, paroxysmal, and abnormal alteration of activity and divided into electroclinical seizures and electrographic-only seizures according to their clinical signs, thus excluding clinical events without an electrographic correlation. Seizure types are described by their predominant clinical features and divided into motor (automatisms, clonic, epileptic spasms, myoclonic, tonic, and sequential), nonmotor (autonomic and behavioral arrest), and unclassified. Although many neonatal seizures are acute reactive events caused by hypoxic-ischemic encephalopathy or vascular insults, structural, genetic, or metabolic etiologies of neonatal-onset epilepsy should also be thoroughly evaluated to determine their appropriate management.
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Affiliation(s)
- Eun-Hee Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Jeongmin Shin
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Byoung Kook Lee
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
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Diagnosis and Management of Seizures in the Preterm Infant. Semin Pediatr Neurol 2022; 42:100971. [PMID: 35868735 DOI: 10.1016/j.spen.2022.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
Abstract
The risk of seizure is increased in premature neonates compared to full term infants, with a distinct profile of etiologies, timing and character. Despite improvements in neonatal care, preterm infants with seizure continue to have higher risk of abnormal neurodevelopmental outcomes when compared to preterm infants without seizures, or to full term infants with seizures. Very limited evidence guides the care of this challenging population, therefore, management of the preterm neonate with seizure is largely extrapolated from the care of full-term neonates. A critical need exists for well-designed clinical trials investigating and validating the safety, efficacy, and outcomes of seizure management in this vulnerable population.
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Vawter-Lee M, Natarajan N, Rang K, Horn PS, Pardo AC, Thomas CW. Topiramate Is Safe for Refractory Neonatal Seizures: A Multicenter Retrospective Cohort Study of Necrotizing Enterocolitis Risk. Pediatr Neurol 2022; 129:7-13. [PMID: 35131568 DOI: 10.1016/j.pediatrneurol.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND A previously published, single-institution, case series suggested an association between topiramate administration in neonates and subsequent development of necrotizing enterocolitis (NEC). This contradicted our more extensive experiences using topiramate in this population. We therefore studied safety and tolerability of topiramate for treating refractory neonatal seizures, hypothesizing that the risk of developing NEC following topiramate exposure was low and that most infants tolerate topiramate. METHODS This multicenter retrospective cohort study included seventy-five neonates who received topiramate to treat seizures from January 2011 to October 2019 at three geographically diverse level IV neonatal intensive care units affiliated with pediatric tertiary hospitals. Data included demographics, birth history, seizure etiology, treatment response, side effects, and occurrence and details of NEC. RESULTS Three of seventy-five infants (4%) developed NEC following topiramate exposure. These infants did not differ in gestational age, birth weight, seizure etiology, postmenstrual age, weight when topiramate was initiated, or dosing of topiramate. Topiramate was well tolerated. Only three infants (4%) discontinued due to side effects. The most common side effect (20%) was weight loss (typically <5%). Topiramate was felt to be efficacious (61%). Most infants (72%) continued topiramate when discharged. CONCLUSIONS Our multicenter, 75-infant study demonstrated that development of NEC after treatment with topiramate was rare (4%) and refutes prior literature suggesting an association. Topiramate was felt to be efficacious and was well tolerated. Although limited by retrospective design, study data are broadly applicable and support thoughtful use of topiramate as a safe, reasonable option for treating refractory neonatal seizures.
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Affiliation(s)
- Marissa Vawter-Lee
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Niranjana Natarajan
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington; Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington
| | - Kelly Rang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Horn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrea C Pardo
- Division of Pediatric Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cameron W Thomas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Chalia M, Hartmann H, Pressler R. Practical Approaches to the Treatment of Neonatal Seizures. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:14-25. [PMID: 35177171 PMCID: PMC8802390 DOI: 10.7499/j.issn.1008-8830.2110018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.
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Shipley L, Mistry A, Sharkey D. Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:6-12. [PMID: 34045283 DOI: 10.1136/archdischild-2020-320966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes. DESIGN Retrospective cohort study using National Neonatal Research Database and propensity score-matching. SETTING UK neonatal units. PATIENTS Infants ≥36 weeks gestational age with moderate or severe HIE admitted 2011-2016. INTERVENTIONS Birth in non-CC compared with CC. MAIN OUTCOME MEASURES Primary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer. RESULTS 5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth. CONCLUSIONS Almost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.
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Affiliation(s)
- Lara Shipley
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aarti Mistry
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
Seizures are the abnormal, excessive, synchronous discharge of cortical neurons that results in injury to the brain. Seizures presenting in the neonatal period may be the first and only clue to underlying neurological pathology. Despite advances in care, the mortality rate for infants experiencing neonatal seizures is still as high as 20 percent, with up to 65 percent of infants with seizures demonstrating significant morbidity. Early identification and treatment of the seizure or modifiable underlying etiology greatly reduces the extent of morbidity associated with neonatal seizures. Literature, including journal articles and relevant textbooks, was reviewed and condensed into a practical guide to neonatal seizures which includes the pathophysiology of injury associated with neonatal seizures, clinical manifestations, methods of diagnosis, and various options available for treatment.
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Trofimova A, Milla SS, Ryan ME, Pruthi S, Blount JP, Desai NK, Glenn OA, Islam MP, Kadom N, Mirsky DM, Myseros JS, Partap S, Radhakrishnan R, Rose E, Soares BP, Trout AT, Udayasankar UK, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Seizures-Child. J Am Coll Radiol 2021; 18:S199-S211. [PMID: 33958113 DOI: 10.1016/j.jacr.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
In children, seizures represent an extremely heterogeneous group of medical conditions ranging from benign cases, such as a simple febrile seizure, to life-threatening situations, such as status epilepticus. Underlying causes of seizures also represent a wide range of pathologies from idiopathic cases, usually genetic, to a variety of acute and chronic intracranial or systemic abnormalities. This document discusses appropriate utilization of neuroimaging tests in a child with seizures. The clinical scenarios in this document take into consideration different circumstances at the time of a child's presentation including the patient's age, precipitating event (if any), and clinical and electroencephalogram findings and include neonatal seizures, simple and complex febrile seizures, post-traumatic seizures, focal seizures, primary generalized seizures in a neurologically normal child, and generalized seizures in neurologically abnormal child. This practical approach aims to guide clinicians in clinical decision-making and to help identify efficient and appropriate imaging workup. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Sarah S Milla
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sumit Pruthi
- Panel Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | - Orit A Glenn
- University of California San Francisco, San Francisco, California
| | - Monica P Islam
- Nationwide Children's Hospital, Columbus, Ohio, American Academy of Neurology, Acting Director, Nationwide Children's Hospital Epilepsy Program, Director, Nationwide Children's Hospital Evoked Potential and Neurophysiologic Intraoperative Monitoring Program; Director, Nationwide Children's Hospital Tuberous Sclerosis Complex Clinic
| | - Nadja Kadom
- Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia
| | | | - John S Myseros
- Children's National Hospital, Children's National Health System, Washington, District of Columbia, Neurosurgery expert, Vice Chief, Neurosurgery, Children's National Hospital
| | - Sonia Partap
- Stanford University, Stanford, California, American Academy of Pediatrics
| | | | - Emily Rose
- Keck School of Medicine of USC, Los Angeles, California, American College of Emergency Physicians
| | - Bruno P Soares
- University of Vermont Medical Center, Burlington, Vermont, Division Director, Neuroradiology, Vice Chair of Imaging Research, University of Vermont Medical Center
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Officer, Joint Review Committee on Educational Programs in Nuclear Medicine Technology
| | | | | | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Neamțu BM, Visa G, Maniu I, Ognean ML, Pérez-Elvira R, Dragomir A, Agudo M, Șofariu CR, Gheonea M, Pitic A, Brad R, Matei C, Teodoru M, Băcilă C. A Decision-Tree Approach to Assist in Forecasting the Outcomes of the Neonatal Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4807. [PMID: 33946326 PMCID: PMC8124811 DOI: 10.3390/ijerph18094807] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.
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Affiliation(s)
- Bogdan Mihai Neamțu
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Gabriela Visa
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Ionela Maniu
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
- Department of Mathematics and Informatics, Faculty of Sciences, Lucian Blaga University Sibiu, 550012 Sibiu, Romania
| | - Maria Livia Ognean
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
- Neonatology Department, Sibiu Clinical and Emergency County Hospital, Lucian Blaga University Sibiu, 550245 Sibiu, Romania
| | - Rubén Pérez-Elvira
- Neuropsychophysiology Lab., NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain;
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, 280048 Madrid, Spain
| | - Andrei Dragomir
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
- The N.1 Institute for Health, National University of Singapore, 28, Medical Dr. #05-COR, Singapore 117456, Singapore
| | - Maria Agudo
- Neuropsychophysiology Lab., NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain;
| | - Ciprian Radu Șofariu
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Mihaela Gheonea
- Neonatology Department, Craiova Clinical and Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Antoniu Pitic
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
| | - Remus Brad
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
| | - Claudiu Matei
- Dental and Nursing Medical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (C.M.); (C.B.)
| | - Minodora Teodoru
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
| | - Ciprian Băcilă
- Dental and Nursing Medical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (C.M.); (C.B.)
- Dr. Gheorghe Preda Psychiatric Hospital, 550082 Sibiu, Romania
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15
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Noorlag L, van 't Klooster MA, van Huffelen AC, van Klink NEC, Benders MJNL, de Vries LS, Leijten FSS, Jansen FE, Braun KPJ, Zijlmans M. High-frequency oscillations recorded with surface EEG in neonates with seizures. Clin Neurophysiol 2021; 132:1452-1461. [PMID: 34023627 DOI: 10.1016/j.clinph.2021.02.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Neonatal seizures are often the first symptom of perinatal brain injury. High-frequency oscillations (HFOs) are promising new biomarkers for epileptogenic tissue and can be found in intracranial and surface EEG. To date, we cannot reliably predict which neonates with seizures will develop childhood epilepsy. We questioned whether epileptic HFOs can be generated by the neonatal brain and potentially predict epilepsy. METHODS We selected 24 surface EEGs sampled at 2048 Hz with 175 seizures from 16 neonates and visually reviewed them for HFOs. Interictal epochs were also reviewed. RESULTS We found HFOs in thirteen seizures (7%) from four neonates (25%). 5025 ictal ripples (rate 10 to 1311/min; mean frequency 135 Hz; mean duration 66 ms) and 1427 fast ripples (rate 8 to 356/min; mean frequency 298 Hz; mean duration 25 ms) were marked. Two neonates (13%) showed interictal HFOs (285 ripples and 25 fast ripples). Almost all HFOs co-occurred with sharp transients. We could not find a relationship between neonatal HFOs and outcome yet. CONCLUSIONS Neonatal HFOs co-occur with ictal and interictal sharp transients. SIGNIFICANCE The neonatal brain can generate epileptic ripples and fast ripples, particularly during seizures, though their occurrence is not common and potential clinical value not evident yet.
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Affiliation(s)
- Lotte Noorlag
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands.
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Alexander C van Huffelen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
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16
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Kaminiów K, Kozak S, Paprocka J. Neonatal Seizures Revisited. CHILDREN-BASEL 2021; 8:children8020155. [PMID: 33670692 PMCID: PMC7922511 DOI: 10.3390/children8020155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022]
Abstract
Seizures are the most common neurological disorder in newborns and are most prevalent in the neonatal period. They are mostly caused by severe disorders of the central nervous system (CNS). However, they can also be a sign of the immaturity of the infant’s brain, which is characterized by the presence of specific factors that increase excitation and reduce inhibition. The most common disorders which result in acute brain damage and can manifest as seizures in neonates include hypoxic-ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the CNS as well as electrolyte and biochemical disturbances. The therapeutic management of neonates and the prognosis are different depending on the etiology of the disorders that cause seizures which can lead to death or disability. Therefore, establishing a prompt diagnosis and implementing appropriate treatment are significant, as they can limit adverse long-term effects and improve outcomes. In this review paper, we present the latest reports on the etiology, pathomechanism, clinical symptoms and guidelines for the management of neonates with acute symptomatic seizures.
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Affiliation(s)
- Konrad Kaminiów
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.)
| | - Sylwia Kozak
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.)
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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17
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Pressler RM, Cilio MR, Mizrahi EM, Moshé SL, Nunes ML, Plouin P, Vanhatalo S, Yozawitz E, de Vries LS, Puthenveettil Vinayan K, Triki CC, Wilmshurst JM, Yamamoto H, Zuberi SM. The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures. Epilepsia 2021; 62:615-628. [PMID: 33522601 DOI: 10.1111/epi.16815] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/23/2022]
Abstract
Seizures are the most common neurological emergency in the neonatal period and in contrast to those in infancy and childhood, are often provoked seizures with an acute cause and may be electrographic-only. Hence, neonatal seizures may not fit easily into classification schemes for seizures and epilepsies primarily developed for older children and adults. A Neonatal Seizures Task Force was established by the International League Against Epilepsy (ILAE) to develop a modification of the 2017 ILAE Classification of Seizures and Epilepsies, relevant to neonates. The neonatal classification framework emphasizes the role of electroencephalography (EEG) in the diagnosis of seizures in the neonate and includes a classification of seizure types relevant to this age group. The seizure type is determined by the predominant clinical feature. Many neonatal seizures are electrographic-only with no evident clinical features; therefore, these are included in the proposed classification. Clinical events without an EEG correlate are not included. Because seizures in the neonatal period have been shown to have a focal onset, a division into focal and generalized is unnecessary. Seizures can have a motor (automatisms, clonic, epileptic spasms, myoclonic, tonic), non-motor (autonomic, behavior arrest), or sequential presentation. The classification allows the user to choose the level of detail when classifying seizures in this age group.
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Affiliation(s)
- Ronit M Pressler
- Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK.,Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Maria Roberta Cilio
- Division of Pediatric Neurology, Institute for Experimental and Clinical Research, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Eli M Mizrahi
- Departments of Neurology and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Magda L Nunes
- Pontificia Universidade Catolica do Rio Grande do Sul - PUCRS School of Medicine and the Brain Institute, Porto Alegre, RS, Brazil
| | - Perrine Plouin
- Department of Clinical Neurophysiology, Hospital Necker Enfant Malades, Paris, France
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology and BABA center Children's Hospital, HUS Imaging, Neuroscience Center, Helsinki Institute of Life Science, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Chahnez C Triki
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15 Sfax University, Sfax, Tunisia
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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18
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Pisani F, Spagnoli C, Falsaperla R, Nagarajan L, Ramantani G. Seizures in the neonate: A review of etiologies and outcomes. Seizure 2021; 85:48-56. [PMID: 33418166 DOI: 10.1016/j.seizure.2020.12.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/21/2022] Open
Abstract
Neonatal seizures occur in their majority in close temporal relation to an acute brain injury or systemic insult, and are accordingly defined as acute symptomatic or provoked seizures. However less frequently, unprovoked seizures may also present in the neonatal period as secondary to structural brain abnormalities, thus corresponding to structural epilepsies, or to genetic conditions, thus corresponding to genetic epilepsies. Unprovoked neonatal seizures should be thus considered as the clinical manifestation of early onset structural or genetic epilepsies that often have the characteristics of early onset epileptic encephalopathies. In this review, we address the conundrum of neonatal seizures including acute symptomatic, remote symptomatic, provoked, and unprovoked seizures, evolving to post-neonatal epilepsies, and neonatal onset epilepsies. The different clinical scenarios involving neonatal seizures, each with their distinct post-neonatal evolution are presented. The structural and functional impact of neonatal seizures on brain development and the concept of secondary epileptogenesis, with or without a following latent period after the acute seizures, are addressed. Finally, we underline the need for an early differential diagnosis between an acute symptomatic seizure and an unprovoked seizure, since it is associated with fundamental differences in clinical evolution. These are crucial aspects for neonatal management, counselling and prognostication. In view of the above aspects, we provide an outlook on future strategies and potential lines of research in this field.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Medicine and Surgery Department, University of Parma, Italy
| | - Carlotta Spagnoli
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, University-Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Australia
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Switzerland.
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19
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Abstract
Metabolic disorders in a neonate can present with involvement of any organ system and can be challenging to diagnose. A newborn can present with an acute metabolic crisis such as hyperammonemia or seizures needing immediate management, with a more chronic clinical picture such as cholestatic liver disease, or with structural abnormalities such as skeletal manifestations. Early detection of treatable metabolic conditions is important to improve outcomes. Newborn screening has facilitated early detection and initiation of therapy for many metabolic disorders. However, normal testing does not rule out a metabolic disorder and a high index of suspicion should remain when caring for any critically ill neonate without a diagnosis. Whole exome sequencing (WES) or whole genome sequencing (WGS) can be powerful tools in rapid diagnosis of a potentially treatable metabolic condition in a critically ill neonate. This review presents classic clinical presentations of neonatal metabolic disorders and also highlights some uncommon neonatal manifestations of metabolic disorders to improve the recognition and diagnosis of these conditions.
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Affiliation(s)
- Anna-Kaisa Niemi Md
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
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20
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Czech T, Pardo AC. Utility of Rapid Sequence Magnetic Resonance Imaging in Guiding Management of Patients With Neonatal Seizures. Pediatr Neurol 2020; 103:57-60. [PMID: 31570293 DOI: 10.1016/j.pediatrneurol.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether the use of rapid sequence magnetic resonance imaging (rsMRI) is associated with improved efficiency of care when managing infants with suspected neonatal onset seizures. METHODS We conducted a preintervention and postintervention study of the use of rsMRI in term infants with suspected neonatal onset seizures without evidence of hypoxic ischemic encephalopathy. Study patients were collected from a contemporary cohort from 2016 to 2017 and were compared with a historical cohort from 2014. The primary outcome was hospital length of stay. Secondary outcomes included use of other imaging modalities (head ultrasound, computed tomography [CT], and MRI), use of antiseizure medications at the time of discharge, and cost of hospitalization. Continuous variables were compared using the Mann-Whitney U test and categorical variables using the Fisher's exact or χ2 tests. A two-tailed P < 0.05 was considered statistically significant. RESULTS Ninety-five patients met inclusion criteria, 47 in the preintervention and 48 in the postintervention group. Incorporation of the protocol-guided rsMRI in the evaluation of patients with neonatal seizures was associated with decreased use of CT scans (34% vs 10%, P = 0.007) and full MRIs (85% vs 62%, P = 0.019). Use of head ultrasound, length of stay, and costs were not different between groups. CONCLUSIONS In patients with neonatal seizures, rsMRI was not associated with a reduced hospital length of stay. The use of rsMRI resulted in fewer neonates receiving CT scans during their hospitalization. rsMRI may hasten the identification of stroke or hemorrhage in neonates with seizures.
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Affiliation(s)
- Theresa Czech
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Andrea C Pardo
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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21
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Apers WMJ, de Vries LS, Groenendaal F, Toet MC, Weeke LC. Delay in Treatment of Neonatal Seizures: A Retrospective Cohort Study. Neonatology 2020; 117:599-605. [PMID: 32814323 DOI: 10.1159/000509282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Neonatal seizures are common and caused by a variety of underlying disorders. There is increasing evidence that neonatal seizures result in further brain damage. OBJECTIVE To describe the time interval between diagnosis of amplitude-integrated electroencephalography (aEEG)-confirmed seizures and administration of anti-epileptic drugs (AEDs). METHODS Single-centre retrospective cohort study, with full-term infants (n = 106) admitted to a level III neonatal intensive care unit between 2012 and 2017 with seizures confirmed on 2-channel aEEG and corresponding raw electroencephalography traces, treated with AEDs. The time interval between the first seizure on the aEEG registration and AED administration was calculated. Factors associated with early treatment were analysed. RESULTS The median time interval of initiating treatment of aEEG-confirmed seizures was 01:50 h (interquartile range 00:43-4:30 h). Treatment of aEEG-confirmed seizures was initiated <1 h in 34/106 infants (32.1%), between 1 and 2 h in 21/106 infants (19.8%), 2-4 h in 23/106 infants (21.7%), 4-8 h in 14/106 infants (13.2%), and ≥8 h in 14/106 infants (13.2%). Seizures treated <1 h were significantly more often recognized by the seizure detection algorithm (SDA) compared to seizures treated >1 h (67 vs. 42%, p = 0.02) and showed more clinical signs (79.4 vs. 37.5%, p < 0.01). There was no difference for out-of-office hours (23.5 vs. 22.2%, p = 0.88). CONCLUSION With only 32.1% of the seizures being treated <1 h, there is room for improvement. Timely treatment occurred more often when seizures were clinical or recognised by the SDA. aEEG is a helpful tool for diagnosing seizures 24/7.
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Affiliation(s)
- Wievineke M J Apers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.,Brain Centre, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.,Brain Centre, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands,
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22
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Pellegrin S, Munoz FM, Padula M, Heath PT, Meller L, Top K, Wilmshurst J, Wiznitzer M, Das MK, Hahn CD, Kucuku M, Oleske J, Vinayan KP, Yozawitz E, Aneja S, Bhat N, Boylan G, Sesay S, Shrestha A, Soul JS, Tagbo B, Joshi J, Soe A, Maltezou HC, Gidudu J, Kochhar S, Pressler RM. Neonatal seizures: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7596-7609. [PMID: 31783981 PMCID: PMC6899436 DOI: 10.1016/j.vaccine.2019.05.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Serena Pellegrin
- Clinical Neuroscience, UCL-Institute of Child Health, London, UK; Department of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Flor M Munoz
- Baylor College of Medicine, Department of Pediatrics, Houston, TX, USA
| | | | - Paul T Heath
- Vaccine Institute, St Georges University of London, London, UK
| | - Lee Meller
- Syneos Health, Safety & Pharmacovigilance, Raleigh, NC, USA
| | - Karina Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Max Wiznitzer
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | | | - Cecil D Hahn
- Division of Neurology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Merita Kucuku
- National Agency for Medicines and Medical Devices, Tirana, Albania
| | - James Oleske
- Department of Pediatrics, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | | | - Elissa Yozawitz
- Saul R. Korey Department of Neurology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access PATH, Seattle, WA, USA
| | | | - Sanie Sesay
- Clinical Sciences, Sanofi Pasteur, Marcy L'Etoile, France
| | | | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Beckie Tagbo
- Institute of Child Health, University of Nigeria Teaching Hospital, Nigeria
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
| | - Aung Soe
- Medway NHS Foundation Trust, Kent, UK
| | - Helena C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, USA
| | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Global Health, University of Washington, Seattle, USA
| | - Ronit M Pressler
- Clinical Neuroscience, UCL-Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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23
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Dwivedi D, Lin N, Venkatesan C, Kline-Fath B, Holland K, Schapiro M. Clinical, Neuroimaging, and Electrographic Predictors of Phenobarbital Failure in Newborns With Hypoxic Ischemic Encephalopathy and Seizures. J Child Neurol 2019; 34:458-463. [PMID: 30966848 DOI: 10.1177/0883073819838171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many neonates with hypoxic ischemic encephalopathy and seizures do not respond to the first line antiepileptic drug, phenobarbital. Little is known about what factors are associated with its failure. OBJECTIVE To examine factors associated with failure of phenobarbital therapy in neonates with hypoxic ischemic encephalopathy and seizures. DESIGN/METHODS A single-center retrospective review of 50 term (>35 weeks) neonates with hypoxic ischemic encephalopathy and seizures treated with phenobarbital as the first-line antiepileptic. Neonates were classified into either responders (n = 30) or nonresponders (n = 20). Nonresponse was defined as continued seizures after maximum dosing of phenobarbital or an additional antiepileptic. Subjects with acceptable magnetic resonance imaging (MRI) scans obtained within 2 weeks of birth were included in the study and rated using an MRI injury scoring system. Charts were reviewed for demographic, clinical, and laboratory variables. Resuscitation and seizure scores were also calculated. Electroencephalographic (EEG) background activity was reviewed in 2 different time epochs (12-24 hours and 24-36 hours of life) and graded as per ACNS guidelines. RESULTS There were no significant group differences in demographic, clinical, and laboratory variables except nonresponders, who had higher mean seizure score (P = .01) and significantly more injury on MRI scan for white matter (P = .004), parenchymal cortex (P = .027), and watershed (P = .009) regions. Neonates with moderately abnormal or severely abnormal background EEG responded poorly to phenobarbital. CONCLUSION In the presence of above factors, one can anticipate that additional antiepileptic medication may be needed. These data also support that larger studies should be done to look prospectively at using alternative agents first line in patients with severe injury.
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Affiliation(s)
- Deepak Dwivedi
- 1 Department of Paediatrics, SS Medical College, Rewa, Madhya Pradesh, India
| | - Nan Lin
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charu Venkatesan
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B Kline-Fath
- 3 Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Holland
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Schapiro
- 2 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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Pisani F, Spagnoli C. Diagnosis and Management of Acute Seizures in Neonates. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
The first weeks of life are a time of heightened risk for seizures due to age-dependent physiologic features of the developing brain that lead to increased neuronal excitation and decreased inhibition. Usually, seizures in neonates are a symptom of an acute brain injury; seizures are only rarely due to neonatal-onset epilepsy syndromes. Neonatal seizures are harmful to the developing brain; early and accurate diagnosis is critical. For suspected seizures, EEG monitoring should be initiated as soon as is feasible, in order to evaluate for events of concern, screen for subclinical seizures, and assess the EEG background. Amplitude-integrated EEG can provide excellent complementary data, particularly with regard to evolution of background patterns, but has limited sensitivity to detect individual neonatal seizures. An urgent and systematic approach to precise etiologic diagnosis is key for optimal management and estimates of prognosis. Evaluation of the seizure etiology must occur in parallel with initiation of appropriate treatment. It is critical that neonatologists and neurologists develop hospital-specific, consensus-based practice pathways for neonatal seizure evaluation and treatment. Such practice pathways can streamline medical decision making, facilitate rapid medication administration, and potentially decrease seizure burden and optimize outcomes. Herein, the pathophysiology, epidemiology, treatment, and long-term management considerations for neonatal seizures are presented.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, United States.
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Spagnoli C, Falsaperla R, Deolmi M, Corsello G, Pisani F. Symptomatic seizures in preterm newborns: a review on clinical features and prognosis. Ital J Pediatr 2018; 44:115. [PMID: 30382869 PMCID: PMC6211591 DOI: 10.1186/s13052-018-0573-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/16/2018] [Indexed: 01/23/2023] Open
Abstract
Neonatal seizures are the most common neurological event in newborns, showing higher prevalence in preterm than in full-term infants. In the majority of cases they represent acute symptomatic phenomena, the main etiologies being intraventricular haemorrhage, hypoxic-ischemic encephalopathy, central nervous system infections and transient metabolic derangements.Current definition of neonatal seizures requires detection of paroxysmal EEG-changes, and in preterm newborns the incidence of electrographic-only seizures seems to be particularly high, further stressing the crucial role of electroencephalogram monitoring in this population. Imaging work-up includes an integration of serial cranial ultrasound and brain magnetic resonance at term-equivalent age. Unfavourable outcomes following seizures in preterm infants include death, neurodevelopmental impairment, epilepsy, cerebral palsy, hearing and visual impairment. As experimental evidence suggests a detrimental role of seizures per se in determining subsequent outcome, they should be promptly treated with the aim to reduce seizure burden and long-term disabilities. However, neonatal seizures show low response to conventional anticonvulsant drugs, and this is even more evident in preterm newborns, due to intrinsic developmental factors. As a consequence, as literature does not provide any specific guidelines, due to the lack of robust evidence, off-label medications are often administered in clinical practice.
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Affiliation(s)
- Carlotta Spagnoli
- Child Neuropsychiatry Unit, Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCSS, Reggio Emilia, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, Santo Bambino Hospital, University Hospital "Policlinico-Vittorio Emanuele", Via Tindaro 2, 95124, Catania, Italy.
| | - Michela Deolmi
- Pediatrics Unit, Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Medicine & Surgery Department, Neuroscience Division, University of Parma, Parma, Italy
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De Haan TR, Langeslag J, van der Lee JH, van Kaam AH. A systematic review comparing neurodevelopmental outcome in term infants with hypoxic and vascular brain injury with and without seizures. BMC Pediatr 2018; 18:147. [PMID: 29720158 PMCID: PMC5930747 DOI: 10.1186/s12887-018-1116-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/16/2018] [Indexed: 12/03/2022] Open
Abstract
Background There is increasing evidence that neonatal seizures in term neonates with stroke, asphyxia or brain haemorrhage might be associated with adverse neurodevelopment and development of epilepsy. The extent of this association is not known. The objective of this study was to assess the possible impact of neonatal seizures on these outcomes and if possible calculate a relative risk. Methods A systematic review and meta-analysis was performed (study period January 2000–June 2015). PubMed, Medline and Embase were searched for cohort studies evaluating neurodevelopmental outcome at the age of at least 18 months or development of epilepsy in surviving term neonates with or without neonatal seizures. The methodological quality of included studies was assessed and data extractions were performed in a standardized manner by independent reviewers. Pooled Relative Risks (RR) with 95% confidence intervals for adverse outcome were calculated if possible. Results Out of 1443 eligible studies 48 were selected for full text reading leaving 9 cohort studies for the final analyses (4 studies on stroke, 4 on perinatal asphyxia and one on cerebral hemorrhage). For all cases with stroke or asphyxia combined the pooled risk ratio (RR) for adverse outcome when suffering neonatal seizures was 7.42 (3.84–14.34); for neonates with perinatal asphyxia: 8.41 (4.07–17.39) and for neonates with stroke: 4.95 (1.07–23.0). The pooled RR for development of late onset epilepsy could only be determined for infants suffering from stroke: 1.48 (0.82–2.68). Results were biased and evidence sparse. Conclusions The presence of neonatal seizures in term newborns with vascular or hypoxic brain injury may have an impact on or be a predictor of neurodevelopmental outcome. The biased available data yield insufficient evidence about the true size of this association. Electronic supplementary material The online version of this article (10.1186/s12887-018-1116-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T R De Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - J Langeslag
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - J H van der Lee
- Pediatric clinical Research Office, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - A H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, the Netherlands
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MR imaging for accurate prediction of outcome after perinatal arterial ischemic stroke: Sooner not necessarily better. Eur J Paediatr Neurol 2017; 21:666-670. [PMID: 28499876 DOI: 10.1016/j.ejpn.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/16/2017] [Accepted: 04/04/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Involvement of the corticospinal tracts after perinatal arterial ischemic stroke (PAIS) is strongly correlated with adverse motor outcome. METHODS Two full-term infants with PAIS, with two early MRI scans available, are reported. RESULTS Diffusion weighted imaging (DWI)-MRI, performed within 24 h following onset of seizures and repeated 48 h later, clearly showed restricted diffusion within the middle cerebral artery territory on both MRIs, but clear patterns of signal intensity changes in the descending corticospinal tracts on the second MRI only. CONCLUSION Since involvement of the corticospinal tracts is essential for prediction of motor outcome, we may need to reconsider optimal timing of MR imaging for prediction of neurodevelopmental outcome after PAIS.
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Weeke LC, Boylan GB, Pressler RM, Hallberg B, Blennow M, Toet MC, Groenendaal F, de Vries LS. Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia. Eur J Paediatr Neurol 2016; 20:855-864. [PMID: 27370316 DOI: 10.1016/j.ejpn.2016.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/04/2016] [Accepted: 06/11/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia. METHODS Twenty-six full-term infants with HIE (September 2011-September 2012), who had video-EEG monitoring during the first 72 h, an MRI performed within the first two weeks and neurodevelopmental assessment at two years were evaluated. EEG background activity at age 24, 36 and 48 h, seizure burden, and severity of brain injury on MRI, were compared and related to neurodevelopmental outcome. RESULTS EEG background activity was significantly associated with neurodevelopmental outcome at 36 h (p = 0.009) and 48 h after birth (p = 0.029) and with severity of brain injury on MRI at 36 h (p = 0.002) and 48 h (p = 0.018). All infants with a high seizure burden and moderate-severe injury on MRI had an abnormal outcome. The positive predictive value (PPV) of EEG for abnormal outcome was 100% at 36 h and 48 h and the negative predictive value (NPV) was 75% at 36 h and 69% at 48 h. The PPV of MRI was 100% and the NPV 85%. The PPV of seizure burden was 78% and the NPV 71%. CONCLUSION Severely abnormal EEG background activity at 36 h and 48 h after birth was associated with severe injury on MRI and abnormal neurodevelopmental outcome. High seizure burden was only associated with abnormal outcome in combination with moderate-severe injury on MRI.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Wilton, Co. Cork, Ireland
| | - Ronit M Pressler
- Clinical Neurosciences, UCL-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Boubou Hallberg
- Department of Neonatology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden
| | - Mats Blennow
- Department of Neonatology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands.
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30
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Pisani F, Spagnoli C. Monitoring of newborns at high risk for brain injury. Ital J Pediatr 2016; 42:48. [PMID: 27180227 PMCID: PMC4867092 DOI: 10.1186/s13052-016-0261-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/06/2016] [Indexed: 01/06/2023] Open
Abstract
Due to the increasing number of surviving preterm newborns and to the recognition of therapeutic hypothermia as the current gold standard in newborns with hypoxic-ischaemic encephalopathy, there has been a growing interest in the implementation of brain monitoring tools in newborns at high risk for neurological disorders.Among the most frequent neurological conditions and presentations in the neonatal period, neonatal seizures and neonatal status epilepticus, paroxysmal non-epileptic motor phenomena, hypoxic-ischaemic encephalopathy, white matter injury of prematurity and stroke require specific approaches to diagnosis. In this review we will describe the characteristics, aims, indications and limitations of routinely available diagnostic techniques such as conventional and amplitude-integrated EEG, evoked potentials, cranial ultrasound and brain MRI. We will conclude by briefly outlining potential future perspectives from research studies.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Carlotta Spagnoli
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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Srinivasakumar P, Zempel J, Trivedi S, Wallendorf M, Rao R, Smith B, Inder T, Mathur AM. Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial. Pediatrics 2015; 136:e1302-9. [PMID: 26482675 DOI: 10.1542/peds.2014-3777] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The impact of treating electrographic seizures in hypoxic ischemic encephalopathy (HIE) is unknown. METHODS Neonates ≥36 weeks with moderate or severe HIE were randomly assigned to either treatment of electrographic seizures alone (ESG) or treatment of clinical seizures (CSG). Conventional EEG video was monitored in both groups for up to 96 hours. Cumulative electrographic seizure burden (SB) was calculated in seconds and converted to log units for analysis. MRI scans were scored for severity of brain injury. Infants underwent neurodevelopmental evaluation at 18 to 24 months. Statistical analyses were performed by using SAS 9.3 version (SAS Institute, Inc, Cary, NC). RESULTS Thirty-five of 69 neonates (51%) who were randomly assigned and included in the study developed seizures (15 in ESG and 20 in CSG). Excluding infants with status epilepticus, median SB (interquartile range) in seconds in ESG (n = 10) was lower than in CSG (n = 16) (449 [113-2070] vs 2226 [760-7654]; P = .02). ESG had fewer seizures with shorter time to treatment (P = .04). Twenty-four of 30 (80%) surviving infants with seizures underwent neurodevelopmental evaluation at 18 to 24 months. Increasing SB in the combined cohort was significantly associated with higher brain injury scores (P < .03) and lower performance scores across all 3 domains on BSID III (P = .03). CONCLUSIONS In neonates with HIE, EEG monitoring and treatment of electrographic seizures results in significant reduction in SB. SB is associated with more severe brain injury and significantly lower performance scores across all domains on BSID III.
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Affiliation(s)
| | | | | | | | | | - Barbara Smith
- Clinical Neurophysiology Laboratory, St Louis Children's Hospital, St Louis, Missouri; and
| | - Terrie Inder
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Dereymaeker A, Vanhaesebrouck S, Jansen K, Lagae L, de Vries L, Naulaers G. Transient hypothyroidism associated with viral Human Parechovirus encephalitis in a newborn. Eur J Paediatr Neurol 2015; 19:706-10. [PMID: 26314768 DOI: 10.1016/j.ejpn.2015.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/13/2015] [Accepted: 07/29/2015] [Indexed: 01/07/2023]
Abstract
Human Parechovirus type 3 (HPeV-3) is a neurotropic virus which can cause neonatal encephalitis, presenting as encephalopathy with seizures and diffuse white matter lesions on brain imaging. Neurodevelopmental outcome is linked to the extent of white matter abnormalities. We report on a neonate with clinical and biochemical findings of transient central hypothyroidism associated with HPeV-3 encephalitis. The co-occurrence of transient hypothyroidism and viral encephalitis has not been reported in newborns before. Transient suppression of the hypothalamo-pituitary-thyroidal axis is described in critically ill babies as the nonthyroidal-illness syndrome. Assessment of thyroid function in neonatal cases of HPeV-3 infection is required to conclude whether a transient hypothyroidism as in nonthyroidal-illness syndrome may be triggered by viral meningo-encephalitis and if treatment may influence neurodevelopmental outcome.
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Affiliation(s)
- Anneleen Dereymaeker
- Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Pediatrics, Children's Clinical Neurophysiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Sophie Vanhaesebrouck
- Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Neonatology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Katrien Jansen
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Pediatrics, Children's Clinical Neurophysiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Lieven Lagae
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Pediatrics, Children's Clinical Neurophysiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Linda de Vries
- Neonatal Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center, Lundlaan 6, 3584, EA Utrecht, The Netherlands.
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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Perinatal brain damage: The term infant. Neurobiol Dis 2015; 92:102-12. [PMID: 26409031 PMCID: PMC4915441 DOI: 10.1016/j.nbd.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
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Soltirovska Salamon A, Neubauer D, Paro-Panjan D. Development of epilepsy after neonatal seizures. Eur J Paediatr Neurol 2015; 19:612-3. [PMID: 26051920 DOI: 10.1016/j.ejpn.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Aneta Soltirovska Salamon
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Neonatology, Ljubljana, Slovenia
| | - David Neubauer
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Neurology, Ljubljana, Slovenia
| | - Darja Paro-Panjan
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Neonatology, Ljubljana, Slovenia.
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Buerki SE, Connolly MB. The importance of cerebral magnetic resonance imaging in evaluation of neonatal seizures. Dev Med Child Neurol 2015; 57:210-1. [PMID: 25407829 DOI: 10.1111/dmcn.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah E Buerki
- Division of Neurology, Department of Pediatrics, Children's Hospital and University of British Columbia, Vancouver, BC, Canada
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