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Alemayehu T, Gebre T, Asmare B, Tafere Y, Kassie B, Tsega TD, Alemu M, Messelu MA. Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study. Heliyon 2024; 10:e29999. [PMID: 38707374 PMCID: PMC11066383 DOI: 10.1016/j.heliyon.2024.e29999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital. Methods An institutional-based prospective follow-up study was conducted in Debre Markos comprehensive specialized hospital from February 1, 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of <0.05 was used to declare the statistical significance of the association with the outcome variable. Results The overall incidence rate of neonatal seizures was 35 per 1000 person-day observations. The mean follow-up time for this study was 123.4 h. The cumulative survival probability of neonates' at 0 to 24 and 0-72 h was 89.8 % and 81.71 %, respectively. The statistically significant predictors for the incidence of neonatal seizures were perinatal asphyxia (AHR = 10.95; 95%CI: 4.81, 24.93), subgaleal hemorrhage (AHR = 5.17; 95%CI: 2.09, 12.79), and gestational age <37 weeks (AHR = 4.62; 95%CI: 1.62, 13.22). Conclusions The incidence rate of neonatal seizures in this study was high. Neonates born with gestational age <37 weeks, having perinatal asphyxia, and having subgaleal hemorrhage were statistical predictors for the incidence of neonatal seizures. Thus, healthcare professionals should give special attention to neonates born with gestational age <37 weeks, prevent perinatal asphyxia and subgaleal hemorrhage.
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Affiliation(s)
- Tefera Alemayehu
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Tsige Gebre
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bayachew Asmare
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yilkal Tafere
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kassie
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tilahun Degu Tsega
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mulu Alemu
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Saker Z, Rizk M, Merie D, Nabha RH, Pariseau NJ, Nabha SM, Makki MI. Insight into brain sex differences of typically developed infants and brain pathologies: A systematic review. Eur J Neurosci 2024. [PMID: 38693604 DOI: 10.1111/ejn.16364] [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: 12/15/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
The continually advancing landscape of neuroscientific and imaging research has broadened our comprehension of sex differences encoded in the human brain, expanding from the hypothalamus and sexual behaviour to encompass the entire brain, including its diverse lobes, structures, and functions. However, less is known about sex differences in the brains of neonates and infants, despite their relevance to various sex-linked diseases that develop early in life. In this review, we provide a synopsis of the literature evidence on sex differences in the brains of neonates and infants at the morphological, structural and network levels. We also briefly overview the present evidence on the sex bias in some brain disorders affecting infants and neonates.
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Affiliation(s)
- Zahraa Saker
- Research Department, Al-Rassoul Al-Aazam Hospital, Beirut, Lebanon
| | - Mahdi Rizk
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Diana Merie
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Nicole J Pariseau
- Department of Pediatrics-Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanaa M Nabha
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Malek I Makki
- Laboratory of Functional Neurosciences and Pathologies, University of Picardy Jules Verne, Amiens, France
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Akter H, Dey SK, Shabuj MKH, Fatema K, Jahan I, Sihan N, Rahman T, Khan MAS, Hasan MJ. Predictors of poor neurodevelopmental outcomes in neonates with clinically observed seizures: A prospective observational study in a tertiary care hospital of Bangladesh. Epilepsy Behav Rep 2024; 26:100665. [PMID: 38708367 PMCID: PMC11068513 DOI: 10.1016/j.ebr.2024.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024] Open
Abstract
Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to aid in early intervention and referral for follow-up and rehabilitation. This observational study was conducted in the Department of Neonatology and Institute of Paediatric Neurodisorder and Autism, Bangabandhu Sheikh Mujib Medical University. Among 75 study cases of neonatal seizure, 23 died, and 46 were followed-up at 6 and 9 months after discharge. EEGs were performed on every patient. A comprehensive neurological examination and developmental evaluation were performed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III). Three-fourths of neonates were born at term (76.1 %), and over half were male (56.5 %). The majority were appropriate for gestational age (79.7 %) and had an average birth weight of 2607 ± 696 g (±SD). Over half of the neonates (52.2 %) had adverse neurodevelopmental outcomes, with global developmental delay being the most common. Recurrent seizures, the number of anticonvulsants needed to control seizures, and abnormal Electroencephalograms were identified as independent predictors of adverse neurodevelopmental outcomes. The study highlights the need for early referral for follow-up and rehabilitation of neonates with seizures having abnormal electroencephalograms, recurrent seizures and requiring more anticonvulsants to control seizures.
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Affiliation(s)
- Humayra Akter
- Department of Neonatology, Chittagong Medical College, Chattogram 4203, Bangladesh
| | - Sanjoy Kumer Dey
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | | | - Kanij Fatema
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | - Ismat Jahan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | - Nazmus Sihan
- Department of Neonatology, Cumilla Medical College Hospital, Cumilla 3500, Bangladesh
| | - Tareq Rahman
- Monowara Hospital Pvt. Ltd, Dhaka 1217, Bangladesh
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Garg A, Suthar R, Sundaram V, Kumar P, Angurana SK. Clinical profile, aetiology, short-term outcome and predictors of poor outcome of neonatal seizures among out-born neonates admitted to a neonatal unit in Paediatric emergency of a tertiary care hospital in North India: A prospective observational study. Trop Doct 2021; 51:365-371. [PMID: 34018889 DOI: 10.1177/00494755211016226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neonatal seizures are common manifestations of several neurological or systemic disorders and associated with high morbidity, mortality and poor short- and long-term developmental outcomes. It is important to determine the aetiology and factors that determine the poor outcome, more so in a newly developed setting. The early detection of predictors of poor outcome will help in planning acute management, counselling, follow-up and rehabilitation services. In this prospective observational study, we looked at the clinical profile, aetiology, short-term outcomes and predictors of poor outcome of neonatal seizures among out-born neonates. The common causes were hypoxic ischaemic encephalopathy, sepsis and metabolic disturbances. One-third of neonates had poor outcome. Abnormal neurological and cardiorespiratory examination at admission; low oxygen saturation, glucose and pH; and hypoxic ischemic encephalopathy-III were predictors of poor outcome.
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Affiliation(s)
- Ashish Garg
- Junior Resident, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research (29751PGIMER), Chandigarh, India
| | - Renu Suthar
- Associate Professor, Pediatric Neurology Unit, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research (29751PGIMER), Chandigarh, India
| | - Venkataseshan Sundaram
- Additional Professor, Neonatology Unit, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research (29751PGIMER), Chandigarh, India
| | - Praveen Kumar
- Professor and Unit Head, Neonatology Unit, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research (29751PGIMER), Chandigarh, India
| | - Suresh K Angurana
- Assistant Professor, Division of Paediatric Critical Care, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research (29751PGIMER), Chandigarh, India
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Famra K, Batra P, Aggarwal A, Banerjee BD. Prevalence and predictors of adverse outcomes in neonatal seizures. J Neonatal Perinatal Med 2021; 15:29-35. [PMID: 34024787 DOI: 10.3233/npm-200499] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neonatal seizures are significant cause of neonatal mortality and morbidity. Current study was planned to study prevalence of adverse outcomes in neonatal seizures and identify its predictors. METHODS This observational descriptive study was carried out on 220 neonates with seizures. Neonates who succumbed to illness/ death before investigations, or whose maternal records were incomplete were excluded. Blood sugar, serum calcium, serum electrolytes, and USG skull were done in all patients. CT scan, MRI and inborn errors of metabolism profile were done as and when indicated. Adverse outcomes were defined as death, phenobarbitone non responders, or abnormal examination at discharge. Antenatal, perinatal and neonatal predictors of adverse outcomes in neonatal seizures were evaluated. RESULTS Out of 220 neonates with seizures 76(34.5%) had adverse outcomes. Very low birth weight babies (≤1500 gm) [OR 1.27(CI 0.57-2.84)], microcephaly [OR 5.93 (CI 0.55-64.41)], Apgar score≤3 at 5 minutes [OR 11.28(CI 14.18-30.45)], seizure onset within 24 hours [OR 5.99(CI 12.43-14.78)], meningitis [OR 2.63(CI 0.08-6.39)], septicemia [OR1.22(CI 0.45-3.31)] and abnormal cranial USG [OR 7.95(CI 12.61-24.22)] were significant predictors of adverse outcomes in neonates with seizures. CONCLUSION Prematurity, very low birth weight, birth asphyxia, meningitis, septicemia and abnormal USG could predict adverse outcomes in neonatal seizures. Improved antenatal and neonatal clinical practices may help reduce adverse outcomes in these patients.
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Affiliation(s)
- K Famra
- Department of Paediatrics, University College of Medical sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - P Batra
- Department of Paediatrics, University College of Medical sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - A Aggarwal
- Department of Paediatrics, University College of Medical sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - B D Banerjee
- Department of Biochemistry, University College of Medical sciences and Guru Teg Bahadur Hospital, Delhi, India
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Tanous O, Watad M, Felszer-Fisch C, Peniakov M, Miron D, Salim R. Risk Factors for Mortality among Newborns with Neonatal Seizures. Neuropediatrics 2021; 52:84-91. [PMID: 33091941 DOI: 10.1055/s-0040-1712487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of the study is to examine the incidence and risk factors for death among neonates who developed neonatal seizures (NS) in an ethnically distinctive community with high consanguinity rate in Israel. METHODS Retrospective study was conducted at a single institution on data between January 2001 and January 2016. All neonates diagnosed with NS developed up to age 28 days were included. Mortality was defined as death within the first year of life. RESULTS Of all 69,460 neonates born during the study period, 118 (1.7 per 1,000 live births) developed NS; 35 (29.7%) died within the first year while 83 (70.3%) survived. The leading causes of death were developmental brain malformation (31.4%), genetic/metabolic (20%), hypoxic ischemic encephalopathy (20%), intracranial hemorrhage (11.4%) and infections (11.4%). Any consanguinity between the parents was found in 18 and 14.6% among the survivors and deceased groups, respectively (p = 0.24). Developmental brain malformations that lead to death were present in 3.6 and 31.4% in the survivors and deceased groups, respectively (p = 0.001; relative risk 8.70; 95% confidence interval 2.58-29.27). Stepwise backward logistic regression analysis revealed that developmental brain malformations (p < 0.0001), use of more than one antiepileptic medication (p = 0.006), and multiorgan failure (p = 0.004) were significant risk factors that predicted death. CONCLUSION The results of the current study show that developmental brain malformations that cause NS were the leading risk factor for death.
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Affiliation(s)
- Osama Tanous
- Pediatric Department A', Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mohamad Watad
- Pediatric Department A', Emek Medical Center, Afula, Israel
| | | | - Marina Peniakov
- Neonatal Intensive Care Unit, Emek Medical Center, Afula, Israel
| | - Dan Miron
- Pediatric Department A', Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
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Jindal A, Angurana SK, Suthar R, Kumar P, Sundaram V. Effect of early withdrawal of phenobarbitone on the recurrence of neonatal seizures: An open-label randomized controlled trial. Epilepsy Behav 2021; 117:107875. [PMID: 33706247 DOI: 10.1016/j.yebeh.2021.107875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The long-term administration of phenobarbitone in neonates may be associated with adverse neurological outcome. The timing of stopping phenobarbitone maintenance after acute seizure control in neonates is a matter of debate. OBJECTIVES To study the effect of early withdrawal of phenobarbitone on recurrence of neonatal seizures. STUDY DESIGN Open-label randomized controlled trial. PARTICIPANTS Outborn neonates (≥34 weeks of gestation to <28 days of postnatal period) with seizures (n = 221) admitted to Neonatal unit in Pediatric emergency of a tertiary care hospital in north India over 1 year. INTERVENTION After a loading dose of phenobarbitone (20 mg/kg), neonates who remained seizure free for at least 12 h were enrolled after written informed consent from parents, and randomized (computer generated block randomization) to 'phenobarbitone withdrawal group' (n = 112) where phenobarbitone maintenance was stopped and 'phenobarbitone continued group' (n = 109) where phenobarbitone maintenance was continued until discharge and further as per clinician's discretion. OUTCOMES The primary outcome was seizure recurrence until discharge and secondary outcomes were time to reach full enteral feeds, duration of hospital stay, abnormal neurological status at discharge, and mortality in two groups. RESULTS The baseline variables were comparable in 2 groups. The incidence of seizure recurrence was similar in the phenobarbitone withdrawal and phenobarbitone continued groups (50% vs. 37.6%, respectively, p = 0.078). Among secondary outcomes, the phenobarbitone withdrawal and continued groups had similar time to reach full enteral feeds (4.02 days vs. 4.2 days, p = 0.75), duration of hospital stay (6.3 days vs. 6.5 days, p = 0.23), abnormal neurological status at discharge (45.6% vs. 38%, p = 0.39), and mortality (11.6% vs. 8.3%, p = 0.50). CONCLUSION Early withdrawal of phenobarbitone in neonatal seizures does not lead to a significant increase in the rate of seizure recurrence.
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Affiliation(s)
- Ankush Jindal
- Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Renu Suthar
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ahmad SF, Ahmad KA, Ng YT. Neonatal Epileptic Encephalopathies. Semin Pediatr Neurol 2021; 37:100880. [PMID: 33892847 DOI: 10.1016/j.spen.2021.100880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
The majority of neonatal seizures are related to common diagnoses, including hypoxic-ischemic encephalopathy and intraventricular hemorrhage. While relatively uncommon, neonatal epileptic encephalopathies represent an important group of neonatal seizure disorders that require immediate diagnosis and intervention. In this review, we provide a summary of the benign and severe neonatal epilepsy syndromes. While benign epilepsy syndromes have favorable prognoses, rapid and accurate diagnosis may prevent an unnecessarily long course of antiseizure medications. The severe epilepsy syndromes may be related to a number of underlying genetic disorders and often carry a poor prognosis. Herein we review diagnostic and therapeutic strategies, and provide a set or algorithms for said purposes.
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Affiliation(s)
- Samiya Fatima Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX; The Children's Hospital of San Antonio, San Antonio, TX.
| | - Kaashif Aqeeb Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX; The Children's Hospital of San Antonio, San Antonio, TX; Pediatrix Medical Group of San Antonio, San Antonio, TX
| | - Yu-Tze Ng
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX; The Children's Hospital of San Antonio, San Antonio, TX
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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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Pisani F, Fusco C, Spagnoli C. Linking acute symptomatic neonatal seizures, brain injury and outcome in preterm infants. Epilepsy Behav 2020; 112:107406. [PMID: 32889509 DOI: 10.1016/j.yebeh.2020.107406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatric Unit, Medicine & Surgery Department, Neuroscience Section, University of Parma, Italy.
| | - Carlo Fusco
- Department of Pediatrics, Child Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Carlotta Spagnoli
- Department of Pediatrics, Child Neurology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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Clinical value of a set of neuropeptides in term and preterm neonates with seizures: Brain derived neurotrophic factor, galanin and neuropeptide Y. J Clin Neurosci 2020; 74:168-174. [PMID: 32098713 DOI: 10.1016/j.jocn.2020.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/10/2020] [Indexed: 12/26/2022]
Abstract
The aim of our study to investigate clinical value of a set of neuropeptides (brain derived neurotrophic factor-BDNF, galanin and neuropeptide Y-NPY) in critically ill neonates. A total of 53 neonates (preterm: 26, term: 27) evaluated with lumbar pucture for etiologic evaluation were consequtively included into the study. Serum and CSF levels of the neuropeptides were measured in the first 48 h of life. All infants were prospectively followed for prognostic outcome (survival and neurodevelopmental) at the first year of life. The study cohort was categorized into four groups with respect to seizure development; preterm neonates with or without seizure and term neonates with or without seizure. Mean CSF levels of NPY (pg/ml) were significantly higher in term neonates with than those without seizures (389.76 vs. 122.66) and galanin (3.31 vs. 1.55) respectively. Term neonates with seizures had significantly higher serum levels of NPY (ng/mL) as compared with neonates without seizures (54.00 vs. 9.10). No significant difference was noted in serum and CSF levels for the set of neuropeptides in neonates with respect to prognostic outcome. Serum NPY and CSF NPY and galanin levels have a potential role for detection of clinical seizures in term neonates.
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Turova V, Sidorenko I, Eckardt L, Rieger-Fackeldey E, Felderhoff-Müser U, Alves-Pinto A, Lampe R. Machine learning models for identifying preterm infants at risk of cerebral hemorrhage. PLoS One 2020; 15:e0227419. [PMID: 31940391 PMCID: PMC6961932 DOI: 10.1371/journal.pone.0227419] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
Intracerebral hemorrhage in preterm infants is a major cause of brain damage and cerebral palsy. The pathogenesis of cerebral hemorrhage is multifactorial. Among the risk factors are impaired cerebral autoregulation, infections, and coagulation disorders. Machine learning methods allow the identification of combinations of clinical factors to best differentiate preterm infants with intra-cerebral bleeding and the development of models for patients at risk of cerebral hemorrhage. In the current study, a Random Forest approach is applied to develop such models for extremely and very preterm infants (23-30 weeks gestation) based on data collected from a cohort of 229 individuals. The constructed models exhibit good prediction accuracy and might be used in clinical practice to reduce the risk of cerebral bleeding in prematurity.
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Affiliation(s)
- Varvara Turova
- Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Orthopedic Department, Klinikum Rechts der Isar, Technical University of Munich, München, Germany
- * E-mail:
| | - Irina Sidorenko
- Chair of Mathematical Modelling, Mathematical Faculty, Technical University of Munich, Garching bei München, Germany
| | - Laura Eckardt
- Departments of Pediatrics and Neonatology, University Hospital Essen, University of Duisburg‐Essen, Essen, Germany
| | - Esther Rieger-Fackeldey
- Department of Pediatrics, Neonatology, Klinikum Rechts der Isar, Technical University of Munich, München, Germany
| | - Ursula Felderhoff-Müser
- Departments of Pediatrics and Neonatology, University Hospital Essen, University of Duisburg‐Essen, Essen, Germany
| | - Ana Alves-Pinto
- Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Orthopedic Department, Klinikum Rechts der Isar, Technical University of Munich, München, Germany
| | - Renée Lampe
- Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Orthopedic Department, Klinikum Rechts der Isar, Technical University of Munich, München, Germany
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13
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Pisani F, Prezioso G, Spagnoli C. Neonatal seizures in preterm infants: A systematic review of mortality risk and neurological outcomes from studies in the 2000's. Seizure 2019; 75:7-17. [PMID: 31864147 DOI: 10.1016/j.seizure.2019.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Medicine & Surgery Department, Neuroscience Division, University of Parma, Parma, Italy
| | - Giovanni Prezioso
- Pediatrics & Neonatology Unit, Ospedale San Timoteo, ASREM Molise, Termoli, CB, Italy
| | - Carlotta Spagnoli
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy.
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Kadivar M, Moghadam EM, Shervin Badv R, Sangsari R, Saeedy M. A Comparison Of Conventional Electroencephalography With Amplitude-Integrated EEG In Detection Of Neonatal Seizures. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:489-496. [PMID: 31849541 PMCID: PMC6911316 DOI: 10.2147/mder.s214662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Amplitude-integrated electroencephalogram (aEEG) is widely used in Neonatal Intensive Care Units (NICUs) to monitor neonatal seizures. This method is still not well established compared to conventional electroencephalogram (cEEG), the diagnostic gold standard. However, aEEG can be a good screening tool for the diagnosis of seizures in infants. Our aim in this review study is to evaluate aEEG diagnostic accuracy in comparison with cEEG, for detection of neonatal seizures. Methods In this work, we studied the published articles which used EEG and aEEG in the evaluation process of seizures in neonates and compared these techniques to obtain an approach for the detection of neonatal seizures. Results Seventeen articles were included. Using aEEG with raw trace to detect individual seizures showed median sensitivity of 78% (range: 68-85) and median specificity of 78% (range: 71-84). The median sensitivity and specificity were 54% (range: 25-95) and 81% (range: 50-100), respectively, in case of using aEEG without raw traces. Brief duration seizures and those occurring away from aEEG leads were less detected. Conclusion Studies showed that aEEG has variable sensitivity and specificity. Based on the evidences, aEEG cannot be recommended as the only way for diagnosis and management of seizures in neonates; however, it could complete the diagnosis of seizures in the infant and could be a very good tool for screening seizures.
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Affiliation(s)
- Maliheh Kadivar
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Movahedi Moghadam
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziye Sangsari
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saeedy
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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15
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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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16
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Sobczak A, Klepacka J, Amrom D, Żak I, Kruczek P, Kwinta P. Umbilical catheters as vectors for generalized bacterial infection in premature infants regardless of antibiotic use. J Med Microbiol 2019; 68:1306-1313. [PMID: 31274401 DOI: 10.1099/jmm.0.001034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction. Umbilical catheterization offers unique vascular access that is only possible in the neonatal setting due to unobstructed umbilical vessels from foetal circulation. With the cut of the umbilical cord, two arteries and a vein are dissected, allowing quick and painless catheterization of the neonate. Unfortunately, keeping the umbilical access sterile is challenging due to its mobility and necrosis of the umbilical stump, which makes it a perfect model for vessel catheter colonization analysis.Aim. The aim of this study was to evaluate bacterial colonization of the umbilical catheter, with a focus on the difference between various sections of the catheter, the duration of catheterization, patient status and gestational age.Methodology. We performed bacterial cultures for 44 umbilical catheters, analysing the superficial and deep parts of the catheter separately, and revealed colonization in one-third of cases.Results. One hundred per cent of the colonization occurred in preterm infants, with a shift towards extreme prematurity. The catheters were mainly colonized by coagulase-negative staphylococci. The majority of catheters presented with superficial colonization dominance, and there were no cases of deep colonization. The bacterial strains and their resistance were consistent between the catheter's proximal and distal parts, as well as positive blood cultures. The patients with the most intense bacterial catheter colonization presented with sepsis around removal time or a couple of days later, especially if they were extremely premature and exhibited very low birth weight. Catheterization time did not play a major role.Conclusion. Umbilical catheters are vectors for skin microflora transmission to the bloodstream via biofilm formation, regardless of antibiotic use and the duration of catheterization, especially in preterm neonates.
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Affiliation(s)
- Alina Sobczak
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Joanna Klepacka
- Microbiology Department, University Children's Hospital, Kraków, Poland
| | - Dalia Amrom
- Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Żak
- Microbiology Department, University Children's Hospital, Kraków, Poland
| | - Piotr Kruczek
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Przemko Kwinta
- Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
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17
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Goasdoue K, Chand KK, Miller SM, Lee KM, Colditz PB, Wixey JA, Bjorkman ST. Seizures Are Associated with Blood-Brain Barrier Disruption in a Piglet Model of Neonatal Hypoxic-Ischaemic Encephalopathy. Dev Neurosci 2019; 40:1-16. [PMID: 31048585 DOI: 10.1159/000499365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Seizures in the neonatal period are most often symptomatic of central nervous system (CNS) dysfunction and the most common cause is hypoxic-ischaemic encephalopathy (HIE). Seizures are associated with poor long-term outcomes and increased neuropathology. Blood-brain barrier (BBB) disruption and inflammation may contribute to seizures and increased neuropathology but are incompletely understood in neonatal HIE. The aim of this study was to investigate the impact of seizures on BBB integrity in a preclinical model of neonatal hypoxic-ischaemic (HI) injury. Piglets (age: <24 h) were subjected to a 30-min HI insult followed by recovery to 72 h post-insult. Amplitude-integrated electroencephalography (aEEG) was performed and seizure burden and background aEEG pattern were analysed. BBB disruption was evaluated in the parietal cortex and hippocampus by means of immunohistochemistry and Western blot. mRNA and protein expression of tight-junction proteins (zonula-occludens 1 [ZO1], occludin [OCLN], and claudin-5 [CLDN5]) was assessed using quantitative polymerase chain reaction (qPCR) and Western blot. In addition, mRNA from genes associated with BBB disruption vascular endothelial growth factor (VEGF) and matrix metalloproteinase 2 (MMP2) as well as inflammatory cytokines and chemokines was assessed with qPCR. Piglets that developed seizures following HI (HI-Sz) had significantly greater injury, as demonstrated by poorer aEEG background pattern scores, lower neurobehavioural scores, and greater histopathology. HI-Sz animals had severe IgG extravasation into brain tissue and uptake into neurons as well as significantly greater levels of IgG in both brain regions as assessed by Western blot. IgG protein in both brain regions was significantly associated with seizure burden, aEEG pattern scores, and neurobehavioural scores. There was no difference in mRNA expression of the tight junctions, however a significant loss of ZO1 and OCLN protein was observed in the parietal cortex. The inflammatory genes TGFβ, IL1β, IL8, IL6, and TNFα were significantly upregulated in HI-Sz animals. MMP2 was significantly increased in animals with seizures compared with animals without seizures. Increasing our understanding of neuropathology associated with seizure is vital because of the association between seizure and poor outcomes. Investigating the BBB is a major untapped area of research and a potential avenue for novel treatments.
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Affiliation(s)
- Kate Goasdoue
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Kirat Kishore Chand
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Stephanie Melita Miller
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Kah Meng Lee
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul Bernard Colditz
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Julie Anne Wixey
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Stella Tracey Bjorkman
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia,
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18
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Abstract
Most neonatal seizures in preterm newborns are of acute symptomatic origin with a prevalence higher than in full-term infants. To date, recommendations for management of seizures in preterm newborns are scarce and do not differ from those in full-term newborns. Mortality in preterm newborns with seizures has significantly declined over the last decades, from figures of 84%-94% in the 1970s and 1980s to 22%-45% in the last years. However, mortality is significantly higher in those with a birth weight<1000g and a gestational age<28 weeks. Seizures are a strong predictor of unfavorable outcomes, including not only cerebral palsy, epilepsy, and intellectual disability, but also vision, hearing impairment, and microcephaly. The majority of patients with developmental delay are severely affected and this is usually associated with cerebral palsy. Furthermore, the incidence of epilepsy after neonatal seizures seems to be lower in preterm than in full-term infants but the risk is approximately 40 times greater than in the general population. Clinical studies cannot disentangle the specific and independent contributions of seizure-induced functional changes and the role of etiology and brain damage severity in determining the long-term outcomes in these newborns.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Department of Medicine & Surgery, University of Parma, Parma, Italy.
| | - Carlotta Spagnoli
- Child Neurology Unit, Department of Pediatrics, Santa Maria Nuova Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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19
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NEMATI H, KARIMZADEH P, FALLAHI M. Causes and Factors Associated with Neonatal Seizure and its Short-term Outcome: A Retrospective Prognostic Cohort Study. IRANIAN JOURNAL OF CHILD NEUROLOGY 2018; 12:59-68. [PMID: 30026769 PMCID: PMC6045936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 07/02/2017] [Accepted: 10/07/2017] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Neonatal seizures are common, difficult to diagnose and treat, and associated with a great mortality rate and long-term risk of neurodevelopmental impairments. We aimed to determine the etiology, clinical presentation, and neurodevelopmental outcome of neonatal seizures. MATERIALS AND METHODS In this cross-sectional study, 88 neonates, aged < 28 days, admitted to Mofid Children's Hospital, Tehran, Iran, from September 2011 to 2013 with the initial diagnosis of seizure were enrolled by convenient sampling method. Data, including age, gestational age, birth weight, Apgar of the fifth minute, neonatal intensive care unit (NICU) admission, family history, type, cause, and age of seizure, EEG and paraclinic findings, anticonvulsant used for treatment, neurodevelopmental status, and the final outcome, were collected from medical records and the missed cases were completed by phone calls. The frequency and association of variables were analyzed using SPSS software. RESULTS Among neonates with seizures, 67% were male, 79.5% were born term, and 72.7% had normal birth weight. The most common type of seizure was multifocal clonic seizures (45.5%). The main diagnosis in neonates with seizures was hypoxic-ischemic encephalopathy (HIE) (23.9%) and hypoglycemia (10.22%). The mortality rate was 11.36% during a mean follow-up period of 21.4±6.4 months. Neurodevelopmental assessments showed that 64% were normal, 27% had global delay, and 9% had motor delay. Positive family history of epilepsy (P=0.006), low Apgar score (P=0.002) and epilepsy (P<0.001) were significantly associated with adverse neurodevelopmental outcome. CONCLUSION Since HIE and hypoglycemia were the most common cause of neonatal seizures, efforts should be made to improve care during delivery and early breastfeeding.
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Affiliation(s)
- Hamid NEMATI
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvaneh KARIMZADEH
- Department of Pediatric Neurology, Mofid Children’s Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Pediatric of Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo FALLAHI
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Huang J, Tang J, Qu Y, Zhang L, Zhou Y, Bao S, Mu D. Mapping the Knowledge Structure of Neonatal Hypoxic-Ischemic Encephalopathy Over the Past Decade: A Co-word Analysis Based on Keywords. J Child Neurol 2016; 31:797-803. [PMID: 26661482 DOI: 10.1177/0883073815615673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022]
Abstract
The aim of this study was to analyze the knowledge structure and report the evolution of hypoxic-ischemic encephalopathy research over the past decade based on co-word analysis. Scientific publications focusing on neonatal hypoxic-ischemic encephalopathy were searched from the Web of Science database (January 2005 to December 2014). The keywords from these articles were extracted, and a knowledge network based on these keywords was built using Ucinet6.212 and NetDraw2.084 software. A total of 1892 papers were included, and 39 high-frequency keywords were defined. "HIE" and "neonate" located at the center of the knowledge network. Etiology and pathogenesis, clinical manifestation, and therapy were researched more widely in the network than other aspects of hypoxic-ischemic encephalopathy. This co-word analysis provides an overview of neonatal hypoxic-ischemic encephalopathy research and suggests that the etiology, clinical manifestation, and therapy of hypoxic-ischemic encephalopathy have become research cores over the past decade.
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Affiliation(s)
- Jichong Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Yan Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Shan Bao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
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21
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Pisani F, Facini C, Pelosi A, Mazzotta S, Spagnoli C, Pavlidis E. Neonatal seizures in preterm newborns: A predictive model for outcome. Eur J Paediatr Neurol 2016; 20:243-251. [PMID: 26777334 DOI: 10.1016/j.ejpn.2015.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND With a reported prevalence of 22.2%, seizures in preterm newborns represent an emergent challenge, because they are often related to adverse outcome. The electroclinical features of preterm infants with neonatal seizures were evaluated in order to predict outcome. METHODS From 154 newborns with video-EEG confirmed neonatal seizures admitted to Parma University Hospital between January 1999 and December 2012, we collected 76 preterm newborns with neonatal seizures. Outcome was assessed at least at one year. Student t-test for unpaired data was used to compare means of continuous variables. We applied the χ(2) test to compare nominal data between preterm newborns with favorable versus adverse outcome, and between those with seizures versus those with status epilepticus. Then we determined the independent risk factors for adverse outcome with multivariate logistic regression analysis. RESULTS Birth weight, Apgar at 1st minute, neurologic examination, EEG, US brain scans and the presence of neonatal status epilepticus were different between preterm newborns with favorable and adverse outcome (p ≤ .049). Furthermore, birth weight, seizure onset, neurologic examination and EEG were different between the group with or without status (p ≤ .031). None of the infants with status epilepticus had a favorable outcome compared to 22.3% of those with neonatal seizures (p = .004). We also identified a predictive model that correctly classified outcome in 85.5% of subjects, with a high sensitivity for adverse outcome (>91.5%). CONCLUSION The presence of neonatal seizures in preterm newborns is highly related to an adverse outcome that can be predicted since the first days of life.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Italy.
| | - Carlotta Facini
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Italy
| | - Annalisa Pelosi
- Psychometrics, Neuroscience Department, University of Parma, Italy
| | - Silvia Mazzotta
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Italy
| | - Carlotta Spagnoli
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Italy
| | - Elena Pavlidis
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Italy
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Hart AR, Pilling EL, Alix JJP. Neonatal seizures-part 2: Aetiology of acute symptomatic seizures, treatments and the neonatal epilepsy syndromes. Arch Dis Child Educ Pract Ed 2015; 100:226-32. [PMID: 25824891 DOI: 10.1136/archdischild-2014-306388] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 02/25/2015] [Indexed: 01/02/2023]
Abstract
Most neonatal epileptic seizures are provoked by an underlying condition or problem-'acute symptomatic seizures'. However, a few neonatal epilepsy syndromes exist, and these are defined by the constellation of seizure types, EEG findings and family history seen. Making an accurate diagnosis of an epilepsy syndrome can help direct investigations, treatment options and provide prognostic information. This article discusses the investigative approach and treatments for neonatal epileptic seizures, including the neonatal epilepsy syndromes.
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Affiliation(s)
- Anthony R Hart
- Department of Paediatric and Neonatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, South Yorkshire, UK Department of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elizabeth L Pilling
- Department of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James J P Alix
- Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
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23
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Kang SK, Kadam SD. Neonatal Seizures: Impact on Neurodevelopmental Outcomes. Front Pediatr 2015; 3:101. [PMID: 26636052 PMCID: PMC4655485 DOI: 10.3389/fped.2015.00101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022] Open
Abstract
Neonatal period is the most vulnerable time for the occurrence of seizures, and neonatal seizures often pose a clinical challenge both for their acute management and frequency of associated long-term co-morbidities. Etiologies of neonatal seizures are known to play a primary role in the anti-epileptic drug responsiveness and the long-term sequelae. Recent studies have suggested that burden of acute recurrent seizures in neonates may also impact chronic outcomes independent of the etiology. However, not many studies, either clinical or pre-clinical, have addressed the long-term outcomes of neonatal seizures in an etiology-specific manner. In this review, we briefly review the available clinical and pre-clinical research for long-term outcomes following neonatal seizures. As the most frequent cause of acquired neonatal seizures, we focus on the studies evaluating long-term effects of HIE-seizures with the goal to evaluate (1) what parameters evaluated during acute stages of neonatal seizures can reliably be used to predict long-term outcomes? and (2) what available clinical and pre-clinical data are available help determine importance of etiology vs. seizure burdens in long-term sequelae.
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Affiliation(s)
- Seok Kyu Kang
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger , Baltimore, MD , USA
| | - Shilpa D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger , Baltimore, MD , USA ; Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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