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Nazeer SA, Chen HY, Chauhan SP, Blackwell SC, Sibai B, Fishel Bartal M. Gestational diabetes mellitus and late preterm birth: outcomes with and without antenatal corticosteroid exposure. Am J Obstet Gynecol MFM 2024; 6:101268. [PMID: 38242498 DOI: 10.1016/j.ajogmf.2023.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Unlike pregestational diabetes mellitus, the American College of Obstetricians and Gynecologists recommends antenatal corticosteroids in those with gestational diabetes mellitus at risk for preterm birth. However, this recommendation is based on limited data, only 10.6% of the Antenatal Late Preterm Steroids study sample had gestational diabetes mellitus. There is a paucity of data on the risk of neonatal respiratory and other morbidity in this population. OBJECTIVE This study aimed to examine respiratory outcomes in parturients with gestational diabetes mellitus who received antenatal corticosteroids and delivered during the late preterm period vs those who did not. STUDY DESIGN This population-based cohort study used the US Vital Statistics dataset between 2016 to 2020. The inclusion criteria were singleton, nonanomalous individuals who delivered between 34.0 to 36.6 weeks with gestational diabetes mellitus and known status of antepartum corticosteroid exposure. The primary outcome, a composite neonatal adverse outcome, included Apgar score <5 at 5 minutes, immediate assisted ventilation, assisted ventilation >6 hours, surfactant use, seizure, or neonatal mortality. The secondary outcome was a composite maternal adverse outcome, including maternal blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the intensive care unit. Multivariable Poisson regression models were used to estimate adjusted relative risks and 95% confidence intervals. Average annual percent change was calculated to assess changes in rates of corticosteroid exposure over the study period. RESULTS Of 19 million births during the study period, 110,197 (0.6%) met the inclusion criteria, and among them, 23,028 (20.9%) individuals with gestational diabetes mellitus received antenatal corticosteroids. The rate of antenatal steroid exposure remained stable over the 5 years (APC=10.7; 95% confidence interval, -5.4 to 29.4). The composite neonatal adverse outcome was significantly higher among those who received corticosteroids than among those who did not (137.1 vs 216.5 per 1000 live births; adjusted relative risk 1.24; 95% confidence interval, 1.20-1.28). Three components of the composite neonatal adverse outcome-immediate assisted ventilation, intubation >6 hours, and surfactant use-were significantly higher with exposure than without. In addition, the composite maternal adverse outcome was significantly higher among those who received corticosteroids (adjusted relative risk, 1.34; 95% confidence interval, 1.18-1.52). Three components of the composite maternal adverse outcome-admission to intensive care unit, blood transfusion, and unplanned hysterectomy-were significantly higher among the exposed group. Subgroup analysis, among large for gestational age, by gestational age, and race and ethnicity, confirm the trend of increased likelihood of adverse outcomes with exposure to corticosteroid. CONCLUSION Individuals with gestational diabetes mellitus and antenatal corticosteroid exposure, who delivered in the late preterm, were at higher risk of neonatal and maternal adverse outcomes than those unexposed to corticosteroid.
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Affiliation(s)
- Sarah A Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal).
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal)
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal)
| | - Sean C Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal)
| | - Baha Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal)
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Nazeer, Chen, Chauhan, Blackwell, Sibai, and Fishel Bartal); Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Fishel Bartal)
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Debelo BS, Thamineni BL, Dasari HK, Dawud AA. Detection and Severity Identification of Neonatal Seizure Using Deep Convolutional Neural Networks from Multichannel EEG Signal. Pediatric Health Med Ther 2023; 14:405-417. [PMID: 37933303 PMCID: PMC10625745 DOI: 10.2147/phmt.s427773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
Introduction One of the most frequent neurological conditions in newborns is neonatal seizures, which may indicate severe neurological dysfunction. These seizures may have very subtle or very modest clinical indications because patterns like oscillatory (spike) trains begin with relatively low amplitude and gradually increase over time. This becomes very challenging and erroneous if clinical observation is the primary basis for identifying newborn seizures. In this study, a diagnosis system using deep convolutional neural networks is proposed to determine and classify the severity level of neonatal seizures using multichannel neonatal EEG data. Methods Datasets from publicly accessible online sources were used to compile clinical multichannel EEG datasets. Various preprocessing steps were taken, including the conversion of 2D time series data to equivalent waveform pictures. The proposed models have undergone training, and evaluations of their performance were conducted. Results The proposed CNN was used to perform binary classification with an accuracy of 92.6%, F1-score of 92.7%, specificity of 92.8%, and precision of 92.6%. To detect newborn seizures, this model is utilized. Using the proposed CNN model, multiclassification was performed with accuracy rates of 88.6%, specificity rates of 92.18%, F1-score rates of 85.61%, and precision rates of 88.9%. The results demonstrated that the suggested strategy can assist medical professionals in making accurate diagnoses close to healthcare institutions. Conclusion The developed system was capable of detecting neonatal seizures and has the potential to be used as a decision-making tool in resource-limited areas with a scarcity of expert neurologists.
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Affiliation(s)
- Biniam Seifu Debelo
- Department of Biomedical Engineering, Nigist Eleni Mohamed Memorial Compressive Specialized Hospital, Wachamo University, Hosanna, Ethiopia
| | | | - Hanumesh Kumar Dasari
- Department of Electronics and Communication, Rayalaseema University, Kurnool, AP, India
| | - Ahmed Ali Dawud
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
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Zullo F, Di Mascio D, Raghuraman N, Wagner S, Brunelli R, Giancotti A, Mendez-Figueroa H, Cahill AG, Gupta M, Berghella V, Blackwell SC, Chauhan SP. Three-tiered fetal heart rate interpretation system and adverse neonatal and maternal outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:377-387. [PMID: 37044237 DOI: 10.1016/j.ajog.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the rate of adverse neonatal or maternal outcomes in parturients with fetal heart rate tracings categorized as I, II or, III within the last 30 to 120 minutes of delivery. DATA SOURCES The MEDLINE Ovid, Scopus, Embase, CINAHL, and Clinicaltrials.gov databases were searched electronically up to May 2022, using combinations of the relevant medical subject heading terms, keywords, and word variants that were considered suitable for the topic. STUDY ELIGIBILITY CRITERIA Only observational studies of term infants reporting outcomes of interest with category I, II, or III fetal heart rate tracings were included. STUDY APPRAISAL AND SYNTHESIS METHODS The coprimary outcome was the rate of either Apgar score <7 at 5 minutes or umbilical artery pH <7.00. Secondary outcomes were divided into neonatal and maternal adverse outcomes. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. Random-effect meta-analyses of proportions were used to estimate the pooled rates of each categorical outcome in fetal heart rate tracing category I, II, and III patterns, and random-effect head-to-head meta-analyses were used to directly compare fetal heart rate tracings category I vs II and fetal heart rate tracing category II vs III, expressing the results as summary odds ratio or as mean differences with relative 95% confidence intervals. RESULTS Of the 671 articles reviewed, 3 publications met the inclusion criteria. Among them were 47,648 singletons at ≥37 weeks' gestation. Fetal heart rate tracings in the last 30 to 120 minutes before delivery were characterized in the following manner: 27.0% of deliveries had category I tracings, 72.9% had category II tracings, and 0.1% had category III tracings. A single study, which was rated to be of poor quality, contributed 82.1% of the data and it did not provide any data for category III fetal heart rate tracings. When compared with category I fetal heart rate tracings (0.74%), the incidence of an Apgar score <7 at 5 minutes were significantly higher among deliveries with category II fetal heart rate tracings (1.51%) (odds ratio, 1.56; 95% confidence interval, 1.23-1.99) and among those with category III tracings (14.63%) (odds ratio, 14.46; 95% confidence interval, 2.77-75.39). When compared with category II tracings, category III tracings also had a significantly higher likelihood of a low Apgar score at 5 minutes (odds ratio, 14.46; 95% confidence interval, 2.77-75.39). The incidence of an umbilical artery pH <7.00 were similar among those with category I and those with category II tracings (0.08% vs 0.24%; odds ratio, 2.85; 95% confidence interval, 0.41-19.55). When compared with category I tracings, the incidence of an umbilical artery pH <7.00 was significantly more common among those with category III tracings (31.04%; odds ratio, 161.56; 95% confidence interval, 25.18-1036.42); likewise, when compared with those with category II tracings, those with category III tracings had a significantly higher likelihood of having an umbilical artery pH <7.00 (odds ratio, 42.29; 95% confidence interval, 14.29-125.10). Hypoxic-ischemic encephalopathy occurred with similar frequency among those with categories I and those with category II tracings (0 vs 0.81%; odds ratio, 5.86; 95% confidence interval, 0.75-45.89) but was significantly more common among those with category III tracings (0 vs 18.97%; odds ratio, 61.43; 95% confidence interval, 7.49-503.50). Cesarean delivery occurred with similar frequency among those with category I (13.41%) and those with category II tracings (11.92%) (odds ratio, 0.87; 95% confidence interval, 0.72-1.05) but was significantly more common among those with with category III tracings (14.28%) (odds ratio, 3.97; 95% confidence interval, 1.62-9.75). When compared with those with category II tracings, cesarean delivery was more common among those with category III tracings (odds ratio, 4.55; 95% confidence interval, 1.88-11.01). CONCLUSION Although the incidence of an Apgar score <7 at 5 minutes and umbilical artery pH <7.00 increased significantly with increasing fetal heart rate tracing category, about 98% of newborns with category II tracings do not have these adverse outcomes. The 3-tiered fetal heart rate tracing interpretation system provides an approximate but imprecise measurement of neonatal prognosis.
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Affiliation(s)
- Fabrizio Zullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Steve Wagner
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Megha Gupta
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
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Weldegerima K, Gebremariam DS, Haftu H, Berhe G, Hadgu A, Mohammedamin MM. Neonatal Seizure Pattern, Outcome, and its Predictors Among Neonates Admitted to NICU of Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia. Int J Gen Med 2023; 16:4343-4355. [PMID: 37781273 PMCID: PMC10540696 DOI: 10.2147/ijgm.s414420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
Background Seizure is the most frequently observed symptom of neurological disorders and an important determinant of outcome during neonatal period. In clinical practice, it is prevalent and observed in neonates admitted to hospital in low-resources countries, but due to the paucity of studies in these regions, little is known about its pattern, clinical outcomes of hospitalization, and its predictors. Therefore, aims to evaluate seizure patterns, clinical outcomes, and its predictors among neonates admitted to the NICU of ACSH, Mekelle, and Tigray. Methods A hospital-based cross-sectional study design was conducted among neonates with neonatal seizures admitted to NICU of Ayder Comprehensive Specialized Hospital. Data collection was done from record reviews. SPSS Version 25 was used. Descriptive statistics and bivariate logistic regressions where a p-value of <0.05 is considered statistically significant. Results Out of 1622 NICU admissions, 155 (9.6%) were cases of neonatal seizure. The most frequently observed types of seizure in this study were subtle 70 (45.1%) and tonic 49 (31.6%) respectively. At the end of hospitalization 70.3% of neonates were discharged improved, 21.3% of neonates died and 8.4% of neonates had severe neurologic deficits. Poorly controlled seizures (AOR 4.8, 95% CI 2.6-9.2), prolonged duration of labor (AOR 4.3, 95% CI 2.2-8.8) and seizure onset <72 hours (AOR 3.7, 95% CI 1.6-8.5), respectively, were found to be independent predictors of poor neonatal outcome. Conclusion Of all neonatal admissions, neonatal seizure was observed in close to 9.6%. The most frequently observed type of seizure was subtle. Of those admitted neonates, 30% had poor outcomes following the end of their hospitalization or when they leave against medical advice for lack of improvement). Poorly controlled seizures, prolonged duration of labor, and seizure onset <72 hours were independent predictors of poor neonatal outcomes.
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Affiliation(s)
- Kiros Weldegerima
- Mekelle University, College of Health Sciences, School of Medicine, Department of Pediatrics and Child Health, Mekelle, Ethiopia
| | - Dawit Seyoum Gebremariam
- Mekelle University, College of Health Sciences, School of Medicine, Department of Pediatrics and Child Health, Mekelle, Ethiopia
| | - Hansa Haftu
- Mekelle University, College of Health Sciences, School of Medicine, Department of Pediatrics and Child Health, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- Mekelle University, College of Health Sciences, School of Public Health, Department of Epidemiology, Mekelle, Ethiopia
| | - Amanuel Hadgu
- Mekelle University, College of Health Sciences, School of Medicine, Department of Pediatrics and Child Health, Mekelle, Ethiopia
| | - Mohammed Mustefa Mohammedamin
- Mekelle University, College of Health Sciences, School of Medicine, Department of Pediatrics and Child Health, Mekelle, Ethiopia
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Almuqbil M, Alrumayyan Y, Alattas S, Baarmah D, AlTuwaijri W, AlRumayyan A, AlRifai MT, Al Madhi A, Al-shehri H, Alsaif S. Neonatal seizures: Etiologies, clinical characteristics, and radiological features: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35185. [PMID: 37713864 PMCID: PMC10508452 DOI: 10.1097/md.0000000000035185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
Seizures are a common clinical indication of central nervous system damage or abnormality in neonates. We aimed to identify the etiologies, clinical characteristics, and radiological features of neonatal seizures. This is a cross-sectional, retrospective, descriptive study using data obtained from the neonatal intensive care unit in King Abdulaziz Medical City (KAMC), a governmental, academic tertiary hospital in Riyadh, Saudi Arabia. The population of interest were neonates diagnosed with a neonatal seizure at KAMC between April 2015 and March 2019. A total of 61 patients with neonatal seizures were included in the study. The most common etiology was hypoxic-ischemic encephalopathy (43%). A total of 32 patients were full-term (52.5%). Around one-fifth of the study sample (21.3%) had a family history of neonatal seizures. Around 43.0% of the patients had epilepsy episodes. More than half of the patients (57.0%) were on one anti-seizure medication. Patients were followed up after 1 year, they had multiple comorbidities, including developmental delay, epilepsy, and cerebral palsy. Developmental delay was identified in 62.3% of the patients. A total of 19 patients have passed away (31%). Neonatal seizures are a common manifestation of neurologic disorders in neonates and are associated with high morbidity and mortality. Therefore, early identification of seizure etiology and proper management may help to improve the outcome.
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Affiliation(s)
- Mohammed Almuqbil
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia
| | - Yousof Alrumayyan
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Shahad Alattas
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Duaa Baarmah
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Waleed AlTuwaijri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Ahmed AlRumayyan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Mohammed Tala AlRifai
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Asma Al Madhi
- Department of Pediatric Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan Al-shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Saif Alsaif
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Neonatology, King Abdulaziz Medical City (KAMC), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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Mumenin KM, Biswas P, Khan MAM, Alammary AS, Nahid AA. A Modified Aquila-Based Optimized XGBoost Framework for Detecting Probable Seizure Status in Neonates. Sensors (Basel) 2023; 23:7037. [PMID: 37631573 PMCID: PMC10458382 DOI: 10.3390/s23167037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
Electroencephalography (EEG) is increasingly being used in pediatric neurology and provides opportunities to diagnose various brain illnesses more accurately and precisely. It is thought to be one of the most effective tools for identifying newborn seizures, especially in Neonatal Intensive Care Units (NICUs). However, EEG interpretation is time-consuming and requires specialists with extensive training. It can be challenging and time-consuming to distinguish between seizures since they might have a wide range of clinical characteristics and etiologies. Technological advancements such as the Machine Learning (ML) approach for the rapid and automated diagnosis of newborn seizures have increased in recent years. This work proposes a novel optimized ML framework to eradicate the constraints of conventional seizure detection techniques. Moreover, we modified a novel meta-heuristic optimization algorithm (MHOA), named Aquila Optimization (AO), to develop an optimized model to make our proposed framework more efficient and robust. To conduct a comparison-based study, we also examined the performance of our optimized model with that of other classifiers, including the Decision Tree (DT), Random Forest (RF), and Gradient Boosting Classifier (GBC). This framework was validated on a public dataset of Helsinki University Hospital, where EEG signals were collected from 79 neonates. Our proposed model acquired encouraging results showing a 93.38% Accuracy Score, 93.9% Area Under the Curve (AUC), 92.72% F1 score, 65.17% Kappa, 93.38% sensitivity, and 77.52% specificity. Thus, it outperforms most of the present shallow ML architectures by showing improvements in accuracy and AUC scores. We believe that these results indicate a major advance in the detection of newborn seizures, which will benefit the medical community by increasing the reliability of the detection process.
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Affiliation(s)
- Khondoker Mirazul Mumenin
- Electronics and Communication Engineering (ECE) Discipline, Khulna University (KU), Khulna 9208, Bangladesh; (K.M.M.); (P.B.)
| | - Prapti Biswas
- Electronics and Communication Engineering (ECE) Discipline, Khulna University (KU), Khulna 9208, Bangladesh; (K.M.M.); (P.B.)
| | - Md. Al-Masrur Khan
- Department of ICT Integrated Ocean Smart Cities Engineering, Dong-A University, Busan 49315, Republic of Korea;
| | - Ali Saleh Alammary
- College of Computing and Informatics, Saudi Electronic University, Riyadh 11673, Saudi Arabia
| | - Abdullah-Al Nahid
- Electronics and Communication Engineering (ECE) Discipline, Khulna University (KU), Khulna 9208, Bangladesh; (K.M.M.); (P.B.)
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Liang Y, Liu J, Lin X. The association between maternal diabetes and neonatal seizures: a nested case-Control study. Front Pediatr 2023; 11:1145443. [PMID: 37520060 PMCID: PMC10373587 DOI: 10.3389/fped.2023.1145443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
Aim We aimed to evaluate the association of pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) with neonatal seizures during neonatal hospitalization. Methods In this nested case-control study, all data were collected from the data files of the National Vital Statistics System (NVSS) 2016-2021. Considering the effect of confounders, we used the propensity-score matching (PSM; case:control = 1:4) method to select the study population. The outcome was considered the occurrence of neonatal seizures. Univariate and multivariate logistic regression analyses were adopted to assess the association of PGDM and GDM with neonatal seizures. We also conducted stratified analyses according to gestational age, birthweight, 5 min Apgar score, and maternal age to explore the potential disparities. Results After using the PSM method, a total of 6,674 cases of neonatal seizures and 26,696 controls were included. After adjusting for covariates, PGDM was associated with an increased risk of neonatal seizures [odds ratio (OR) = 1.51, 95% confidence interval (CI): 1.15-1.98], whereas the association between GDM and neonatal seizures is not statistically significant. In addition, the correlation between PGDM and increased risk of neonatal seizures was observed in neonates with a gestational age of 37-42 weeks and ≥42 weeks, with a 5 min Apgar score of ≥7, and with a maternal age of ≤40 years. Conclusion PGDM was found to be closely associated with an increased risk of neonatal seizures. The findings of our study indicated that neonatologists should consider monitoring the incidence of neonatal seizures in neonates born to mothers with PGDM.
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Chen H, Wang Z, Lu C, Shu F, Chen C, Wang L, Chen W. Neonatal Seizure Detection Using a Wearable Multi-Sensor System. Bioengineering (Basel) 2023; 10:658. [PMID: 37370589 DOI: 10.3390/bioengineering10060658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Neonatal seizure is an important clinical symptom of brain dysfunction, which is more common in infancy than in childhood. At present, video electroencephalogram (VEEG) technology is widely used in clinical practice. However, video electroencephalogram technology has several disadvantages. For example, the wires connecting the medical instruments may interfere with the infant's movement and the gel patch electrode or disk electrode commonly used to monitor EEG may cause skin allergies or even tears. For the above reasons, we developed a wearable multi-sensor platform for newborns to collect physiological and movement signals. In this study, we designed a second-generation multi-sensor platform and developed an automatic detection algorithm for neonatal seizures based on ECG, respiration and acceleration. Data for 38 neonates were recorded at the Children's Hospital of Fudan University in Shanghai. The total recording time was approximately 300 h. Four of the patients had seizures during data collection. The total recording time for the four patients was approximately 34 h, with 30 seizure episodes recorded. These data were evaluated by the algorithm. To evaluate the effectiveness of combining ECG, respiration and movement, we compared the performance of three types of seizure detectors. The first detector included features from ECG, respiration and acceleration records; the second detector incorporated features based on respiratory movement from respiration and acceleration records; and the third detector used only ECG-based features from ECG records. Our study illustrated that, compared with the detector utilizing individual modal features, multi-modal feature detectors could achieve favorable overall performance, reduce false alarm rates and give higher F-measures.
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Affiliation(s)
- Hongyu Chen
- Greater Bay Area Institute of Precision Medicine, Guangzhou 511466, China
| | - Zaihao Wang
- School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Chunmei Lu
- National Health Commission Key Laboratory of Neonatal Diseases, Department of Neonatology, Children's Hospital of Fudan University, Shanghai 200433, China
| | - Feng Shu
- Collaborative Innovation Center of Polymers and Polymer Composites, Department of Macromolecular Science, Fudan University, Shanghai 201203, China
| | - Chen Chen
- School of Information Science and Technology, Fudan University, Shanghai 200438, China
| | - Laishuan Wang
- National Health Commission Key Laboratory of Neonatal Diseases, Department of Neonatology, Children's Hospital of Fudan University, Shanghai 200433, China
| | - Wei Chen
- School of Information Science and Technology, Fudan University, Shanghai 200438, China
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Doandes FM, Manea AM, Lungu N, Brandibur T, Cioboata D, Costescu OC, Zaharie M, Boia M. The Role of Amplitude-Integrated Electroencephalography (aEEG) in Monitoring Infants with Neonatal Seizures and Predicting Their Neurodevelopmental Outcome. Children (Basel) 2023; 10:children10050833. [PMID: 37238381 DOI: 10.3390/children10050833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Newborn monitoring in neonatal intensive care units (NICU) is mandatory, but neurological and especially electroencephalographic (EEG) monitoring can be overlooked or delayed until the newborn is clinically stable. However, the neonatal period is associated with the highest risk of seizures in humans, and the clinical symptoms may often be discrete, but the evolution and long-term neurodevelopmental disorders in these patients may be important. In response to this issue, we conducted a study to evaluate newborns who experienced neonatal seizures (NS) in the NICU and monitored their long-term neurological development. We enrolled 73 term and preterm newborns who underwent EEG monitoring using amplitude-integrated electroencephalography (aEEG). We then followed their neurological development until around 18 months of age, with 59 patients remaining in the long-term study. A total of 22% of patients with NS developed epilepsy, 12% cerebral palsy, 19% severe neurodevelopmental disabilities, and 8.5% died within the first 18 months of life. Our findings indicate that aEEG background pattern is a strong predictor of unfavorable neurological outcomes, with an odds ratio of 20.4174 (p < 0.05). Additionally, higher Apgar scores were associated with better outcomes (p < 0.05), with the odds of unfavorable neurological outcomes decreasing by 0.7-fold for every point increase in Apgar score. Furthermore, we found a statistically significant association between preterm birth and unfavorable neurological outcomes (p = 0.0104). Our study highlights the importance of early EEG monitoring in the NICU and provides valuable insights into predictors of unfavorable neurological outcomes in newborns who experienced NS.
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Affiliation(s)
- Florina Marinela Doandes
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Aniko Maria Manea
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Nicoleta Lungu
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Timea Brandibur
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniela Cioboata
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Oana Cristina Costescu
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mihaela Zaharie
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Marioara Boia
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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10
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Donner JR, Ganta A, Polikoff L, Snelling L, Serrano-Gonzalez M. A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium. AACE Clin Case Rep 2023; 9:85-88. [PMID: 37251976 PMCID: PMC10213609 DOI: 10.1016/j.aace.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background/Objective Hypocalcemia is a common, treatable cause of neonatal seizures. The rapid repletion of calcium is essential for restoring normal calcium homeostasis and resolving seizure activity. The accepted approach to administer calcium to a hypocalcemic newborn is via peripheral or central intravenous (IV) access. Case Report We discuss a case of a 2-week-old infant who presented with hypocalcemia and status epilepticus. The etiology was determined to be neonatal hypoparathyroidism secondary to maternal hyperparathyroidism. Following an initial dose of IV calcium gluconate, the seizure activity abated. However, stable peripheral intravenous access could not be maintained. After weighing the risks and benefits of placing a central venous line for calcium replacement, it was decided to use continuous nasogastric calcium carbonate at a rate of 125 mg of elemental calcium/kg/d. Ionized calcium levels were used to guide the course of the therapy. The infant remained seizure-free and was discharged on day 5 on a treatment regimen that included elemental calcium carbonate, calcitriol, and cholecalciferol. He remained seizure free since discharge and all medications were discontinued by 8 weeks of age. Discussion Continuous enteral calcium is an effective alternate therapy for restoration of calcium homeostasis in a neonate presenting with hypocalcemic seizures in the intensive care unit (ICU). Conclusion We propose that continuous enteral calcium be considered as an alternative approach for calcium repletion in neonatal hypocalcemic seizures, one that avoids the potential complications of peripheral or central IV calcium administration.
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Affiliation(s)
- Julia R. Donner
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Avani Ganta
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Lee Polikoff
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Linda Snelling
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Monica Serrano-Gonzalez
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island
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11
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Yozawitz EG, Cilio MR, Mizrahi EM, Moon JY, Moshé SL, Nunes ML, Plouin P, Vanhatalo S, Zuberi S, Pressler RM. Application of the ILAE Neonatal Seizure Framework to an international panel of medical personnel. Epileptic Disord 2023; 25:123-130. [PMID: 36960785 DOI: 10.1002/epd2.20005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/27/2022] [Accepted: 09/13/2022] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The International League Against Epilepsy (ILAE) Neonatal Seizure Framework was tested by medical personnel. METHODS Attendees at the 2016 ILAE European Congress on Epileptology in Prague, the International Video-EEG Course in Pediatric Epilepsies in Madrid 2017, and a local meeting in Utrecht, The Netherlands, were introduced to the proposed ILAE neonatal classification system with teaching videos covering the seven types of clinical seizures in the proposed neonatal classification system. Five test digital video recordings of EEG-confirmed motor neonatal seizures were then shown and classified by the rater based on their knowledge of the proposed ILAE Neonatal Seizure Framework. A multirater Kappa statistic was used to assess agreement between observers and the true diagnosis. RESULTS The responses of 194 raters were obtained. There was no single predominant classification system that was currently used by the raters. Using the ILAE framework, 78-93% of raters correctly identified the clinical seizure type for each neonate; the overall inter-rater agreement (Kappa statistic) was 0.67. The clonic motor seizure type was most frequently identified (93% of the time; Kappa = 0.870). EEG technicians correctly identified all presented motor seizure types more frequently than any other group (accuracy = 0.9). SIGNIFICANCE The ILAE Neonatal Seizure Framework was judged by most raters to be better than other systems for the classification of clinical seizures. Among all seizure types presented, clonic seizures appeared to be the easiest to accurately identify. Average accuracy across the five seizure types was 84.5%. These data suggest that the ILAE neonatal seizure classification may be used by all healthcare professionals to accurately identify the predominant clinical seizure type.
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Affiliation(s)
- Elissa G Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology and Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York, USA
| | - Maria R Cilio
- Department of Pediatrics, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Eli M Mizrahi
- Departments of Neurology and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York, USA
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Department of Pediatrics, and Dominick P. Purpura Department of Neuroscience Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York, USA
| | - Magda L Nunes
- Pontifical Catholic University of Rio Grande do Sul School of Medicine and Brain Institute (BraIns) Porto Alegre RS Brazil, USA
| | - Perrine Plouin
- Clinical Neurophysiology Unit in Saint Vincent de Paul and in Necker Hospital Paris, France
| | - Sampsa Vanhatalo
- BABA Center, Departments of Clinical Neurophysiology and Physiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sameer Zuberi
- Fraser of Allander Neurosciences Unit Royal Hospital for Children Glasgow Glasgow, UK
| | - Ronit M Pressler
- Clinical Neuroscience, UCL- GOS Institute of Child Health and Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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12
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Kochetkova TO, Maslennikov DN, Tolmacheva ER, Shubina J, Bolshakova AS, Suvorova DI, Degtyareva AV, Orlovskaya IV, Kuznetsova MV, Rachkova AA, Sukhikh GT, Rebrikov DV, Trofimov DY. De Novo Variant in the KCNJ9 Gene as a Possible Cause of Neonatal Seizures. Genes (Basel) 2023; 14:genes14020366. [PMID: 36833293 PMCID: PMC9956824 DOI: 10.3390/genes14020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reduction in next-generation sequencing (NGS) costs allows for using this method for newborn screening for monogenic diseases (MDs). In this report, we describe a clinical case of a newborn participating in the EXAMEN project (ClinicalTrials.gov Identifier: NCT05325749). METHODS The child presented with convulsive syndrome on the third day of life. Generalized convulsive seizures were accompanied by electroencephalographic patterns corresponding to epileptiform activity. Proband WES expanded to trio sequencing was performed. RESULTS A differential diagnosis was made between symptomatic (dysmetabolic, structural, infectious) neonatal seizures and benign neonatal seizures. There were no data in favor of the dysmetabolic, structural, or infectious nature of seizures. Molecular karyotyping and whole exome sequencing were not informative. Trio WES revealed a de novo variant in the KCNJ9 gene (1:160087612T > C, p.Phe326Ser, NM_004983), for which, according to the OMIM database, no association with the disease has been described to date. Three-dimensional modeling was used to predict the structure of the KCNJ9 protein using the known structure of its homologs. According to the predictions, Phe326Ser change possibly disrupts the hydrophobic contacts with the valine side chain. Destabilization of the neighboring structures may undermine the formation of GIRK2/GIRK3 tetramers necessary for their proper functioning. CONCLUSIONS We believe that the identified variant may be the cause of the disease in this patient but further studies, including the search for other patients with the KCNJ9 variants, are needed.
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13
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Guo M, Wang J, Tang C, Deng J, Zhang J, Xiong Z, Liu S, Guan Y, Zhou J, Zhai F, Luan G, Li T. Effectiveness of vagus nerve stimulation therapy in refractory hypoxic-ischemic encephalopathy-induced epilepsy. Ther Adv Neurol Disord 2022; 15:17562864221144351. [PMID: 36578694 PMCID: PMC9791287 DOI: 10.1177/17562864221144351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Epilepsy is one of the important long-term sequelae of neonatal hypoxic-ischemic encephalopathy (HIE) and is typically characterized by drug resistance and poor surgical outcomes. Vagus nerve stimulation (VNS) is a promising neuromodulation therapy for refractory epilepsy. Objectives The present study aimed to first evaluate the effectiveness of VNS in patients with refractory HIE-induced epilepsy and scrutinize potential clinical predictors. Methods We retrospectively collected the outcomes of VNS in all patients with refractory HIE-induced epilepsy and at least 2 years of follow-up. Subgroups were classified as responders and nonresponders according to the effectiveness of VNS (⩾50% or <50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS effectiveness. Results A total of 55 patients with refractory HIE-induced epilepsy who underwent VNS therapy were enrolled. Responders represented 56.4% of patients, and 12.7% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time with rates of 23.6%, 38.2%, 50.9%, and 56.4% at the 3-, 6-, 12- and 24-month follow-ups, respectively. After multivariate analysis, neonatal seizure was identified as a negative predictor (OR: 4.640, 95% CI: 1.129-19.066), and a predominant seizure type of generalized onset was identified as a positive predictor (OR: 0.261, 95% CI: 0.078-0.873) of VNS effectiveness. Conclusion VNS therapy was effective in patients with refractory HIE-induced epilepsy and was well tolerated over a 2-year follow-up period. VNS therapy demonstrated better effectiveness in patients without neonatal seizures or with a predominant seizure type of generalized onset.
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Affiliation(s)
- Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Xiong
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China,Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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14
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Leon RL, Kalvacherla V, Andrews MM, Thomas JM, Mir IN, Chalak LF. Placental pathologic lesions associated with stroke in term neonates. Front Endocrinol (Lausanne) 2022; 13:920680. [PMID: 36157451 PMCID: PMC9492924 DOI: 10.3389/fendo.2022.920680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine the birth prevalence of perinatal stroke in term born infants at our high-volume delivery center and assess the frequency of both gross and histologic placental pathologies associated with perinatal stroke using the Amsterdam Placental Workshop Group Consensus Statement guidelines and definitions. STUDY DESIGN A single-center retrospective cohort study spanning 2010-2020. RESULTS There were 129,759 live births at Parkland Hospital during the study period and a total of 18 term born infants leading to a birth prevalence of 1 in 6,829 infants. Perinatal risk factors were found in all but one patient, and 74% presented with seizures. Pathologic placental examination was available in 56% of the cohort and only one patient had normal placental examination. Acute histologic chorioamnionitis was described in five placentas (50%) and an additional two had isolated umbilical and/or chorionic plate vasculitis with or without funisitis compared to a rate of 28% with acute inflammation in a Control group. Chronic inflammation in the form of villitis of unknown etiology was described in three of the acutely inflamed placentas and was high-grade in each of those while none of the placentas from our Control group showed evidence of any chronic lesion. CONCLUSION Both acute and chronic placental inflammation are common in perinatal stroke; placental examination should be considered an essential component to the diagnostic workup.
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Affiliation(s)
- Rachel L. Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- *Correspondence: Rachel L. Leon,
| | | | | | - Jennifer M. Thomas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Imran N. Mir
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F. Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Verma V, Lange F, Bainbridge A, Harvey-Jones K, Robertson NJ, Tachtsidis I, Mitra S. Brain temperature monitoring in newborn infants: Current methodologies and prospects. Front Pediatr 2022; 10:1008539. [PMID: 36268041 PMCID: PMC9577084 DOI: 10.3389/fped.2022.1008539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023] Open
Abstract
Brain tissue temperature is a dynamic balance between heat generation from metabolism, passive loss of energy to the environment, and thermoregulatory processes such as perfusion. Perinatal brain injuries, particularly neonatal encephalopathy, and seizures, have a significant impact on the metabolic and haemodynamic state of the developing brain, and thereby likely induce changes in brain temperature. In healthy newborn brains, brain temperature is higher than the core temperature. Magnetic resonance spectroscopy (MRS) has been used as a viable, non-invasive tool to measure temperature in the newborn brain with a reported accuracy of up to 0.2 degrees Celcius and a precision of 0.3 degrees Celcius. This measurement is based on the separation of chemical shifts between the temperature-sensitive water peaks and temperature-insensitive singlet metabolite peaks. MRS thermometry requires transport to an MRI scanner and a lengthy single-point measurement. Optical monitoring, using near infrared spectroscopy (NIRS), offers an alternative which overcomes this limitation in its ability to monitor newborn brain tissue temperature continuously at the cot side in real-time. Near infrared spectroscopy uses linear temperature-dependent changes in water absorption spectra in the near infrared range to estimate the tissue temperature. This review focuses on the currently available methodologies and their viability for accurate measurement, the potential benefits of monitoring newborn brain temperature in the neonatal intensive care unit, and the important challenges that still need to be addressed.
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Affiliation(s)
- Vinita Verma
- Institute for Women's Health, University College London, London, United Kingdom
| | - Frederic Lange
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics and Engineering, University College London Hospital, London, United Kingdom
| | - Kelly Harvey-Jones
- Institute for Women's Health, University College London, London, United Kingdom
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, United Kingdom
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16
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Qiao MY, Cui HT, Zhao LZ, Miao JK, Chen QX. Efficacy and Safety of Levetiracetam vs. Phenobarbital for Neonatal Seizures: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:747745. [PMID: 34867732 PMCID: PMC8636327 DOI: 10.3389/fneur.2021.747745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Neonatal seizures are a common neurological emergency in newborns. Phenobarbital (PB) is the first-line antiepileptic drug (AED). However, PB has some side effects, such as hypotension and respiratory depression, and it can accelerate neuronal apoptosis in the immature brain. Levetiracetam (LEV), a new antiepileptic drug, has been used as a second-line drug for the treatment of neonatal seizures. Compared with PB, LEV has many advantages, including a low incidence of side effects and better neurodevelopmental outcomes. However, there are only a few systematic reviews of LEV for the treatment of neonatal seizures. Objective: To evaluate the efficacy and safety of LEV for neonatal seizures and to compare the efficacy, side effects, and neurological outcomes between LEV and PB in the treatment of neonatal seizures. Methods: The keywords LEV, PB, and neonatal seizure were searched in the MEDLINE, Cochrane Library, Web of Science, EMBASE, clinicaltrials.gov, and China National Knowledge Internet (CNKI) databases with a last update in July 2021 to collect high-quality studies. We collected studies studying the efficacy or safety of LEV and PB in the treatment of neonatal seizures applying strict inclusion and exclusion criteria. The data were extracted and outcome measures, including efficacy, side effect rate, neurological score, and mortality rate, were analyzed with RevMan 5.3 software. Results: Ten articles were finally included in the meta-analysis. The meta-analysis showed that there was no difference in efficacy between LEV and PB in the treatment of neonatal seizures. Compared with PB, the incidence of side effects of LEV was lower. The incidence of hypotension and respiratory depression in the LEV group was significantly lower than that in the PB group. In terms of long-term neurodevelopmental outcomes, there was no significant difference in the Bayley Scales of Infant Development (BSID) scores between LEV and PB. Conclusion: PB is still the first-line AED recommended by the WHO for the treatment of neonatal seizures. The new AEDs LEV may not have better efficacy than PB. At the same time, LEV is associated with better neurodevelopment outcomes and a lower risk of adverse effects. In addition, continuous EEG monitoring should be used to diagnose neonatal seizures to evaluate the severity of the seizures, remission, and drug efficacy. Systematic Review Registration: PROSPERO, identifier: CRD42021279029.
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Affiliation(s)
- Meng-Yuan Qiao
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hong-Tao Cui
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.,Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Zhi Zhao
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Jing-Kun Miao
- Chongqing Health Center for Women and Children, Chongqing, China
| | - Qi-Xiong Chen
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
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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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Abdulqader SA, Wli WA, Qaryaqos SH. Schuurs-Hoeijmakers syndrome in a patient from Iraq - Kirkuk. Clin Case Rep 2021; 9:e04897. [PMID: 34631081 PMCID: PMC8489269 DOI: 10.1002/ccr3.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/08/2022] Open
Abstract
Schuurs-Hoeijmakers syndrome is a very rare disorder with less than 60 cases reported worldwide. This is a case report of a patient with SHMS from Iraq, the first in the area of the Middle East. He had epilepsy during his first days of life and a subsequent neurodevelopmental delay.
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19
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Donner J, Ruest S. Neonate with Seizures After Consuming Star Anise Tea. R I Med J (2013) 2021; 104:8-10. [PMID: 34582506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chinese Star Anise (Illicium verum) is a common spice used in many cultures as an herbal treatment for infant colic.1,2 Often, it has been found to be contaminated with Japanese Star Anise (Illicium anisatum) or is used in high doses resulting in neurotoxicity and gastrointestinal disturbances.1,3,4 Here we present a case of a previously healthy 2-week-old male who was evaluated in the emergency department for abnormal movements, irritability, and emesis after ingestion of star anise tea for the treatment of colic.
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Affiliation(s)
- Julia Donner
- Division of Pediatrics, Hasbro Children's Hospital; Alpert Medical School of Brown University, Providence, RI
| | - Stephanie Ruest
- Assistant Professor of Pediatrics and Emergency Medicine, Pediatric Emergency Medicine, Hasbro Children's Hospital; Alpert Medical School of Brown University, Providence, RI
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Morichi S, Ishida Y, Yamanaka G, Kato M, Kawashima H. Epileptic encephalopathy patients with SCN2A variant initiated by neonatal seizure. Pediatr Int 2021; 63:971-972. [PMID: 34004075 DOI: 10.1111/ped.14509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shinichiro Morichi
- Departments of, Department of, Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yu Ishida
- Departments of, Department of, Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gaku Yamanaka
- Departments of, Department of, Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mitsuhiro Kato
- Department of, Department of Pediatrics, Showa University, Tokyo, Japan
| | - Hisashi Kawashima
- Departments of, Department of, Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
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21
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Qureshey EJ, Mendez-Figueroa H, Wiley RL, Bhalwal AB, Chauhan SP. Cesarean delivery at term for non-reassuring fetal heart rate tracing: risk factors and predictability. J Matern Fetal Neonatal Med 2021; 35:6714-6720. [PMID: 33969774 DOI: 10.1080/14767058.2021.1920914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To delineate risk factors for adverse outcomes among those who underwent cesarean delivery (CD) for non-reassuring fetal heart rate tracing (NRFHT) and ascertain whether neonatal or maternal morbidity can be predicted accurately. METHODS The Consortium on Safe Labor Database was utilized for this secondary analysis. Inclusion criteria were non-anomalous, singleton gestations between 37.0 and 41.6 weeks who underwent CD for NRFHT. Composite adverse neonatal outcomes (CANO) included Apgar <5 at 5 min, seizures, mechanical ventilation, sepsis, intraventricular hemorrhage, necrotizing enterocolitis or neonatal death. Composite adverse maternal outcomes (CAMO) included endometritis, blood transfusion, wound complication, admission to intensive care unit, thromboembolism, hysterectomy or death. Bivariable analysis and multivariable Poisson regression were used to identify risk factors independently associated with adverse outcomes. Receiver operating characteristic (ROC) curves were created to evaluate the predictive value of the models for adverse outcomes. RESULTS Of 228,438 births in the database, 7310 individuals (3.7%) met inclusion criteria. Among this cohort, CANO occurred 3.8% of the time. CANO was less common among people over 35 years (9.8% versus 18.4% p < .01) but was more common among those with at least high-school education (15.3% versus 11.2%; p < .01), varying by ethnicity (p < .01). CAMO occurred in 3.4% and was less common among those undergoing induction of labor (37.3% versus 49.4%; p < .01) and more common among those with clinical chorioamnionitis (8.4% versus 4.3%; p < .01). The area under the curve (AUC) for ROC curve to identify CANO was 0.63 implying a limited ability to predict neonatal adverse outcomes. The AUC for identifying women with maternal adverse outcomes was 0.69 also indicating a moderate prediction ability. CONCLUSIONS Among singletons between 37 and 41 weeks who labored, the rate of CD for NRFHT was about 3.7% and among them CANO occurred in 3.8%. While risk factors for adverse neonatal outcomes following CD for NRFHT are identifiable, they do not suffice to predict them.
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Affiliation(s)
- Emma J Qureshey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rachel L Wiley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Asha B Bhalwal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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22
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Jayswal D, Roy UK, Ghosh T, Mandal P. Effectiveness and adverse drug reactions of levetiracetam and midazolam in refractory neonatal seizure: A cross-sectional comparative study. J Educ Health Promot 2021; 10:118. [PMID: 34084865 PMCID: PMC8150062 DOI: 10.4103/jehp.jehp_937_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Neonatal seizure (NS) reflects serious underlying brain injury, requiring immediate evaluation and early treatment. In neonates, phenobarbitone and phenytoin are used primarily to control the seizures. If uncontrolled, widespread off-label use of midazolam and levetiracetam was practiced. These drugs gained popularity though there are no such studies available on literature search comparing them. The present study was designed to explore these lacunae using these two drugs in refractory cases. To study the efficacy and adverse drug reactions (ADRs) of midazolam and levetiracetam not responding to usual line of therapy. MATERIALS AND METHODS This was a prospective cross-sectional study conducted on 69 neonates in the NICU and Department of Pharmacology in Burdwan Medical College and Hospital, West Bengal. Patients receiving midazolam or levetiracetam when uncontrolled with first line antiepileptics, namely, phenobarbitone and phenytoin, were considered eligible. The study variables were time to control seizure, seizure recurrence and frequency, and treatment-related adverse events. analysis used Mann-Whitney U-test were applied Comparison with respect to time to control and Chi-square test were applied to detect difference in proportion for ADRs. The SPSS Statistics 17.0 was used for analysis. RESULTS We compared the time periods to control neonatal seizure for effectiveness between levetiracetam and midazolam showing no significant difference (P = 0.190). Comparing the portion of recurrences in two groups gives statistically nonsignificant (P = 0.878) result. Only respiratory depression was seen in the levetiracetam group (12.90%) and midazolam group (18.42%). All adverse events were 'probable' as per the WHO-UMC criteria, and there was no statistically significant difference between the two drugs (P = 0.533). CONCLUSIONS Both midazolam and levetiracetam are equally effective and safe in NS not responding to usual line of treatment.
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Affiliation(s)
- Diptiman Jayswal
- Department of Pharmacology, Burdwan Medical College and Hospital, Bardhaman, West Bengal, India
| | - Uttam Kumar Roy
- Department of Pharmacology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
| | - Taraknath Ghosh
- Department of Pediatrics, Burdwan Medical College and Hospital, Bardhaman, West Bengal, India
| | - Purnendu Mandal
- Department of Pharmacology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
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23
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Takeuchi A, Inoue T, Nakamura M, Kageyama M, Akiyama T, Kobayashi K. Case Report: High-Gamma Oscillations on an Ictal Electroencephalogram in a Newborn Patient With Hypoxic-Ischemic Encephalopathy. Front Pediatr 2021; 9:679771. [PMID: 34660474 PMCID: PMC8518698 DOI: 10.3389/fped.2021.679771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Fast oscillations (FOs) >40 Hz in electroencephalograms (EEGs) are associated with ictogenesis and epileptogenesis in adults and children with epilepsy. However, only a few previous studies showed FOs in neonates. Reported frequencies of such neonatal FOs were in the low-gamma (<60 Hz) band and, therefore, they were not high compared to those in pediatric patients. We herein report a newborn patient with severe hypoxic-ischemic encephalopathy (HIE), who showed pathological FOs with a frequency in the high-gamma band. She was born at a gestational age of 39 weeks 4 days by emergency cesarean section because of non-reassuring fetal status. She had focal motor seizures involving unilateral upper and lower limbs lasting for tens of seconds on days 0, 1, 4, 5, 8, and 9 and subclinical seizures on days 4-11. Phenobarbital (PB) was intravenously administered on days 0, 2, 4, 5, and 6. We found FOs that were superimposed on the ictal delta activities using visual inspection and time-frequency analysis on 8-11 days of age. Among them, we detected high-gamma (71.4-100 Hz) oscillations that appeared to be temporally independent of low-gamma activities in the ictal EEG on 11 days of age. To the best of our knowledge, this is one of the earliest reports showing pathological FOs with a frequency of >60 Hz in the high-gamma band in human neonatal seizures, which were previously observed in animal studies. Further studies are needed to elucidate the pathophysiology of ictal FOs in neonatal seizures.
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Affiliation(s)
- Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan.,Division of Child Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takushi Inoue
- Division of Child Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Makoto Nakamura
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Misao Kageyama
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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24
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Chow CK, Luk HM, Wong SN. KCNQ2 Encephalopathy and Responsiveness to Pyridoxal-5'-Phosphate. J Pediatr Genet 2020; 12:90-94. [PMID: 36684546 PMCID: PMC9848766 DOI: 10.1055/s-0040-1721384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/25/2020] [Indexed: 01/25/2023]
Abstract
KCNQ2 mutations encompass a wide range of phenotypes, ranging from benign familial neonatal seizure to a clinical spectrum of early-onset epileptic encephalopathy that occurs in the early neonatal period. We report an infant with KCNQ2 encephalopathy presenting as neonatal seizure, initially controlled by two anticonvulsants. Electroencephalogram (EEG) showed repetitive multifocal epileptiform discharges, which remained similar after administration of intravenous pyridoxine injection. Seizure recurred at the age of 3 months preceded by an episode of minor viral infection, which occurred multiple times per day. No significant change in seizure frequency was observed after 5-day oral pyridoxine trial, but subsequently, there was dramatic seizure improvement with oral pyridoxal-5'-phosphate (PLP). We hope to alert clinicians that in patients with neonatal epileptic encephalopathy, particularly with known KCNQ2 mutations, intravenous injection of pyridoxine (preferably with EEG monitoring), followed by both oral trial of pyridoxine and PLP should be considered. KCNQ2 mutations should also be considered in vitamin B6-responsive patients.
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Affiliation(s)
- Chit Kwong Chow
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, HKSAR, Hong Kong,Address for correspondence Chit Kwong Chow, MBBS (HK), FHKC (Paed), FHKAM (Paediatrics) Department of Paediatrics and Adolescent Medicine, United Christian Hospital130 Hip Wo Street, Kwun Tong, Kowloon, HKSARHong Kong
| | - Ho Ming Luk
- Clinical Genetic Service, Department of Health, HKSAR, Hong Kong
| | - Suet Na Wong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, HKSAR, Hong Kong
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25
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Di Rosa G, Dicanio D, Nicotera AG, Mondello P, Cannavò L, Gitto E. Efficacy of Intravenous Hydrocortisone Treatment in Refractory Neonatal Seizures: A Report on Three Cases. Brain Sci 2020; 10:E885. [PMID: 33233684 DOI: 10.3390/brainsci10110885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
Neonatal seizures are the most common neurological emergency, and neonatal status epilepticus (NSE) remains a controversial entity, with no general consensus about its definition and treatment. Here, we report on three newborns with NSE refractory to first- and second-line antiepileptic drugs successfully treated with intravenous (IV) hydrocortisone. The patients had previously failed therapy with levetiracetam, phenobarbital and midazolam, showing persistent clinical and electrical seizures. Modulation of brain inflammation triggered during prolonged epileptic activity has been thought to potentially explain the beneficial effects of anti-inflammatory treatment.
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26
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Bohannon KK, Leung N, Cook AM, Autry E, Gibson J, Naranjo V, Baumann R, Gardner B. Evaluation of Two Fosphenytoin Loading Dose Regimens and Monitoring in Infants and Neonates Less Than Six Months of Age. J Pediatr Pharmacol Ther 2020; 25:617-622. [PMID: 33041716 DOI: 10.5863/1551-6776-25.7.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objectives of the study were to compare the free serum concentrations after different fosphenytoin loading dose strategies in patients younger than 6 months old and to investigate the frequency of seizure cessation following a loading dose of fosphenytoin. METHODS This retrospective cohort study included neonates and infants admitted to a 150-bed children's hospital between August 1, 2014, and February 1, 2018. Patients were included if they were younger than 6 months old and had a postload free phenytoin serum concentration collected during the specified time frame. Patients were identified through a database query screening for the inclusion criteria. Patients were separated into 2 groups with the 15 mg/kg group as per protocol and the 20 mg/kg group as noted in common practice. Data collection included demographic information, fosphenytoin dose, time of administration of the fosphenytoin loading dose, time of sampling, free phenytoin serum concentration results, concomitant antiepileptic agents, albumin serum concentration, and total bilirubin serum concentration. RESULTS Forty-one patients were included for analysis, 12 in the 15 mg/kg group and 29 in the 20 mg/kg group. The average free phenytoin concentration after the loading dose was 2.45 ± 0.54 mg/L in the 15 mg/kg group and 2.52 ± 0.66 mg/L in the 20 mg/kg group. Seizure cessation after the fosphenytoin loading dose was achieved in 3 of 12 (25%) patients in the 15 mg/kg group and in 13 of 29 (45%) patients in the 20 mg/kg group (p = 0.305). CONCLUSIONS The study demonstrates that a traditional range of fosphenytoin loading dose (15-20 mg/kg) led to elevated postloading dose free phenytoin serum concentrations in the majority of patients with a seizure cessation rate of approximately 39%. The question remains as to what the optimal dose and target concentration should be in this patient population to achieve the best efficacy without risking associated toxicities.
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27
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Abbasi H, Unsworth CP. Applications of advanced signal processing and machine learning in the neonatal hypoxic-ischemic electroencephalogram. Neural Regen Res 2020; 15:222-231. [PMID: 31552887 PMCID: PMC6905345 DOI: 10.4103/1673-5374.265542] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/24/2019] [Indexed: 01/15/2023] Open
Abstract
Perinatal hypoxic-ischemic-encephalopathy significantly contributes to neonatal death and life-long disability such as cerebral palsy. Advances in signal processing and machine learning have provided the research community with an opportunity to develop automated real-time identification techniques to detect the signs of hypoxic-ischemic-encephalopathy in larger electroencephalography/amplitude-integrated electroencephalography data sets more easily. This review details the recent achievements, performed by a number of prominent research groups across the world, in the automatic identification and classification of hypoxic-ischemic epileptiform neonatal seizures using advanced signal processing and machine learning techniques. This review also addresses the clinical challenges that current automated techniques face in order to be fully utilized by clinicians, and highlights the importance of upgrading the current clinical bedside sampling frequencies to higher sampling rates in order to provide better hypoxic-ischemic biomarker detection frameworks. Additionally, the article highlights that current clinical automated epileptiform detection strategies for human neonates have been only concerned with seizure detection after the therapeutic latent phase of injury. Whereas recent animal studies have demonstrated that the latent phase of opportunity is critically important for early diagnosis of hypoxic-ischemic-encephalopathy electroencephalography biomarkers and although difficult, detection strategies could utilize biomarkers in the latent phase to also predict the onset of future seizures.
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Affiliation(s)
- Hamid Abbasi
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Charles P. Unsworth
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
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28
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Buttle SG, Sell E, Dyment D, Bulusu S, Pohl D. Pointed rhythmic theta waves: a unique EEG pattern in KCNQ2-related neonatal epileptic encephalopathy. Epileptic Disord 2017; 19:351-6. [PMID: 28832002 DOI: 10.1684/epd.2017.0927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of an infant with KCNQ2-related neonatal epileptic encephalopathy presenting with intractable seizures beginning on the second day of life, which were resistant to multiple antiepileptic drugs. Continuous EEG recordings starting on the sixth day of life demonstrated a unique pattern of inter-and postictal focal rhythmic pointed theta waves of lambdoid morphology in the immediate postictal period, localizing to the side of the antecedent seizure. Interictal EEG exhibited discontinuous background, including patterns of burst suppression and multifocal discharges, predominantly in the centrotemporal regions, which were aggravated during sleep. MRI demonstrated T1 signal abnormalities in the basal ganglia, bilaterally. Genetic testing revealed a de novo missense mutation in KCNQ2 at position c.545 T>G, encoding a previously unreported substitution (p.Val182Gly). Seizure control was achieved immediately after starting a lidocaine infusion at age 4 weeks. The patient remained largely seizure-free following add-on oral carbamazepine for maintenance therapy and weaning off lidocaine. This is the first report of a patient with KCNQ2-related neonatal epileptic encephalopathy and therapy-refractory seizures aborted by lidocaine, demonstrating a unique EEG pattern of inter- and postictal focal rhythmic pointed theta waves. Whether this pattern could be an early EEG marker for this disorder remains to be confirmed. [Published with video sequences on www.epilepticdisorders.com].
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Dao K, Giannoni E, Diezi M, Roulet-Perez E, Lebon S. Midazolam as a first-line treatment for neonatal seizures: Retrospective study. Pediatr Int 2018; 60:498-500. [PMID: 29878631 DOI: 10.1111/ped.13554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/29/2018] [Accepted: 03/09/2018] [Indexed: 01/03/2023]
Abstract
Midazolam is commonly used to treat refractory seizures in newborns and as a first-line anti-epileptic drug in children. Its use as first-line treatment of neonatal seizures has not been investigated so far. We retrospectively studied the tolerability of midazolam in 72 newborn infants who received i.v. or i.n. midazolam as first-line treatment for seizures. No major side-effect exclusively due to midazolam was reported. The i.n. route was used for 20 patients (27.8%). Effectiveness could not be formally evaluated due to the absence of systematic electroencephalogram recording while midazolam was administered. In conclusion, midazolam was well-tolerated as a first-line abortive emergency treatment of neonatal seizure. The i.n. route offers a useful alternative to i.v. phenobarbital or phenytoin in emergency settings.
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Affiliation(s)
- Kim Dao
- Paediatrics, Lausanne University Hospital, Lausanne, Switzerland.,Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Diezi
- Paediatrics, Lausanne University Hospital, Lausanne, Switzerland.,Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Eliane Roulet-Perez
- Unit of Pediatric Neurology and Neurorehabilitation, Mother-Woman-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Sebastien Lebon
- Unit of Pediatric Neurology and Neurorehabilitation, Mother-Woman-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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30
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Chu YJ, Chang CF, Shieh JS, Lee WT. The Potential Application of Multiscale Entropy Analysis of Electroencephalography in Children with Neurological and Neuropsychiatric Disorders. Entropy (Basel) 2017; 19:428. [PMID: 33535366 DOI: 10.3390/e19080428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 01/25/2023]
Abstract
Electroencephalography (EEG) is frequently used in functional neurological assessment of children with neurological and neuropsychiatric disorders. Multiscale entropy (MSE) can reveal complexity in both short and long time scales and is more feasible in the analysis of EEG. Entropy-based estimation of EEG complexity is a powerful tool in investigating the underlying disturbances of neural networks of the brain. Most neurological and neuropsychiatric disorders in childhood affect the early stage of brain development. The analysis of EEG complexity may show the influences of different neurological and neuropsychiatric disorders on different regions of the brain during development. This article aims to give a brief summary of current concepts of MSE analysis in pediatric neurological and neuropsychiatric disorders. Studies utilizing MSE or its modifications for investigating neurological and neuropsychiatric disorders in children were reviewed. Abnormal EEG complexity was shown in a variety of childhood neurological and neuropsychiatric diseases, including autism, attention deficit/hyperactivity disorder, Tourette syndrome, and epilepsy in infancy and childhood. MSE has been shown to be a powerful method for analyzing the non-linear anomaly of EEG in childhood neurological diseases. Further studies are needed to show its clinical implications on diagnosis, treatment, and outcome prediction.
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31
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32
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Affiliation(s)
- Stéphane Auvin
- Pediatric Neurology, Robert-Debré University Hospital, APHP & INSERM U1141, Paris, France
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33
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Vilchez G, Dai J, Kumar K, Lagos M, Sokol RJ. Contemporary analysis of maternal and neonatal morbidity after uterine rupture: A nationwide population-based study. J Obstet Gynaecol Res 2017; 43:834-838. [PMID: 28188975 DOI: 10.1111/jog.13300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
Abstract
AIM Uterine rupture is a rare but feared perinatal event. Despite abundant research and changes to guidelines implemented to reduce this complication, evaluation of whether uterine rupture still engenders significant maternal/neonatal morbidity has not been conducted. We analyzed recent cases of maternal/neonatal morbidity after uterine rupture. METHODS Deliveries complicated by uterine rupture from 2011 to 2012 in the United States were selected. Comparison cases without uterine rupture were used as controls. Measures of maternal/neonatal complications were compared with χ2 test, and relative risks were calculated. Logistic regression was used to identify the most significant complications. P < 0.05 indicated statistical significance. RESULTS From 7 922 016 births, 1925 cases of uterine rupture and 3765 controls were identified. Regression models retained four maternal outcomes; blood transfusion was the most common (~15%) and unplanned hysterectomy had the highest odds (~97-fold). For newborns, the model retained three measures of morbidity; neonatal intensive care unit admission was the most common (~35%) and seizures had the highest odds (~20-fold). CONCLUSIONS Despite efforts to reduce complications, mothers remain at significant risk of unplanned hysterectomy and intensive care unit admission. Neonates are at sizeable risk for neonatal intensive care unit admission and seizures, recognized markers of long-term neurobehavioral abnormality. Uterine rupture remains a major risk for mothers and babies.
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Affiliation(s)
- Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jing Dai
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Komal Kumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Moraima Lagos
- School of Biomedical Sciences, Federico Villarreal National University, Lima, Peru
| | - Robert J Sokol
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Ikeno M, Okumura A, Abe S, Igarashi A, Hisata K, Shoji H, Shimizu T. Clinically silent seizures in a neonate with tuberous sclerosis. Pediatr Int 2016; 58:58-61. [PMID: 26712128 DOI: 10.1111/ped.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/08/2015] [Accepted: 06/15/2015] [Indexed: 01/05/2023]
Abstract
Although seizures during infancy in patients with tuberous sclerosis complex are common, seizures in neonates are infrequent. Here, we report the clinical course and electroencephalography (EEG) findings of a neonate with tuberous sclerosis complex associated with clinically silent seizures. The patient was a girl in whom cardiac tumors were detected on fetal ultrasonography. Brain magnetic resonance imaging during the neonatal period showed subependymal and cortical tubers. Routine EEG indicated unexpected ictal changes with no noticeable clinical symptoms. Ictal EEG was associated with a subtle increase in heart rate and a brief increase in chin electromyogram. These changes were difficult to identify clinically. The patient later developed focal seizures and epileptic spasms and had severe psychomotor delay. The present case suggests the occurrence of clinically silent seizures before the appearance of epileptic spasms in infants with tuberous sclerosis, and that EEG is an option for neonates with a prenatal diagnosis.
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Affiliation(s)
- Mitsuru Ikeno
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ayuko Igarashi
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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35
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Kang SK, Johnston MV, Kadam SD. Acute TrkB inhibition rescues phenobarbital-resistant seizures in a mouse model of neonatal ischemia. Eur J Neurosci 2015; 42:2792-804. [PMID: 26452067 PMCID: PMC4715496 DOI: 10.1111/ejn.13094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 02/04/2023]
Abstract
Neonatal seizures are commonly associated with hypoxic-ischemic encephalopathy. Phenobarbital (PB) resistance is common and poses a serious challenge in clinical management. Using a newly characterized neonatal mouse model of ischemic seizures, this study investigated a novel strategy for rescuing PB resistance. A small-molecule TrkB antagonist, ANA12, used to selectively and transiently block post-ischemic BDNF-TrkB signaling in vivo, determined whether rescuing TrkB-mediated post-ischemic degradation of the K(+)-Cl(-) co-transporter (KCC2) rescued PB-resistant seizures. The anti-seizure efficacy of ANA12 + PB was quantified by (i) electrographic seizure burden using acute continuous video-electroencephalograms and (ii) post-treatment expression levels of KCC2 and NKCC1 using Western blot analysis in postnatal day (P)7 and P10 CD1 pups with unilateral carotid ligation. ANA12 significantly rescued PB-resistant seizures at P7 and improved PB efficacy at P10. A single dose of ANA12 + PB prevented the post-ischemic degradation of KCC2 for up to 24 h. As anticipated, ANA12 by itself had no anti-seizure properties and was unable to prevent KCC2 degradation at 24 h without follow-on PB. This indicates that unsubdued seizures can independently lead to KCC2 degradation via non-TrkB-dependent pathways. This study, for the first time as a proof-of-concept, reports the potential therapeutic value of KCC2 modulation for the management of PB-resistant seizures in neonates. Future investigations are required to establish the mechanistic link between ANA12 and the prevention of KCC2 degradation.
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Affiliation(s)
- S K Kang
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, 716 North Broadway, Baltimore, MD, 21205, USA
| | - M V Johnston
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Youn YA, Kim JH, Yum SK, Moon CJ, Lee IG, Sung IK. The hospital outcomes compared between the early and late hypothermia-treated groups in neonates. J Matern Fetal Neonatal Med 2015; 29:2288-92. [PMID: 26364841 DOI: 10.3109/14767058.2015.1083548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence of hypoxic ischemic encephalopathy (HIE) in developed countries is estimated to be 1.5 per 1000 live births. The primary aim of this study was to analyze whether earlier hypothermia (≤1 h) improves hospital outcomes in survivors who underwent therapeutic hypothermia (TH) when compared with late TH (>1 h). METHOD Forty-nine (70%) newborns received TH for 72 h, within 6 h of birth; the remaining 21 received standard care. We divided the TH-treated newborns into early and late groups; early cooling was considered when TH was started ≤1 h after birth; late cooling was considered when started >1 h. RESULTS The early TH group consisted of 20 of 49 (41%) infants; the late TH group consisted of 29 (59%) infants. Apgar score at 1 min and the initial calcium level was significantly lower in the early (≤1 h) TH infants; there were significantly more inborns in the early TH group (p = 0.008). Infants in the late TH group manifested more clinical seizures followed by more abnormal EEG findings, longer ventilator care and longer hospitalization (p = 0.001). TH-related complications and mortality were not significantly different between the two groups. CONCLUSIONS Early TH (≤1 h) had lower Apgar score at 1 min and initial calcium level, but had decreased incidence of clinico-electrical seizures among HIE infants. Also, ventilator support and hospitalization period were longer in the late TH group.
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Affiliation(s)
- Young-Ah Youn
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
| | - Ji Hoon Kim
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
| | - Sook-Kyung Yum
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
| | - Cheong-Jun Moon
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
| | - In-Goo Lee
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
| | - In Kyung Sung
- a Department of Pediatrics , College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital , Seoul , Korea
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Inoue T, Shimizu M, Hamano SI, Murakami N, Nagai T, Sakuta R. Epilepsy and West syndrome in neonates with hypoxic-ischemic encephalopathy. Pediatr Int 2014; 56:369-72. [PMID: 24274080 DOI: 10.1111/ped.12257] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/30/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Perinatal hypoxic-ischemic encephalopathy (HIE) has been linked to the development of late-onset seizures. The aim of the present study was to determine the incidence of epilepsy and West syndrome in children with perinatal HIE and identify factors associated with the development of postnatal seizure disorders. METHODS We retrospectively enrolled 208 term and late-preterm infants diagnosed with perinatal HIE from April 2000 to March 2009 at Saitama Children's Medical Center. Children with obvious multiple anomalies and known chromosomal abnormalities were excluded. A questionnaire was distributed to parents to determine seizure-related outcomes. Medical records were retrospectively reviewed and relevant clinical parameters were analyzed. RESULTS In total, 162 questionnaires were answered (77.9%). Of the 162 subjects, 26 (16.0%) developed epilepsy, and eight subjects (4.9%) were diagnosed with West syndrome. Neonatal seizures occurred in 72 subjects (44.4%). The incidence of epilepsy and West syndrome was significantly higher in infants who experienced neonatal seizures than in those without seizure history. A total of 82 subjects were diagnosed with moderate (n = 52) or severe HIE (n = 30), of whom 57 subjects (69.5%) received therapeutic hypothermia. The incidence of epilepsy was significantly lower in these treated subjects. In addition, subjects with moderate or severe HIE were significantly more likely to develop late-onset epilepsy and West syndrome than those with mild HIE. CONCLUSIONS The severity of perinatal HIE and neonatal seizures is a potential risk factor for the development of late-onset seizures. Therapeutic hypothermia may reduce the risk of the development of epilepsy in such cases.
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Affiliation(s)
- Takeshi Inoue
- Department of Pediatrics, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan; Division of Neonatology, Saitama Children's Medical Center, Saitama, Japan
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Abstract
Neonatal seizures constitute the most common and distinctive sign of neurological dysfunction in the first weeks of life and reflect a wide variety of underlying central nervous system disorders. Acute symptomatic seizures occur more often during the neonatal period than at any period of life and are associated with adverse long-term neurodevelopmental sequelae and an increased risk of post-neonatal epilepsy. The improvements of neonatal care in the last decades have changed the spectrum of insults to which the immature brain is exposed and facilitated a decrease in mortality of newborns with seizures. However, the prevalence of long-term morbidity in survivors remains unchanged. Whereas aetiology is presumed to be the main predictor of long-term outcome in neonates with seizures, there is converging evidence that specific electroencephalographic (EEG) abnormalities are related to unfavourable outcomes. Interictal EEG abnormalities, especially concerning background activity patterns, thus constitute a major indicator of disease severity and predictor of outcome, while the added value of sequential EEG assessments is so far controversial. Moreover, experimental as well as clinical studies of hypoxic-ischaemic encephalopathy support the notion that recurrent seizures may amplify injury to the developing brain beyond that associated with the underlying aetiology, thus justifying antiepileptic drug treatment. To date, unresolved issues in seizure detection and classification, in addition to the significant variation in gestational ages and brain insults of neonates, still impede clinical research of neonatal seizures. The wider use of long-term EEG or amplitude integrated EEG monitoring may prove crucial for timely neonatal seizure identification and treatment initiation, and thus ultimately improve outcome.
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Abstract
Neonatal seizures are a potentially life-threatening pediatric problem with a variety of causes, such as birth trauma, asphyxia, congenital anomalies, metabolic disturbances, infections, and drug withdrawal or intoxication. Thorough and timely evaluations of such patients are necessary to identify and treat the underlying etiology, therefore reducing potential morbidity and mortality. We review neonatal seizures and hypocalcemia and present the case of a 6-day-old male infant who presented to a tertiary pediatric emergency department with seizure-like episodes. He was found to have markedly low serum calcium, magnesium, and parathyroid hormone concentrations, as well as a significantly elevated serum phosphate concentration. The etiology of these abnormalities was found to be maternal ingestion of extremely high doses of calcium carbonate during the third trimester of her pregnancy, an occurrence that has been reported only once in the literature. Education pertaining to the dangers of excessive calcium carbonate intake during pregnancy may be an important piece of anticipatory guidance for pregnant mothers with symptoms of gastroesophageal reflux, and questioning the mother of a neonate presenting with seizures about such over-the-counter medications may help to elucidate the diagnosis.
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Khanna A, Walcott BP, Kahle KT. Limitations of Current GABA Agonists in Neonatal Seizures: Toward GABA Modulation Via the Targeting of Neuronal Cl(-) Transport. Front Neurol 2013; 4:78. [PMID: 23805124 PMCID: PMC3691543 DOI: 10.3389/fneur.2013.00078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/09/2013] [Indexed: 01/18/2023] Open
Abstract
Neonatal intensive care has advanced rapidly in the last 40 years, with dramatic decreases in mortality and morbidity; however, for neonatal seizures, neither therapies nor outcomes have changed significantly. Basic and clinical studies indicate that seizures in neonates have long-term neurodevelopmental and psychiatric consequences, highlighting the need for novel pharmacotherapeutics. First-line treatments targeting GABAA receptors, like barbiturates and benzodiazepines, are limited in their efficacy and carry significant risks to the developing brain. Here, we review the use of current GABA agonist therapies for neonatal seizures and suggest other treatment strategies given recent developments in the understanding of disease pathogenesis. One promising avenue is the indirect manipulation of the GABAergic system, via the modulation of neuronal Cl− gradients, by targeting the cation-Cl− cotransporters (NKCC1 and KCC2) or their regulatory signaling molecules. This strategy might yield a novel class of more efficacious anti-epileptics with fewer side effects by specifically addressing disease pathophysiology. Moreover, this strategy may have ramifications for other adult seizure syndromes in which GABA receptor-mediated depolarizations play a pathogenic role, such as temporal lobe epilepsy.
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Affiliation(s)
- Arjun Khanna
- Division of Neurosurgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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