Antenatal and Intrapartum Risk Factors for Seizures in Term Newborns: A Population-Based Study, California 1998-2002

Abstract

Objective-To assess antenatal and intrapartum risk factors for seizures occurring during the birth admission.Study design-Using multivariable logistic regression analysis, we evaluated the association between maternal characteristics and birth admission seizures in a cohort of 2.3 million California children born ≥36 weeks gestation from 1998-2002 using the California Office of Statewide Planning and Development database containing birth certificates linked to infant and maternal hospital discharge abstracts.Results-The incidence of seizures during the birth admission was 0.95/1000 live births. In an adjusted analysis, infants of women who were 40 or older, were nulliparous, had diabetes mellitus, intrapartum fever or infection or who delivered ≥42 weeks had an increased risk of seizures. Infants of Hispanic and Asian mothers had a lower risk when compared with infants of white mothers.Conclusions-Several maternal antenatal and intrapartum factors increased the risk of seizures during the birth admission. Identifying and avoiding risks for neonatal seizures may lead to lower infant neurological morbidity and mortality. Keywords Population attributable riskThe estimated incidence of seizures in term newborns is 1-3.5 per 1000 live births (1-4) (5,6). Seizures in the neonate frequently reflect significant underlying brain injury such as hypoxic ischemic injury, stroke, intracranial infection or hypoglycemia (2,7). Neonates with seizures have a high incidence of mortality and adverse long-term neurological outcome (5,8).Address correspondence to: Hannah C. Glass, University of California San Francisco, Department of Neurology Box 0663, 521 Parnassus Avenue, San Francisco,, Email: Hannah.Glass@ucsf.edu. Edited by AJ and WFB The NINDS Neurological Sciences Academic Development Award (NS01692) supports HCG.The authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access MethodsWe examined a population-based cohort using a (642.41-642.42, 642.51-642.52, 642.61-642.62). Mode of delivery was categorized into four groups: routine vaginal, operative vaginal (using vacuum or forceps), daytime cesarean (during the hours 6:00-17:00) and nighttime cesarean (17:01-5:59). Potential infant confounding variables included meningitis (320-320.9, 322.9) and other infection, not meningitis (771.4,771.8-89).Our outcome of interest was defined as convulsions (780.3) or seizures in a newborn (779.0) diagnosed during the birth hospitalization. StatisticsContinuous variables were compared using a two-tailed Student's t-test. The association be...

Pandemic Influenza A (H1N1) Infection in Pregnant and Nonpregnant Women in Spain (2009–2010)

“…We propose that future studies on this topic are necessary. For example, maternal fever, which was a very common symptom in our study, has been associated with an increased risk of neural tube defects, neonatal seizures, hypoxic ischemic encephalopathy, cerebral palsy, neonatal death, and other complications (42)(43)(44)(45)(46) as well as with other adverse neonatal and developmental outcomes, when occurring later in pregnancy (47)(48)(49). In the present study, 95.9z of the pregnant women were febrile at some point during treatment; however, their fever lasted for a lesser time than that of nonpregnant women, probably because of a more rapid initiation of treatment.…”

Part 13: Neonatal Resuscitation

“…These include increased mortality, 74,75 neonatal seizures, [74][75][76][77][78][79][80] and adverse neurologic states like encephalopathy. [81][82][83][84] Maternal hypothermia in labor has not been shown to be associated with clinically significant adverse neonatal outcomes at the time of birth.…”

Part 7: Neonatal Resuscitation

“…[115][116][117][118][119][120][121] For the important outcome of adverse neurologic states (encephalopathy), we identified low-quality evidence from 4 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia.…”

“…115,116 For the important outcome of neonatal seizures, we identified low-quality evidence from 7 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia. [115][116][117][118][119][120][121] For the important outcome of adverse neurologic states (encephalopathy), we identified low-quality evidence from 4 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia.…”