Mortality Risk After Neonatal Seizures in Very Preterm Newborns

Pisani, Francesco; Copioli, Cristiana; Turco, Emanuela Claudia; Sisti, Lisa; Cossu, Giuseppe; Seri, Stefano

doi:10.1177/0883073811435244

Cited by 23 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Here, their precise incidence in this population is difficult to define [7], ranging from 4.8% [8] to 8.6% [9]. In our study, a difference in the number of infants with seizures was seen between the two caffeine preparations, but this was based on only 6 (vs. 3) patients and the confidence interval for the RR included 1.…”

Section: Discussionmentioning

confidence: 82%

Safety Profile Comparison between Extemporaneous and a Licensed Preparation of Caffeine Citrate in Preterm Infants with Apnea of Prematurity

Vatlach¹,

Arand²,

Engel

et al. 2013

Neonatology

View full text Add to dashboard Cite

Background: Given the lack of a licensed product (LP), extemporaneous caffeine citrate (ECC) has been used by many hospital pharmacies. Objectives: Since July 2011, an LP has been available in Germany. We prospectively compared the safety profile of ECC and LP in preterm infants with apnea of prematurity. Methods: Between April 2010 and April 2013, selected side effects occurring with ECC or LP were documented in 6 German NICUs for infants ≤34 weeks' gestation using a longitudinal study design. The software developed for daily prescriptions in NICU residents requires entries if any of the following symptoms occurred during the last 24 h: tachycardia (resting heart rate >200/min), clinical or encephalographic seizures, gastric residuals, vomiting, or necrotizing enterocolitis (NEC). ECC and LP were administered at identical doses (20 mg/kg/day loading, 5-10 mg/kg/day maintenance) and in similar formulations either orally or intravenously. Results: 562 infants with 14,590 treatment days on ECC and 538 infants with 12,813 treatment days on LP were evaluated. The mean gestational age was similar (29.20 weeks for ECC vs. 29.14 weeks for LP). No relevant differences were seen concerning tachycardia, gastric residuals, or vomiting, but ECC was associated with a higher risk of NEC (risk ratio: 2.68, 95% CI: 1.01-7.23, p = 0.047) and, albeit not significantly so, seizures (risk ratio: 1.91, 95% CI: 0.53-6.96, p = 0.35). Conclusion: This survey demonstrates a similar safety profile for both forms of caffeine citrate. The lower NEC and seizure rate seen with the LP is intriguing, but requires confirmation in a controlled study design.

show abstract

Section: Discussionmentioning

confidence: 82%

Safety Profile Comparison between Extemporaneous and a Licensed Preparation of Caffeine Citrate in Preterm Infants with Apnea of Prematurity

Vatlach¹,

Arand²,

Engel

et al. 2013

Neonatology

View full text Add to dashboard Cite

show abstract

“…Preterm babies present a worse outcome with a high mortality rate (37.1% in very preterm neonates of 32 wGA) 31 confirmed through the years. 4,8,[31][32][33] This highlights the negative role of the lower gestational ages on the outcome. Moreover, population-based data reveal strikingly different rates for all reported outcomes: cerebral palsy (53% in preterm vs. 17% in full-term neonates), epilepsy (40 vs. 18%), and intellectual disability (40 vs. 14%).…”

Section: Perinatal Clinical Variablesmentioning

confidence: 79%

Neonatal Seizures: A Review of Outcomes and Outcome Predictors

Pisani

Spagnoli

2015

Neuropediatrics

Self Cite

View full text Add to dashboard Cite

The majority of neonatal seizures are of acute symptomatic origin, and their occurrence is associated with higher mortality and morbidity compared with the general population, even if there is conflicting evidence of a detrimental effect per se. Etiology is considered the main determinant of outcome, but other factors, including gestational age, brain damage severity, neonatal neurological examination, and electroencephalographically (EEG) interictal and ictal characteristics are also related to neurodevelopmental outcome or death. Therefore, accuracy in early prognostication since the neonatal period can be improved by conveniently integrating different clinical and instrumental findings.The aim of this review is first to review the outcome of newborns with seizures (mortality, epilepsy, cerebral palsy, and intellectual disability), second to review the risk factors for adverse outcome after seizures in the newborn period, considering clinical, EEG/amplitude-integrated EEG, and neuroimaging findings associated with adverse outcome and lack of response to treatment, and finally to review published scoring systems for predicting neurologic outcome after neonatal seizures.

show abstract

“…The group of Pisani et al [3, 11, 12] explored several aspects of neonatal seizures. In their first study [3] a cohort of 51 (6%) out of 835 premature infants with clinically suspected, EEG-confirmed seizures was assessed.…”

Section: Discussionmentioning

confidence: 99%

“…Infants surviving to hospital discharge had high rates of death and adverse neurodevelopmental outcome, which were mainly related to 1-min Apgar score and to severe EEG background activity irrespective of GA at birth. The aim of the second study [11], based on a cohort of 403 infants, was to assess if seizures in infants born at less than 32 weeks GA were predictive of in-hospital death. The incidence of seizures in this cohort was 8.6% ( n = 35), but, similarly to our study, although infants with seizures were more likely to die (37.1% mortality compared to 16.5%), only severe IVH in a subgroup of infants born under 1,000 g was found to be an independent risk factor predicting mortality.…”

Section: Discussionmentioning

confidence: 99%

Seizures in Premature Infants Born at Less than 28 Weeks’ Gestation

et al. 2019

View full text Add to dashboard Cite

Background: The incidence of seizures in the neonatal period is thought to be high due to a lower seizure threshold of the immature brain. Data on seizures in extremely premature infants are scarce. Objectives: The aim of this study was to determine whether seizures are an independent risk factor for in-hospital death and to determine the incidence of seizures in extremely premature infants. Methods: This was a retrospective cohort study. Included were infants born under 28 weeks’ gestation and monitored with amplitude-integrated electroencephalography (aEEG) over the first 3 days of life. The number and duration of seizures was retrieved from aEEG recordings together with clinical data. The association of seizures and other parameters with mortality was assessed using univariable analyses methods. Relevant parameters were used for a multivariable Cox regression analysis. Results: Overall, 229 infants were included in the study. Forty-six infants had at least one seizure episode yielding an incidence of 20%. In univariable analyses, gestational age (p < 0.001), birthweight Z-score (p < 0.001), seizures (p = 0.025), suppressed background aEEG (p < 0.001), and severe intraventricular hemorrhage (IVH; p < 0.001) were associated with death before discharge. In multivariable analysis, gestational age (HR = 0.61, p < 0.001), background aEEG activity (HR = 0.30, p < 0.001), birth weight Z-score (HR = 0.51, p = 0.04), and severe IVH (HR = 2.60, p < 0.001) were found to be significant predictors of mortality while the presence of seizures in the first 3 days of life trended to significantly predict an increased risk of mortality (HR = 1.53, p = 0.09). Conclusions: Although seizure incidence was relatively high in this cohort of extremely preterm infants and infants with seizures were more likely to die, seizures alone are not a predictor for early death. However, they may be an important indicator of pathologies that are not immediately diagnosed yet could eventually lead to death among this vulnerable population.

show abstract

Mortality Risk After Neonatal Seizures in Very Preterm Newborns

Cited by 23 publications

References 31 publications

Safety Profile Comparison between Extemporaneous and a Licensed Preparation of Caffeine Citrate in Preterm Infants with Apnea of Prematurity

Safety Profile Comparison between Extemporaneous and a Licensed Preparation of Caffeine Citrate in Preterm Infants with Apnea of Prematurity

Neonatal Seizures: A Review of Outcomes and Outcome Predictors

Seizures in Premature Infants Born at Less than 28 Weeks’ Gestation

Contact Info

Product

Resources

About