Neonatal status epilepticus: Differences between preterm and term newborns

Pavlidis, Elena; Spagnoli, Carlotta; Pelosi, Annalisa; Mazzotta, Silvia; Pisani, Francesco

doi:10.1016/j.ejpn.2015.01.002

Cited by 38 publications

(29 citation statements)

References 37 publications

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“…21,22 In our cohort, risk factors for adverse outcome, such as status epilepticus and abnormal neurological examination, occurred at least as often in preterm as in term neonates with seizures, although mortality was higher in our preterm than term neonates. The Neonatal Seizure Registry was not designed to determine the reasons for differences in short-term outcome between preterm and term neonates, but our findings add to the literature showing that preterm neonates with seizures have a very high risk for adverse neurological outcome.…”

Section: Discussionmentioning

confidence: 65%

Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Glass

Shellhaas

Tsuchida

et al. 2017

Pediatric Neurology

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BACKGROUND The purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society’s neonatal electroencephalography monitoring guideline. STUDY DESIGN Of 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extremely preterm (<28 weeks, N = 18), very preterm (28 to <32 weeks, N = 18), and moderate to late preterm (32 to <37 weeks, N = 56) and compared with term neonates. RESULTS Hypoxic-ischemic encephalopathy (33%) and intracranial hemorrhage (27%) accounted for the etiology in more than half of preterm neonates. Hypothermia therapy was utilized in 15 moderate to late preterm subjects with encephalopathy. The presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) was similar in preterm and term neonates. However, exclusively subclinical seizures occurred more often in preterm than term neonates (24% vs 14%). Phenobarbital was the most common initial medication for all gestational age groups, and failure to respond to an initial loading dose was 63% in both preterm and term neonates. Mortality was similar among the three preterm gestational age groups; however, preterm mortality was more than twice that of term infants (35% vs 15%). CONCLUSIONS Subclinical seizures were more common and mortality was higher for preterm than term neonates. These data underscore the importance of electroencephalographic monitoring and the potential for improved management in preterm neonates.

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Section: Discussionmentioning

confidence: 65%

Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Glass

Shellhaas

Tsuchida

et al. 2017

Pediatric Neurology

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“…7,12,14 In critically ill children with diseases of mixed aetiologies, including neonates with HIE, MSB of more than 12 minutes per hour was found to be associated with an increase in short-term neurological decline, independent of the diagnosis or severity of illness. 22 We have shown that, in HIE, an MSB of more than 13 minutes per hour is associated with poor long-term outcome, which is conspicuously less than the traditional definition of status epilepticus (seizure burden ≥30min/h) 23 and slightly less than the threshold of 15 minutes per hour confirmed for aEEG seizures in relation to greater cerebral injury on MRI in a cooled HIE cohort. 12 Therapeutic hypothermia decreases overall neuronal excitability and seizure propagation, downregulates cerebral metabolism and inflammation, and reduces cerebral necrosis and apoptosis.…”

Section: Discussionmentioning

confidence: 85%

Seizure burden and neurodevelopmental outcome in neonates with hypoxic–ischemic encephalopathy

Kharoshankaya

Stevenson

Livingstone

et al. 2016

Develop Med Child Neuro

200

149

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AimTo examine the relationship between electrographic seizures and long‐term outcome in neonates with hypoxic–ischemic encephalopathy (HIE).MethodFull‐term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre‐hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome.ResultsContinuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5–80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43–37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06–31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome.InterpretationIn HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia.

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“…2,17 This variability in defining NSE has led to inconsistent estimates (8-43%) of the burden of NSE in newborns with seizures. [18][19][20] The challenges in defining neonatal seizures and status epilepticus are 21 :…”

Section: Definitionsmentioning

confidence: 99%

Status Epilepticus in Neonates

Saini

Vinayan

2018

International Journal of Epilepsy

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Seizures are a reflection of acute brain injury in the neonatal period, and status epilepticus reflects a state of high seizure burden. Neonatal status epilepticus has been reported in 8 to 43% of newborns with seizures. There is no separate definition for neonatal status epilepticus, and it has been commonly defined as a continuous seizure lasting at least 30 minutes and/or a series of seizures whose total duration exceeds 50% of a given epoch. The causes of status epilepticus in the neonatal period mirror the causes of neonatal seizures. It is symptomatic, usually associated with hypoxic–ischemic encephalopathy, inherited metabolic disorders, infections, and cerebral hemorrhage. Management guidelines are not separately outlined for neonatal status epilepticus and are commonly derived from the recommendations for neonatal and infantile seizures. The presence of neonatal status epilepticus significantly increases the odds for development of cerebral palsy, global developmental delay, and epilepsy later in life. Further research is needed into the role of current antiepileptic drugs in causing neuronal injury and use of neuroprotective agents during neonatal status epilepticus.

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Neonatal status epilepticus: Differences between preterm and term newborns

Cited by 38 publications

References 37 publications

Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Seizure burden and neurodevelopmental outcome in neonates with hypoxic–ischemic encephalopathy

Status Epilepticus in Neonates

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