Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Published on Jul 1, 2017in Pediatric Neurology2.89
· DOI :10.1016/J.PEDIATRNEUROL.2017.04.016
Hannah C. Glass37
Estimated H-index: 37
(UCSF: University of California, San Francisco),
Renée A. Shellhaas32
Estimated H-index: 32
(UM: University of Michigan)
+ 8 AuthorsJanet S. Soul37
Estimated H-index: 37
(Boston Children's Hospital)
Abstract 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 ( 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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