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Published on: November 20, 2015
The timing of brain insults in preterm infants who later developed West syndrome
A Okumura1, K Watanabe, F Hayakawa
1Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. okumura@med.nagoya-u.ac.jp
Insights
Brain injuries leading to West syndrome in preterm infants often occur before birth. This study used serial EEGs to determine injury timing, finding prenatal insults are more common than previously thought.
Area of Science:
- Neonatal neurology
- Developmental neuroscience
Background:
- West syndrome is a severe epilepsy syndrome in infants.
- Preterm infants are at increased risk for neurological complications, including West syndrome.
- Understanding the timing of brain insults is crucial for prevention and treatment.
Purpose of the Study:
- To determine the timing of brain injuries in preterm infants who subsequently develop West syndrome.
- To investigate the relationship between gestational age and the timing of brain insults.
Main Methods:
- Serial electroencephalogram (EEG) recordings were performed immediately after birth in preterm infants (<33 weeks gestational age).
- EEG findings were analyzed in relation to the infant's birth date to classify insults as prenatal, perinatal, or postnatal.
- Periventricular leukomalacia and West syndrome development were documented.
Main Results:
- Of eleven infants with periventricular leukomalacia who developed West syndrome, brain insults were classified as prenatal in 5, perinatal in 2, postnatal in 2, and mixed in 2.
- Infants born earlier (<29 weeks gestation) were more likely to experience postnatal brain damage.
- Infants born later (>28 weeks gestation) were more likely to have prenatal brain injury.
Conclusions:
- The timing of brain injury in preterm infants who develop West syndrome is frequently prenatal, challenging previous assumptions.
- Gestational age influences the timing of brain insults, with earlier preterm infants being more vulnerable to postnatal damage.
Abstract:
Abstract. The aim of this study is to clarify the timing of brain injuries in preterm infants who later developed West syndrome. We assessed the timing of brain insults with serial EEG recordings beginning immediately after birth in preterm infants less than 33 weeks of gestational age. The timing of brain insult was assessed by considering EEG findings in relation to the time of birth. The timing was considered prenatal if an EEG immediately after birth already showed chronic stage abnormalities, perinatal if it showed acute stage abnormalities, and postnatal if it was normal and a later EEG showed acute stage abnormalities. Eleven infants had periventricular leukomalacia and developed West syndrome. The timing of the brain insult was considered prenatal in 5 infants, perinatal in 2, postnatal in 2, prenatal plus postnatal in one, perinatal plus postnatal in one. The infants of less than 29 weeks of gestation were more likely to suffer brain damage postnatally, whereas those of more than 28 weeks tended to have brain injury prenatally. The timing of brain injury of preterm infants who later developed West syndrome is more often prenatal than generally considered.
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