Cerebral palsy following neonatal hypoxic seizures in singleton term infants: the influence of parity

This was a retrospective review of term singleton neonates (> 37 weeks) with early onset seizures, with and without encephalopathy, from 1989 through 2000. Our aim was to examine the relationship between antepartum and intrapartum obstetric events, neonatal hypoxic seizures and subsequent neurological impairment of 77,838 infants, the incidence of seizures was significantly higher among primiparas (2.4/1000; 67/31,729) compared with multiparas (0.35/1000; 16/46,109)(p < 0.001). Compared with multiparas, seizures with encephalopathy occurred more frequently among primiparas (0.8/1000; 26/31,729) vs. multiparas (0.2/1000; 8/46,109), were more commonly associated with unexplained intrapartum hypoxia (0.6/1000, n = 20 vs.0.04/ 1000, n = 2) and the incidence of cerebral palsy, 45% (9/20) vs. 0% (0/2) was significantly higher(p < 0.001). Seizures with encephalopathy (0.2/1000 vs.0.13/1000) and cerebral palsy (33%) had a similar incidence in primiparas and multiparas following a sentinel event. Neonatal seizures with encephalopathy, related to intrapartum events, were 4 times more common following first delivery and associated with a 9 fold higher incidence of cerebral palsy, implicating primiparous labor in the development of cerebral palsy.