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Outcomes after Neonatal Seizures in Infants Less Than 29 Weeks' Gestation: A Population-Based Cohort Study
Hiroko Iwami1, Tetsuya Isayama1, Abhay Lodha2
1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Neonatal seizures in extremely preterm infants are linked to a higher risk of death or neurodevelopmental impairment by 18-24 months. Anticonvulsant treatment effects require further investigation.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Perinatal medicine
Background:
- Neonatal seizures are a critical concern in extremely preterm infants.
- Neurodevelopmental impairment (NDI) is a significant risk for this vulnerable population.
- Understanding risk factors like seizures is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the association between neonatal seizures and NDI at 18-24 months in extremely preterm neonates.
- To assess the impact of anticonvulsant use on NDI in this cohort.
- To identify predictors of adverse neurodevelopmental outcomes.
Main Methods:
- Retrospective cohort study using Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases.
- Inclusion criteria: infants born at <29 weeks' gestation.
- Statistical analysis adjusted for confounders to compare outcomes between infants with and without seizures.
Main Results:
- 4.8% of 2,762 eligible neonates experienced seizures; these infants had lower gestation and birth weight.
- Neonatal seizure independently increased the odds of a composite outcome of death or significant NDI (aOR: 3.4).
- While infants with seizures treated with anticonvulsants had higher mortality/NDI, this difference was not significant after adjustment (aOR: 3.5).
Conclusions:
- Neonatal seizures are an independent risk factor for death or significant NDI in extremely preterm infants.
- The association between anticonvulsant therapy and neurodevelopmental outcomes warrants further research.
- Early identification and management of neonatal seizures are critical for improving long-term neurodevelopmental trajectories.
Objective:
The aim of this study was to evaluate the association between neonatal seizure and neurodevelopmental impairment (NDI) at 18 to 24 months in extremely preterm neonates. The association between anticonvulsants use and NDI was also assessed.
Study Design:
In this retrospective cohort study of infants born at <29 weeks' gestation from the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases, we compared mortality and neurodevelopmental outcomes in infants who had neonatal seizures with those without seizures after adjusting for confounders.
Results:
Of the 2,762 eligible neonates, 133 (4.8%) had seizures. Infants who had seizures were of lower gestation (25.2 vs. 26.2 weeks) and birth weight (819 vs. 920 g) and had higher rates of adverse outcomes. Neonatal seizure was associated with higher odds of composite outcome of death or significant NDI (74 vs. 27%; adjusted odds ratio [OR]: 3.4; 95% confidence interval [CI]: 2.2-5.4). Death or significant NDI was higher in infants with seizures treated with anticonvulsants than those without treatment (89 vs. 70%); however, when adjusted for confounders, it was not significantly different (adjusted OR: 3.5; 95% CI: 0.83-14.6).
Conclusion:
Neonatal seizures were independently associated with higher odds of death or significant NDI at 18 to 24 months of age. Relationship of anticonvulsant and neurodevelopmental outcomes needs further studies.