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Neonatal seizures--recent aspects
Insights
Neonatal seizures, often caused by acute fetal distress, impact infant prognosis. Early treatment cessation showed no adverse effects, with better outcomes for isolated crises versus status epilepticus.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
Background:
- Neonatal seizures are a significant concern with varying etiologies and prognoses.
- Understanding the long-term outcomes of neonatal seizures is crucial for clinical management.
Purpose of the Study:
- To analyze the neonatal characteristics and long-term prognosis of seizures in a cohort of 71 neonates.
- To identify etiological factors and their impact on seizure outcomes.
- To evaluate the relationship between seizure type (status epilepticus vs. isolated crises) and neurological sequelae.
Main Methods:
- Retrospective analysis of 71 neonates with seizures between March 1980 and June 1981.
- Categorization of neonates into term and preterm groups.
- Etiological investigation, including assessment for acute fetal distress and intracranial hemorrhages.
- Follow-up of survivors for at least two years to assess neurological outcomes, including cerebral palsy, mental retardation, and epilepsy.
Main Results:
- Acute fetal distress and intracranial hemorrhages were major etiologies, particularly in term infants.
- Fifteen neonates (21.1%) died during the neonatal period.
- Among 56 survivors, 24.3% of term and 31.6% of preterm infants experienced neurological sequelae.
- Outcomes were significantly better for isolated crises (78% normal) compared to status epilepticus (53% normal).
- Prognosis for hypoxic-ischemic seizures was favorable if seizures lasted less than two days.
Conclusions:
- Neonatal seizures, especially those linked to acute fetal distress, carry a significant risk of neurological sequelae.
- The type of seizure (isolated crises vs. status epilepticus) is a critical determinant of long-term prognosis.
- Early discontinuation of treatment post-resolution of seizures and underlying disease appears safe and effective.
Abstract:
This study reports the neonatal aspects and prognosis of seizures observed in 71 neonates from 1.3. 1980 to 30.6 1981. Forty-five were full-term, 26 preterm babies. Twenty-one children had status epilepticus (SE), 50 isolated crises (IC). An etiology was found in 68 cases. Acute fetal distress (AFD) was observed in half of the cases. AFD and intracranial hemorrhages represented 62% of the etiologies in term babies, 42% in preterm. Fifteen children died in the neonatal period. The outcome of the 56 survivors was followed until at least two years of age. Forty-one children were neurologically normal; 15 were not: 9 had a cerebral palsy, 12 a mental retardation, 1 was deaf, 4 were epileptic. Sequelae occurred in 24.3% of term, 31.6% of preterm survivors (p less than or equal to 0.01). The outcome was normal in 8 out of 15 living children with SE (53%), in 32 out of 41 (78%) with IC (p less than or equal to 0.01). The prognosis of hypoxic-ischemic seizures was good if crises lasted less than two days. Treatment was discontinued as soon as possible, during the days following the end of the crises and the recovery from the initial disease, without adverse effects. Convulsions following obstetrical abnormalities were less frequent, and the prognosis was better in premature babies than in previous studies.