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Significance of seizures in very low-birthweight infants
A Watkins1, W Szymonowicz, X Jin
1Department of Paediatrics, Monash Medical Centre, Clayton, Victoria, Australia.
Insights
Seizures in very low-birthweight (VLBW) infants are linked to significant neurodevelopmental impairment. Birth asphyxia is a major cause, worsening outcomes and mortality in these vulnerable infants.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
Background:
- Very low-birthweight (VLBW) infants are a vulnerable population susceptible to neurological complications.
- Seizures in neonates can indicate underlying brain injury and may impact long-term neurodevelopment.
Purpose of the Study:
- To evaluate the long-term neurodevelopmental outcomes of very low-birthweight infants who experienced seizures.
- To identify risk factors and prognostic indicators for seizures and their associated impairments in VLBW infants.
Main Methods:
- Retrospective review of data from 506 very low-birthweight infants, focusing on 67 with seizures.
- Follow-up assessments at ages one, two, and five years for survivors with and without seizures.
- Statistical analysis to determine the significance of psychological and mental impairment.
Main Results:
- 66% of infants with seizures exhibited impairment compared to 15% in the non-seizure group; 43% of seizure infants had severe impairment.
- Seizures lasting >5 minutes or >7 days were associated with poorer outcomes; late-onset seizures had better outcomes.
- Birth asphyxia caused 40% of seizures and was strongly linked to mortality and impairment; perinatal asphyxia was a key factor in mortality.
Conclusions:
- Seizures represent a significant neurological insult in very low-birthweight infants, contributing to poor neurodevelopmental outcomes.
- Birth asphyxia is a critical etiological factor and prognostic indicator for seizures, mortality, and impairment in this population.
- Early identification and management of seizures and their underlying causes, such as birth asphyxia, are crucial for improving outcomes in VLBW infants.
Abstract:
Of 506 very low-birthweight (VLBW) infants, the authors review data on 67 identified as having seizures. 29 survivors with seizures and 305 without were followed up at the ages of one, two and five years: statistical significance of psychological and mental impairment was evaluated. Impairment was higher in the seizure group at 66 per cent (15 per cent in non-seizure group) and 43 per cent of these were considered to be severely impaired. Infants with seizures occurring for more than seven days and lasting for more than five minutes had the poorest outcome, and infants with late onset had the best outcome. Analysis showed that 40 per cent of seizures were caused by birth asphyxia, and these were strongly prognostic, correlating with mortality and impairment rates. 60 per cent of the infants who died had the same cause for both their seizures and death, and for 57 per cent of these the cause was perinatal asphyxia. The poor outlook for the VLBW infants suggests that the seizures themselves are a serious neurological insult.