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Updated: Jun 4, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal Seizures and Associated Neurobehavioral Profiles in Preschool Age Children
Allyssa M Mattes1, Renée A Shellhaas2, Hannah C Glass3
1Division of Rehabilitation Psychology Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan; New Day Neuropsychology LLC, Noblesville, Indiana.
Insights
Children with postneonatal epilepsy show increased neurobehavioral issues compared to those without. Early screening for these developmental problems is crucial for timely support in affected children.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Epileptology
Background:
- Neonatal seizures frequently occur with acute brain injury, with up to 25% of survivors developing epilepsy.
- Postneonatal epilepsy diagnosed by age 24 months may increase the risk of early neurobehavioral disorder markers compared to acute provoked neonatal seizures alone.
Purpose of the Study:
- To investigate the association between postneonatal epilepsy and early neurobehavioral outcomes in children.
- To compare neurobehavioral functioning in children with and without postneonatal epilepsy.
Main Methods:
- 151 neonates with acute provoked seizures were enrolled across nine sites.
- Parent-completed standardized ratings assessed adaptive, social, executive functioning, self-regulation, and sensory domains.
- Linear regression analyzed differences between children with and without postneonatal epilepsy, adjusting for seizure etiology, sex, gestational age, and cerebral palsy (CP) severity.
Main Results:
- Children with epilepsy (13%) exhibited significantly impaired adaptive (Cohen d=1.62), social (Cohen d=0.86), and executive functioning (Cohen d=0.56) compared to those without.
- These impairments persisted after adjusting for neonatal seizure etiology, sex, and gestational age.
- Cerebral palsy (CP) severity was associated with greater impairment, and epilepsy was an independent predictor of adaptive functioning.
Conclusions:
- Preschool children with postneonatal epilepsy have a higher incidence of adverse neurobehavioral outcomes.
- Epilepsy is an independent predictor of adaptive functioning, and CP severity is linked to greater impairment.
- Screening children with postneonatal epilepsy for neurobehavioral problems is recommended for early identification and developmental support.
Background:
Neonatal seizures are common with acute brain injury. Up to 25% of survivors develop postneonatal epilepsy. We hypothesized postneonatal epilepsy diagnosed by age 24 months would increase risk for early markers of neurobehavioral disorders than acute provoked neonatal seizures alone.
Methods:
Neonates with acute provoked seizures born from July 2015 to March 2018 were enrolled at nine Neonatal Seizure Registry sites. Composite scores from parent-completed standardized ratings assessed Adaptive, Social, Externalizing, Internalizing, Self-Regulation, and Sensory Seeking domains. Linear regression demonstrated relationships between composite scores for children who developed postneonatal epilepsy compared with those who did not. Results were adjusted for seizure etiology, sex, gestational age, and cerebral palsy (CP) severity.
Results:
A total of 151 children (n = 20, 13% with postneonatal epilepsy), 4.1 years median age, participated. Children with epilepsy had impaired adaptive (Cohen d = 1.62, P < 0.0001), social (Cohen d = 0.86, P = 0.004), and executive functioning (Cohen d = 0.56, P = 0.06) compared with children without epilepsy. Mean scores for children without epilepsy were within average range. Risk for impairment among children with epilepsy persisted after adjusting for neonatal seizure etiology, sex, and gestational age, but not when adjusting for CP severity.
Conclusions:
There was higher incidence of adverse neurobehavioral outcomes among preschool children diagnosed with postneonatal epilepsy compared with those without epilepsy. CP severity was associated with greater impairment; results also suggest that epilepsy is an independent predictor of adaptive functioning. Children with postneonatal epilepsy should be screened for neurobehavioral problems to facilitate early identification and developmental support.
