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Seizures in preterm infants with germinal-matrix-intraventricular hemorrhage (GM-IVH): a retrospective monocentric
Stephanie C Schüssler1, Anna Paul1, Undine Niederreiter1
1Department of Pediatrics and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
Insights
Seizures in preterm infants with germinal-matrix-intraventricular hemorrhage (GM-IVH) are linked to lower gestational age and pneumonia. Further research is needed to confirm these findings on seizure development and outcomes.
Area of Science:
- Neonatal neurology
- Pediatric neurology
- Perinatal medicine
Background:
- Germinal-matrix-intraventricular hemorrhage (GM-IVH) is a significant cause of seizures in premature infants.
- Understanding risk factors and neurodevelopmental outcomes is crucial for this vulnerable population.
Purpose of the Study:
- To identify risk factors associated with seizures in preterm infants diagnosed with GM-IVH (grades 2-4).
- To evaluate the neurodevelopmental outcomes of preterm infants experiencing seizures secondary to GM-IVH.
Main Methods:
- A retrospective study analyzed data from 2011-2019, including preterm infants with GM-IVH grades 2-4.
- Seizures were confirmed by clinical signs and EEG; neurodevelopment was assessed using the Bayley Scales of Infant Development II (BSID-II) at two years.
- Infants with seizures were compared to those without seizures and a broader cohort of preterm infants (<1500g).
Main Results:
- Seizures occurred in 52.9% of the 34 preterm infants with GM-IVH.
- Lower gestational age (28.1 vs. 30 weeks) and pneumonia were significantly associated with seizures (p=0.04 and p=0.003, respectively).
- Infants with seizures showed significantly lower BSID-II Mental scores (86.3 ± 18.3 vs. 104.9 ± 8.5, p=0.03), though immaturity was a confounding factor.
Conclusions:
- Seizures in preterm infants with GM-IVH are associated with lower gestational age and pneumonia.
- Infections and inflammation are potential contributors to seizure development.
- Larger studies employing continuous EEG monitoring are recommended to validate these findings and clarify outcome determinants.
Aim:
Germinal-matrix-intraventricular hemorrhage (GM-IVH) is a leading cause of seizures in preterm infants. This study aimed to analyze risk factors associated with seizures and to evaluate neurodevelopmental outcomes in preterm infants with GM-IVH and seizures.
Methods:
We conducted a retrospective study from 2011 to 2019, identifying preterm infants with GM-IVH grades 2-4 through an electronic patient file system. Seizures were diagnosed based on clinical manifestations and abnormal EEG findings. Infants were grouped by the presence or absence of seizures, and associated comorbidities were compared. Neurodevelopmental follow-up was assessed at two years of age using the Mental Bayley Scales of Infant Development II (BSID-II). Outcomes of infants with seizures were compared to all tested preterm infants with birth weight <1500 g born between 2011 and 2019 (n = 195).
Results:
A total of 34 preterm infants with GM-IVH grades 2-4 were included. Seizures occurred in 52.9 % of cases. Their occurrence was significantly associated with lower gestational age (mean 28.1 vs. 30 weeks, p = 0.04) and pneumonia (p = 0.003). Infants with seizures had significantly lower BSID-II Mental scores (n = 15) compared to those without seizures (86.3 ± 18.3 vs. 104.9 ± 8.5, p = 0.03). However, as these infants had a lower gestational age, we could not distinguish if they had a poorer outcome because of seizures or because of immaturity.
Conclusion:
Seizures in preterm infants with GM-IVH were significantly associated with lower gestational age and pneumonia. Infections and inflammation may contribute to seizure development. Larger studies with continuous EEG monitoring are needed to validate these findings.
