Post-neonatal epilepsy in newborns with neurologic conditions: a retrospective cohort study from a tertiary center

To evaluate the incidence and risk factors of epilepsy by ≥3 years of age in newborns presenting with a neurologic complaint.

This is a retrospective cohort study of all newborns admitted to the NICU at Children's National Hospital between 2004 and 2011 with a neurologic condition. Newborns were included if they had post-NICU follow-up for at least three years of age. Cox regression was used for analysis.

A total of 344 newborns met study criteria. The incidence of epilepsy was 25%. The overall rate of developing epilepsy was 44 per 1000 person-years with a median age at onset of 1.85 years. Factors associated with an increased rate of epilepsy included neonatal seizures, hydrocephalus, grade 4 intraventricular hemorrhage, an abnormal EEG, a severe EEG background, the absence of state changes, and the presence of status epilepticus. Infants with a moderate EEG background severity and status epilepticus had the greatest rate of developing epilepsy (HR 10.06, 95% CI 2.66-37.98, p = 0.001). Patients with neonatal seizures were more likely to develop drug-resistant epilepsy (OR 3.41, 95% CI 1.19 to 9.76, p = 0.022).

Regular surveillance of epilepsy in high-risk newborns may aid in early diagnosis and treatment initiation.

Epilepsy outcomes in neonates with neurologic conditions, e.g. acute brain injury, hydrocephalus, periventricular leukomalacia, or brain malformations, independent of presenting with neonatal seizures, are largely unknown This study addresses gaps in predicting post-neonatal epilepsy (PNE) by integrating demographic factors, neurologic diagnoses, neonatal seizure status, and EEG ictal/interictal features One in four newborns with a neurologic brain condition develops PNE regardless of presenting with seizures. EEG background abnormalities show the strongest association with PNE, while neonatal seizures increase the risk of drug-resistant epilepsy. These findings support improved risk counseling and closer surveillance, particularly during the first year of life.