Early neurodevelopmental follow-up results from the NEOLEV2 cohort

The aim of this study was to evaluate predictors of neurodevelopmental outcome following hypoxic-ischemic encephalopathy (HIE) and neonatal seizures in the randomized controlled trial cohort from the NEOLEV2 study.

Seizure burden, randomized levetiracetam versus phenobarbital antiseizure medication, and duration of breastfeeding were studied as predictors of neurodevelopmental outcome.

Outcome could be assessed in 115 patients with HIE and/or seizures; 89 patients with HIE (50% of 178 patients with HIE in the original cohort), and 60 patients with seizures (63% of 96 patients with seizures in the original cohort), and including 34 patients who had both HIE and seizures. A strong association between seizure burden and outcome was shown. However, the association was not statistically significant after correction for known predictors of outcome: magnetic resonance imaging severity of injury score, Sarnat score, and hypothermia treatment. This study was underpowered to assess for effect of randomized antiseizure medication or duration of breastfeeding on neurodevelopmental outcome; however, no large trends were seen.

This study adds to the debate as to whether neonatal seizures have an independent detrimental effect on neurodevelopmental outcome. Larger studies with longer neurodevelopmental follow-up are needed to investigate these questions.