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Outcome in neonates with convulsions treated in an intensive care unit
Insights
Neonatal seizures can lead to significant disabilities, with outcomes depending on seizure type and onset. Premature infants who survive neonatal seizures have similar outcomes to term infants.
Area of Science:
- Neonatology
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Neonatal seizures are a critical concern affecting infant neurological development.
- Long-term outcomes for neonatal seizure survivors require comprehensive assessment.
Purpose of the Study:
- To evaluate the neurological and developmental outcomes of neonatal seizure survivors.
- To identify predictors of poor neurological outcomes in infants treated for neonatal seizures.
Main Methods:
- Retrospective analysis of 131 neonatal seizure survivors treated between 1976-1979.
- Assessment of neurological and developmental status at ages 1-5 years.
- Multivariate analysis to identify predictors of outcome.
Main Results:
- 51% of survivors were normal, while 45% experienced disabilities (moderate to severe).
- Hypoxic-ischemic insult was a common cause, with 41% developing moderate/severe disabilities.
- Late onset, tonic seizures, and prolonged seizures predicted poor outcomes in hypoxic-ischemic cases.
Conclusions:
- Neonatal seizures are associated with a substantial risk of long-term neurological and developmental disabilities.
- Specific seizure characteristics are critical predictors of poor outcomes, particularly in hypoxic-ischemic insults.
- Premature infants who survive neonatal seizures do not have significantly different outcomes compared to term infants.
Abstract:
Neurological and developmental outcome was assessed in 131 survivors of neonatal seizures aged 1 to 5 years who had been treated in a single intensive care unit from 1976 to 1979. Half the children had been born at less than 37 weeks' gestational age, and 28% at 31 weeks or less. Fifty-one children were normal on examination, 17 had minor abnormalities, 25 had moderate disabilities, 30 had severe disabilities, 6 had died because of profound neurological deficits, and 2 could not be located. Recurrent nonfebrile seizures had developed in 26 children. Most children with motor handicaps or visual loss were intellectually retarded, but 10 of 15 children with bilateral hearing loss were intellectually normal. Of 77 children whose seizures were caused by a hypoxic-ischemic insult, 41 developed moderate or severe disabilities. As determined by multivariate analysis, significant neonatal predictors of poor outcome in this group included seizures with late onset, tonic seizures, and seizures lasting for many days. Although seizure frequency and neonatal mortality associated with seizures were greatest in very premature infants, the outcome in premature infants who survived was not significantly different from that of term infants.