Identification of infants at risk for infantile spasms by neonatal polygraphy.
Reevaluation of neonatal EEGs and polygraphic tracings of 40 infants with infantile spasms and/or hypsarrhythmia resulted in the constitution of a compound score for the identification of infants at risk for infantile spasms by neonatal EEG. The score comprises 8 distinct items: 2 concern behavioral characteristics, 6 abnormality of EEG background activity and paroxysmal events. A tracing registered at conceptional age 36 to 44 weeks (eventually up to 50 weeks) presenting at least 4 of these 8 items is scored positive for the risk of evolving hypsarrhythmia. In a prospective study the polygraphic tracings of 941 newborn infants were evaluated for risk: 18 infants suffering from perinatal distress and 7 newborns with malformations of the brain were scored positive and all 25 developed infantile spasms and/or hypsarrhythmia. One infant with later infantile spasms was missed by the scoring system. None of the remaining infants scored negative manifested infantile spasms. Thus, correct positive prognostication was 100% and false negative 0.1%. By conventional EEG 5 out of 8 patients with infantile spasms were correctly predicted. The high validity of the risk-score based on polygraphic tracing between conceptional age 36 to 44 weeks may allow pre-onset treatment preventing secondary mental deterioration due to hypsarrhythmia and infantile spasms.
Department of Pediatrics, University Hospital, Mainz, West Germany.
B
B
Walther
T
T
Schmitt
B
B
Reitter
D004569:Electroencephalography; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D012895:Sleep, REM / Q000502:physiology; D013036:Spasms, Infantile / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology