The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants.
OBJECTIVE
The objectives of this study were to delineate the etiologic profile and neurodevelopmental outcome of neonatal seizures in the current era of neonatal intensive care and to identify predictors of neurodevelopmental outcome in survivors.


METHODS
Eighty-nine term infants with clinical neonatal seizures underwent neurologic examination, electroencephalography (EEG), neuroimaging, and extensive diagnostic tests in the newborn period. After discharge, all infants underwent regular neurologic evaluations and, at 12 to 18 months, formal neurodevelopmental testing. We tested the prognostic value of seizure etiology, neurologic examination, EEG, and neuroimaging.


RESULTS
Etiology was found in 77 infants. Global cerebral hypoxia-ischemia, focal cerebral hypoxia-ischemia, and intracranial hemorrhage were most common. Neonatal mortality was 7%; 28% of the survivors had poor long-term outcome. Association between seizure etiology and outcome was strong, with cerebral dysgenesis and global hypoxia-ischemia associated with poor outcome. Normal neonatal period/early infancy neurologic examination was associated with uniformly favorable outcome at 12 to 18 months; abnormal examination lacked specificity. Normal/mildly abnormal neonatal EEG had favorable outcome, particularly if neonatal neuroimaging was normal. Moderate/severely abnormal EEG, and multifocal/diffuse cortical or primarily deep gray matter lesions, had a worse outcome.


CONCLUSIONS
Mortality associated with neonatal seizures has declined although long-term neurodevelopmental morbidity remains unchanged. Seizure etiology and background EEG patterns remain powerful prognostic factors. Diagnostic advances have changed the etiologic distribution for neonatal seizures and improved accuracy of outcome prediction. Global cerebral hypoxia-ischemia, the most common etiology, is responsible for the large majority of infants with poor long-term outcome.
Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Hasan
H
Tekgul
Kimberlee
K
Gauvreau
Janet
J
Soul
Lauren
L
Murphy
Richard
R
Robertson
Jane
J
Stewart
Joseph
J
Volpe
Blaise
B
Bourgeois
Adré J
AJ
du Plessis
D001921:Brain / Q000002:abnormalities / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D002657:Child Development; D002658:Developmental Disabilities / Q000175:diagnosis; D004569:Electroencephalography; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008659:Metabolic Diseases / Q000150:complications; D009460:Neurologic Examination; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis / Q000209:etiology*