Clinical Neonatal Seizures are Independently Associated with Outcome in Infants at Risk for Hypoxic-Ischemic Brain Injury.
OBJECTIVE
To examine whether neonatal seizures are associated with neurodevelopmental outcomes in infants with hypoxia-ischemia independent of the presence and severity of brain injury seen on magnetic resonance imaging (MRI).


METHODS
We used multivariate regression to examine the independent effect of clinical neonatal seizures and their treatment on neurodevelopment in 77 term newborns at risk for hypoxic-ischemic brain injury. Clinical seizures were recorded prospectively, and high-resolution newborn MRI measured the severity of brain injury. The outcome measure was the Full-Scale Intelligence Quotient (FSIQ) of the Wechsler Preschool and Primary Scale of Intelligence-Revised and neuromotor score at age 4 years.


RESULTS
After controlling for severity of injury on MRI, the children with neonatal seizures had worse motor and cognitive outcomes compared with those without seizures. The magnitude of effect varied with seizure severity; children with severe seizures had a lower FSIQ than those with mild/moderate seizures (P < .0001).


CONCLUSIONS
Clinical neonatal seizures in the setting of birth asphyxia are associated with worse neurodevelopmental outcome, independent of the severity of hypoxic-ischemic brain injury. Randomized controlled trials are needed to determine whether differences in seizure treatment can improve outcome.
Glass
Hannah C
HC
Department of Neurology, University of California San Francisco, San Francisco, CA 94143-0663, USA. Hannah.Glass@ucsf.edu
Glidden
David
D
Jeremy
Rita J
RJ
Barkovich
A James
AJ
Ferriero
Donna M
DM
Miller
Steven P
SP
D001238:Asphyxia Neonatorum / Q000453:epidemiology*; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000453:epidemiology*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D011581:Psychological Tests; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology*; D012720:Severity of Illness Index