A scoring system for early prognostic assessment after neonatal seizures.
OBJECTIVE
The aim of this study was to devise a scoring system that could aid in predicting neurologic outcome at the onset of neonatal seizures.


METHODS
A total of 106 newborns who had neonatal seizures and were consecutively admitted to the NICU of the University of Parma from January 1999 through December 2004 were prospectively followed-up, and neurologic outcome was assessed at 24 months' postconceptional age. We conducted a retrospective analysis on this cohort to identify variables that were significantly related to adverse outcome and to develop a scoring system that could provide early prognostic indications.


RESULTS
A total of 70 (66%) of 106 infants had an adverse neurologic outcome. Six variables were identified as the most important independent risk factors for adverse outcome and were used to construct a scoring system: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from "normal" to "severely abnormal." A total composite score was computed by addition of the raw scores of the 6 variables. This score ranged from 0 to 12. A cutoff score of > or =4 provided the greatest sensitivity and specificity.


CONCLUSIONS
This scoring system may offer an easy, rapid, and reliable prognostic indicator of neurologic outcome after the onset of neonatal seizures. A final assessment of the validity of this score in routine clinical practice will require independent validation in other centers.
Pisani
Francesco
F
Child Neuropsychiatric Unit, University of Parma, Parma, Italy. francesco.pisani@unipr.it
Sisti
Lisa
L
Seri
Stefano
S
D001034:Apgar Score; D001724:Birth Weight; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis*; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D015999:Multivariate Analysis; D009460:Neurologic Examination; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012640:Seizures / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial