Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study.
OBJECTIVE
To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG).


METHODS
We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks' postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at 7 US tertiary care pediatric centers following the guidelines of the American Clinical Neurophysiology Society for cEEG for at-risk neonates. Seizure etiology, burden, management, and outcome were determined by chart review by the use of a case report form designed at study onset.


RESULTS
The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received ≥2 antiseizure medications. During the neonatal admission, 17% died; 49% of survivors had abnormal neurologic examination at hospital discharge. In an adjusted analysis, high seizure burden was a significant risk factor for mortality, length of hospital stay, and abnormal neurological examination at discharge.


CONCLUSIONS
In this large contemporary profile of consecutively enrolled newborns with seizures treated at centers that use cEEG per the guidelines of the American Clinical Neurophysiology Society, about one-half had high seizure burden, received ≥2 antiseizure medications, and/or died or had abnormal examination at discharge. Greater seizure burden was associated with increased morbidity and mortality. These findings underscore the importance of accurate determination of neonatal seizure frequency and etiology and a potential for improved outcome if seizure burden is reduced.
Departments of Neurology & Pediatrics, University of California, San Francisco Benioff Children's Hospital, University of California San Francisco, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA.
Hannah C
HC
Glass
Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI.
Renée A
RA
Shellhaas
Departments of Neurology & Pediatrics, Stanford University, Palo Alto, CA.
Courtney J
CJ
Wusthoff
Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, DC.
Taeun
T
Chang
Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Nicholas S
NS
Abend
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Catherine J
CJ
Chu
Departments of Neurology & Pediatrics, University of California, San Francisco Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
M Roberta
MR
Cilio
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA.
David V
DV
Glidden
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.
Sonia L
SL
Bonifacio
Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Shavonne
S
Massey
Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, DC.
Tammy N
TN
Tsuchida
Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI.
Faye S
FS
Silverstein
Department of Neurology, Boston Children's Hospital, Boston, MA.
Janet S
JS
Soul
D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality
D000927:Anticonvulsants
EEG; critical care; electroencephalogram; epilepsy; hypoxic-ischemic encephalopathy; infant; neonatal encephalopathy; neonatal seizures; neurocritical care