Seizures in Preterm Neonates: A Multicenter Observational Cohort Study

Publication date: Available online 20 April 2017
Source:Pediatric Neurology
Author(s): Hannah C. Glass, Renée A. Shellhaas, Tammy N. Tsuchida, Taeun Chang, Courtney J. Wusthoff, Catherine J. Chu, M. Roberta Cilio, Sonia L. Bonifacio, Shavonne L. Massey, Nicholas S. Abend, Janet S. Soul
ObjectiveThe purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society's neonatal electorencephalogram monitoring guideline.Study DesignOf 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extremely preterm (<28 weeks, N=18), very preterm (28 to <32 weeks, N=18), and moderate/late preterm (32 to <37 weeks, N=56) and compared to term neonates.ResultHypoxic-ischemic encephalopathy (33%) and intracranial hemorrhage (27%) accounted for etiology in >50% of preterm neonates. Hypothermia therapy was administered in 15 moderate/late preterm subjects with encephalopathy. The presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) were similar when comparing preterm and term neonates. However, exclusively subclinical seizures were more common in preterm than term neonates (24% versus 14%). Phenobarbital was the most common initial medication for all gestational age groups and failure to respond to an initial loading dose was 63% in both preterm and term neonates. Mortality was similar among the three preterm gestational age groups; however, preterm mortality was more than twice that of term infants (35% versus 15%).ConclusionSubclinical seizures were more common and mortality was higher for preterm than term neonates. These data underscore the importance of electroencephalographic monitoring and the potential for improved management in preterm neonates.



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