Outcomes After Acute Symptomatic Seizures in Children Admitted to a Neonatal Neurocritical Care Service
Outcomes After Acute Symptomatic Seizures in Children Admitted to a Neonatal Neurocritical Care Service
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DOI：
10.1016/j.pediatrneurol.2018.03.016
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发表时间：
2018-07-01
影响因子：
3.8
通讯作者：
Rogers, Elizabeth E.
中科院分区：
文献类型：
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作者：
Glass, Hannah C.;Numis, Adam L.;Rogers, Elizabeth E.
背景：新生儿急性脑损伤引起的癫痫发作与死亡、残疾和癫痫的高发生率相关。我们的目的是检查癫痫的发病率和危险因素的幸存者的急性症状性新生儿癫痫谁照顾的新生儿neurocritical care service.Methods：新生儿急性症状性癫痫谁被收进加州大学旧金山分校贝尼奥夫儿童医院神经重症监护室从2008年7月至2014年6月被考虑纳入。共有144名急性症状性癫痫发作的儿童符合研究标准，其中37名（26%）在1岁前死亡。87名儿童（85%的合格幸存者）随访了一年或更长时间。8名儿童在中位年龄4.9（四分位距1.7，6.1）岁时被诊断为癫痫。癫痫的累积发病率风险在1年为2%（95%置信区间0.6%至9%），在5年为7%（95%置信区间3%至20%）。21%被诊断为脑瘫。Bayley-III认知子量表小于85分的患者占13%。癫痫患儿更有可能是早产儿，有脑损伤，出院后服用抗癫痫药物，尽管调整后的分析结果并不显著。癫痫的风险较低，发病年龄比以前的报告大，这可能与多种因素有关，包括神经重症监护方法，低温治疗缺氧缺血性脑病，新生儿过渡到姑息治疗的比率很高，新生儿癫痫发作被排除在外。婴儿期继续使用抗癫痫药物并不能降低癫痫的风险。需要进行长期的多中心研究来了解新生儿癫痫发作管理是否可以改变癫痫的风险。(C)2018爱思唯尔公司All rights reserved.
Background: Neonatal seizures due to acute brain injury are associated with high rates of death, disability, and epilepsy. Our objective was to examine incidence of and risk factors for epilepsy among survivors of acute symptomatic neonatal seizures who were cared for by a neonatal neurocritical care service.Methods: Neonates with acute symptomatic seizures who were admitted to UCSF Benioff Children's Hospital Neuro-Intensive Care Nursery from July 2008 to June 2014 were considered for inclusion.Results: A total of 144 children with acute symptomatic seizures met study criteria and 37 (26%) died before age one. Eighty-seven children (85% of eligible survivors) were followed up to one year or longer. Epilepsy was diagnosed in eight children at median age 4.9 (interquartile range 1.7, 6.1) years. The cumulative incidence risk of epilepsy at one year was 2% (95% confidence interval 0.6% to 9%) and at five years was 7% (95% confidence interval 3% to 20%). Cerebral palsy was diagnosed in 21%. Bayley-III cognitive subscale less than 85 was present in 13%. Children with epilepsy were more likely to be preterm, have brain injury, and be discharged home on antiseizure medication, although the results were not significant after adjusted analysis.Conclusions: The risk of epilepsy was lower and age at onset was older than in previous reports, which may be related to multiple factors including a neurocritical care approach, treatment of hypoxic-ischemic encephalopathy with hypothermia, high rate of neonatal transition to palliative care, and the exclusion of neonatal onset epilepsies. Continuation of antiseizure medications in infancy did not decrease the risk of epilepsy. Long-term, multicenter studies are needed to understand whether neonatal seizure management can alter the risk of epilepsy. (C) 2018 Elsevier Inc. All rights reserved.