The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants
The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants
复制标题
DOI：
10.1542/peds.2005-1178
复制
发表时间：
2006-04-01
期刊：
影响因子：
8
通讯作者：
du Plessis, AJ
中科院分区：
文献类型：
--
作者：
Tekgul, H;Gauvreau, K;du Plessis, AJ
目标。本研究的目的是描述当前新生儿重症监护时代新生儿癫痫发作的病因学特征和神经发育结局，并确定幸存者神经发育结局的预测因素。89例临床新生儿癫痫的足月婴儿在新生儿期接受了神经学检查、脑电图（EEG）、神经影像学检查和广泛的诊断检查。出院后，所有婴儿都进行了定期的神经系统评估，并在12至18个月时进行了正式的神经发育测试。我们测试了癫痫病因、神经系统检查、脑电图和神经影像学的预后价值。77例患儿发现病因。全身性脑缺氧缺血、局灶性脑缺氧缺血和颅内出血最为常见。新生儿死亡率为7%；28%的幸存者长期预后不佳。癫痫病因和预后之间的相关性很强，大脑发育不良和全身缺氧缺血与预后不良相关。正常的新生儿期/早期婴儿神经系统检查与12至18个月时一致有利的结果相关；异常检查缺乏特异性。正常/轻度异常的新生儿脑电图有良好的结果，特别是如果新生儿神经影像学正常。中度/重度脑电图异常、多灶性/弥漫性皮质或主要为深部灰质病变的预后较差。与新生儿癫痫发作相关的死亡率已经下降，尽管长期的神经发育发病率保持不变。癫痫的病因和背景脑电图模式仍然是重要的预后因素。诊断的进步改变了新生儿癫痫发作的病因分布，提高了预后预测的准确性。全局性脑缺氧缺血是最常见的病因，是绝大多数婴儿长期预后不良的原因。
OBJECTIVES. The objectives of this study were to delineate the etiologic profile and neurodevelopmental outcome of neonatal seizures in the current era of neonatal intensive care and to identify predictors of neurodevelopmental outcome in survivors.METHODS. Eighty-nine term infants with clinical neonatal seizures underwent neurologic examination, electroencephalography (EEG), neuroimaging, and extensive diagnostic tests in the newborn period. After discharge, all infants underwent regular neurologic evaluations and, at 12 to 18 months, formal neurodevelopmental testing. We tested the prognostic value of seizure etiology, neurologic examination, EEG, and neuroimaging.RESULTS. Etiology was found in 77 infants. Global cerebral hypoxia-ischemia, focal cerebral hypoxia-ischemia, and intracranial hemorrhage were most common. Neonatal mortality was 7%; 28% of the survivors had poor long-term outcome. Association between seizure etiology and outcome was strong, with cerebral dysgenesis and global hypoxia-ischemia associated with poor outcome. Normal neonatal period/early infancy neurologic examination was associated with uniformly favorable outcome at 12 to 18 months; abnormal examination lacked specificity. Normal/mildly abnormal neonatal EEG had favorable outcome, particularly if neonatal neuroimaging was normal. Moderate/ severely abnormal EEG, and multifocal/ diffuse cortical or primarily deep gray matter lesions, had a worse outcome.CONCLUSIONS. Mortality associated with neonatal seizures has declined although long-term neurodevelopmental morbidity remains unchanged. Seizure etiology and background EEG patterns remain powerful prognostic factors. Diagnostic advances have changed the etiologic distribution for neonatal seizures and improved accuracy of outcome prediction. Global cerebral hypoxia-ischemia, the most common etiology, is responsible for the large majority of infants with poor long-term outcome.