Ronen Gabriel M, Buckley David, Penney Sharon, Streiner David L
Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Neurology. 2007 Nov 6;69(19):1816-22. doi: 10.1212/01.wnl.0000279335.85797.2c.
To examine outcome and explore for prognostic markers in a cohort <10 years following neonatal seizures.
We prospectively diagnosed clinical neonatal seizures with high specificity for true epileptic seizures in a population-based setting of all live newborns in the province of Newfoundland, Canada, between 1990 and 1995. Children with neonatal seizures were followed by specialized provincial health services. Follow-up data were collected on epilepsy, physical and cognitive impairments, and other heath issues.
Data were available on 82 out of 90 subjects. We added information on six others whose outcome was clearly predictable from earlier information. Prognosis was better for term than for preterm infants (p = 0.003): term: 28 (45%) normal, 10 (16%) deaths, and 24 (39%) with impairments; preterm: 3 (12%) normal, 11 (42%) deaths, and 12 (46%) with impairments. Of survivors, 17 (27%) developed epilepsy, 16 (25%) had cerebral palsy, 13 (20%) had mental retardation, and 17 (27%) had learning disorders. Variables associated with poor prognosis were Sarnat stage III or equivalent severe encephalopathy, cerebral dysgenesis, complicated intraventricular hemorrhage, infections in the preterm infants, abnormal neonatal EEGs, and the need for multiple drugs to treat the neonatal seizures. Pure clonic seizures without facial involvement in term infants suggested favorable outcome, whereas generalized myoclonic seizures in preterm infants were associated with mortality.
Poor prognosis for premature infants with seizures is reflected in high rates of subsequent long-term disability and mortality. The severity and timing of the pathologic process continue to be the major determinants for outcome.
研究新生儿惊厥发作后10年内队列人群的转归情况并探索预后标志物。
我们在1990年至1995年间，于加拿大纽芬兰省所有活产新生儿的人群基础上，前瞻性地诊断出对真正癫痫发作具有高特异性的临床新生儿惊厥。患有新生儿惊厥的儿童由省级专门的医疗服务机构进行随访。收集了有关癫痫、身体和认知障碍以及其他健康问题的随访数据。
90名受试者中有82名的数据可用。我们补充了另外6名受试者的信息，其转归可根据早期信息明确预测。足月儿的预后优于早产儿（p = 0.003）：足月儿中，28名（45%）正常，10名（16%）死亡，24名（39%）有障碍；早产儿中，3名（12%）正常，11名（42%）死亡，12名（46%）有障碍。在幸存者中，17名（27%）患癫痫，16名（25%）患脑瘫，13名（20%）有智力障碍，17名（27%）有学习障碍。与预后不良相关的变量包括萨纳特Ⅲ期或同等严重的脑病、脑发育异常、复杂性脑室内出血、早产儿感染、异常新生儿脑电图以及需要多种药物治疗新生儿惊厥。足月儿中无面部受累的单纯阵挛性发作提示预后良好，而早产儿的全身性肌阵挛发作与死亡率相关。
惊厥发作的早产儿预后不良体现在随后的长期残疾和死亡率较高。病理过程的严重程度和时间仍是转归的主要决定因素。
