Glass Hannah C, Shellhaas Renée A, Tsuchida Tammy N, Chang Taeun, Wusthoff Courtney J, Chu Catherine J, Cilio M Roberta, Bonifacio Sonia L, Massey Shavonne L, Abend Nicholas S, Soul Janet S
Departments of Neurology and Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
Pediatr Neurol. 2017 Jul;72:19-24. doi: 10.1016/j.pediatrneurol.2017.04.016. Epub 2017 Apr 20.
The 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 electroencephalography monitoring guideline.
Of 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 to late preterm (32 to <37 weeks, N = 56) and compared with term neonates.
Hypoxic-ischemic encephalopathy (33%) and intracranial hemorrhage (27%) accounted for the etiology in more than half of preterm neonates. Hypothermia therapy was utilized in 15 moderate to late preterm subjects with encephalopathy. The presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) was similar in preterm and term neonates. However, exclusively subclinical seizures occurred more often in preterm than term neonates (24% vs 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% vs 15%).
Subclinical 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.
本研究旨在描述纳入新生儿癫痫登记处的早产儿的癫痫发作情况。该登记处是一个前瞻性队列，收录了7个儿科中心连续收治的癫痫新生儿，这些中心遵循美国临床神经生理学会的新生儿脑电图监测指南。
在611名纳入研究的癫痫新生儿中，92名（15%）为早产儿。根据出生时的胎龄，将极早产儿（<28周，n = 18）、早产儿（28至<32周，n = 18）以及中晚期早产儿（32至<37周，n = 56）的癫痫发作特征进行评估，并与足月儿进行比较。
缺氧缺血性脑病（33%）和颅内出血（27%）占早产儿病因的一半以上。15名中晚期早产儿脑病患者接受了低温治疗。早产儿和足月儿的亚临床癫痫发作、单药治疗失败以及癫痫发作负担分布（包括癫痫持续状态）相似。然而，仅亚临床癫痫发作在早产儿中比足月儿更常见（24%对14%）。苯巴比妥是所有胎龄组最常用的初始药物，早产儿和足月儿对初始负荷剂量无反应的比例均为63%。三个早产儿胎龄组的死亡率相似；然而，早产儿死亡率是足月儿的两倍多（35%对15%）。
与足月儿相比，早产儿亚临床癫痫发作更常见，死亡率更高。这些数据强调了脑电图监测的重要性以及改善早产儿管理的潜力。
