Department of Neurology, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Dev Med Child Neurol. 2019 Jun;61(6):661-666. doi: 10.1111/dmcn.14174. Epub 2019 Feb 4.
This population-based study aimed to estimate the impact of neonatal seizures on subsequent neurological outcomes, regardless of underlying etiology.
We performed a retrospective cohort study (1st January 2009-31st December 2014), using a USA nationwide claims database. Newborn infants enrolled in 2009 were followed for up to 6 years. Neonatal seizures were identified by combining the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 779.0 (convulsions in newborn), procedure codes of electroencephalogram and brain imaging, and antiepileptic drugs claims. Cox regression models were built to estimate the independent impact of neonatal seizures on developing epilepsy, intellectual disability, psychiatric/behavioral disorders, and headache.
Out of 490 071 newborn infants (251 850 males [51.4%], 238 221 females [48.6%]), 800 neonatal seizure cases were identified. After controlling for sex, birthweight, preterm birth status, and underlying etiology, neonates with seizures were more likely to have epilepsy (hazard ratio=32.7; 95% confidence interval [CI]=27.7-38.7; p<0.001), intellectual disability (hazard ratio=2.0; 95% CI=1.8-2.3; p<0.001), and headache (hazard ratio=1.6; 95% CI=1.1-2.2; p=0.013) than those without seizures.
Observed covariates being equal, seizures in neonates appeared to play a significant role in developing epilepsy, intellectual disability, and headache. The findings showed a detrimental impact of the event in the very early life on neurological outcomes in later life.
Seizures had their own impact on the development of adverse neurological outcomes. The magnitude of impact was quite large in epilepsy.
本基于人群的研究旨在估计新生儿癫痫发作对随后神经发育结局的影响，而不考虑潜在病因。
我们进行了一项回顾性队列研究（2009 年 1 月 1 日至 2014 年 12 月 31 日），使用美国全国索赔数据库。2009 年入组的新生儿随访时间最长达 6 年。新生儿癫痫发作通过国际疾病分类，第九修订版，临床修正诊断代码 779.0（新生儿惊厥）、脑电图和脑成像程序代码以及抗癫痫药物的索赔来识别。使用 Cox 回归模型来估计新生儿癫痫发作对癫痫、智力障碍、精神/行为障碍和头痛的独立影响。
在 490071 名新生儿（251850 名男性[51.4%]，238221 名女性[48.6%]）中，共发现 800 例新生儿癫痫发作病例。在控制性别、出生体重、早产状况和潜在病因后，癫痫发作的新生儿更有可能患有癫痫（风险比=32.7；95%置信区间[CI]为 27.7-38.7；p<0.001）、智力障碍（风险比=2.0；95%CI 为 1.8-2.3；p<0.001）和头痛（风险比=1.6；95%CI 为 1.1-2.2；p=0.013），而无癫痫发作的新生儿则无上述疾病。
在观察到的协变量相等的情况下，新生儿癫痫发作似乎在癫痫、智力障碍和头痛的发生中起着重要作用。这些发现表明，生命早期的事件对以后的神经发育结局有不利影响。
癫痫发作对不良神经发育结局的发展有其自身的影响。在癫痫中影响程度相当大。
