Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Epilepsia. 2019 Oct;60(10):2086-2094. doi: 10.1111/epi.16340. Epub 2019 Sep 20.
This study investigated the incidence of epilepsy and identified neonatal risk morbidities for epilepsy in children born extremely preterm.
Of the 806 very preterm infants (birth weight < 1500 g, gestational age < 32 weeks) who survived and were discharged from the four neonatal intensive care units in southern Taiwan between 2003 and 2012, 686 (85.1%) had longitudinal neurodevelopmental follow-up assessments up to 5 years of age.
Among the 686 very preterm children, 19 (2.8%) exhibited epilepsy at a mean age of 19 ± 14 months. The incidence of epilepsy was highest among infants with neonatal seizure (33%), followed by cystic periventricular leukomalacia (cPVL, 27%), high-grade intraventricular hemorrhage (IVH, 21%), and necrotizing enterocolitis (NEC) stage III (20%). NEC stage III, neonatal seizure, high-grade IVH, and cPVL were also independent neonatal risk morbidities for epilepsy. Furthermore, the incidence of epilepsy was 21.6% in preterm children with significant neonatal brain injury (SNBI; ie, high-grade IVH and cPVL), but only 1% in preterm children without SNBI. Among preterm children with SNBI, neonatal seizure was higher in preterm children with epilepsy than in those without epilepsy (23.1% vs 2.1%, P = .03). Among preterm children without SNBI, NEC stage III was higher in preterm children with epilepsy than in those without epilepsy (33.3% vs 1.8%, P < .01). The preterm children with epilepsy were prone to have neurodevelopmental disability regardless of whether they had neonatal brain injury, and drug-resistant epilepsy (42%), particularly those with neonatal high-grade IVH.
There is an elevated incidence of epilepsy among very preterm children, and particularly those with significant brain injury and/or severe NEC during the neonatal period. Very preterm children with epilepsy are prone to have neurodevelopmental disability and drug-resistant epilepsy.
本研究旨在调查极低出生体重儿（出生体重＜1500 克，胎龄＜32 周）癫痫的发病率，并确定新生儿期癫痫的发病风险。
在 2003 年至 2012 年间，台湾南部的 4 家新生儿重症监护病房中，共有 806 例极低出生体重儿（出生体重＜1500 克，胎龄＜32 周）存活并出院，其中 686 例接受了长达 5 年的纵向神经发育随访评估。
在这 686 名极低出生体重儿中，有 19 名（2.8%）在平均 19±14 月龄时出现癫痫。癫痫发病率最高的是伴有新生儿惊厥的患儿（33%），其次是囊性脑室周围白质软化（cPVL，27%）、高级别脑室出血（IVH，21%）和坏死性小肠结肠炎（NEC）III 期（20%）。NEC III 期、新生儿惊厥、高级别 IVH 和 cPVL 也是癫痫的独立新生儿发病风险因素。此外，伴有显著新生儿脑损伤（即高级别 IVH 和 cPVL）的早产儿癫痫发生率为 21.6%，而无脑损伤的早产儿癫痫发生率为 1%。在伴有 SNBI 的早产儿中，伴有癫痫的早产儿较无癫痫的早产儿中新生儿惊厥发生率更高（23.1%比 2.1%，P=0.03）。在无脑损伤的早产儿中，伴有癫痫的早产儿较无癫痫的早产儿中 NEC III 期发生率更高（33.3%比 1.8%，P＜0.01）。无论是否存在新生儿脑损伤，患有癫痫的早产儿都容易出现神经发育障碍，且对药物治疗反应差（42%），尤其是伴有新生儿高级别 IVH 的患儿。
极低出生体重儿癫痫发病率较高，尤其是伴有严重脑损伤和/或新生儿期重度 NEC 的患儿。患有癫痫的极低出生体重儿易出现神经发育障碍和药物治疗反应差的癫痫。
