Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Department of Neonatology, Guangzhou Women & Children's Medical Center, Guangdong, China.
JAMA Netw Open. 2023 Jul 3;6(7):e2326301. doi: 10.1001/jamanetworkopen.2023.26301.
Neonatal seizures pose a significant challenge in critical care, and continuous video electroencephalography (cEEG) monitoring holds promise for early detection of seizures. However, large-scale data on the incidence of neonatal seizures and monitoring systems in China are lacking.
To determine the incidence of neonatal seizures in infants with high risk in China.
DESIGN, SETTING, AND PARTICIPANTS: A large, cross-sectional multicenter study was conducted from January 2017 to December 2018 in the neonatal intensive care units (NICUs) of 7 tertiary medical centers in China. Neonates with high risk were included, and cEEG monitoring was conducted. Data were collected between January 1, 2017, and January 31, 2020. The data were analyzed between January 2021 and January 2022.
The incidence of neonatal seizures, categorized by etiology, and seizure burden.
A total of 20 310 neonates with high risk were included (10 495 [51.7%] male; mean [SD] postmenstrual age, 37.7 [3.7] weeks), and seizures were observed in 3423 infants (16.9%). The highest proportion of seizures was attributed to acute neonatal encephalopathy (1448 [42.3%]). The incidence of seizures decreased with postmenstrual age and birth weight, with the highest occurrence observed in neonates with postmenstrual age of less than 28 weeks (237 of 879 [27.0%]) or birth weight of less than 1.0 kg (269 of 914 [29.4%]). Preterm infants had a higher proportion of moderate and severe seizure burdens compared with full-term infants (moderate severity: 248 of 1199 [20.7%] vs 454 of 2224 [20.4%]), but no significant differences were observed in etiology. Seizure burden was highest with genetic syndromes (49 of 188 [26.1%]), central nervous system malformations (33 of 127 [26.0%]), and inborn errors of metabolism (27 of 113 [23.9%]). During hospitalization, 7.8% of neonates with seizures died (267 neonates), with 81.3% of these cases having a moderate or severe seizure burden (217 neonates). Mortality was generally higher in preterm vs full-term infants (98 of 1199 [8.2%] vs 169 of 2224 [7.6%]) and increased with the severity of seizure burden (217 of 267 neonates with moderate or severe burden [81.3%]).
This cross-sectional study of neonatal seizures underscores the substantial burden seizures pose to high-risk infants with brain injury in China, particularly those who are born prematurely or who have congenital conditions.
新生儿癫痫在重症监护中构成重大挑战，而连续视频脑电图（cEEG）监测有望早期发现癫痫。然而，中国关于新生儿癫痫发病率和监测系统的大规模数据仍然缺乏。
确定中国高危新生儿癫痫的发病率。
设计、地点和参与者：这是一项大型的、横断面的多中心研究，于 2017 年 1 月至 2018 年 12 月在中国 7 家三级医疗中心的新生儿重症监护病房（NICU）进行。纳入高危新生儿，并进行 cEEG 监测。数据收集于 2017 年 1 月 1 日至 2020 年 1 月 31 日。数据分析于 2021 年 1 月至 2022 年 1 月进行。
根据病因和癫痫发作负担分类的新生儿癫痫发病率。
共纳入 20310 例高危新生儿（男婴 10495 例[51.7%]；平均[标准差]胎龄 37.7[3.7]周），3423 例婴儿出现癫痫发作（16.9%）。癫痫发作中比例最高的是急性新生儿脑病（1448 例[42.3%]）。癫痫发作的发生率随胎龄和出生体重而降低，胎龄小于 28 周（879 例中的 237 例[27.0%]）或出生体重小于 1.0 kg（914 例中的 269 例[29.4%]）的新生儿发生率最高。早产儿与足月儿相比，中重度癫痫发作负担的比例更高（中度严重程度：1199 例中的 248 例[20.7%] vs 2224 例中的 454 例[20.4%]），但病因无显著差异。遗传综合征（188 例中的 49 例[26.1%]）、中枢神经系统畸形（127 例中的 33 例[26.0%]）和先天性代谢缺陷（113 例中的 27 例[23.9%]）的癫痫发作负担最高。住院期间，7.8%的癫痫发作患儿死亡（267 例），其中 81.3%为中重度癫痫发作负担（217 例）。早产儿的死亡率总体高于足月儿（1199 例中的 98 例[8.2%] vs 2224 例中的 169 例[7.6%]），且随癫痫发作负担的严重程度而增加（267 例中重度或重度负担的患儿中[81.3%]）。
本项关于新生儿癫痫的横断面研究强调了癫痫对中国有脑损伤高危婴儿的巨大负担，尤其是那些早产儿或患有先天性疾病的婴儿。
Zotero 插件
