Neuropaediatric Unit, Astrid Lindgren's Children's Hospital, Karolinska University Hospital and Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Neonatology Unit, Astrid Lindgren's Children's Hospital, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Eur J Paediatr Neurol. 2024 Mar;49:45-54. doi: 10.1016/j.ejpn.2024.02.005. Epub 2024 Feb 12.
To conduct a systematic review of post-neonatal neurological outcomes and mortality following neonatal seizures with electroencephalographical verification.
The databases Medline, Embase and Web of Science were searched for eligible studies. All abstracts were screened in a blinded fashion between research team members and reports found eligible were obtained and screened in full text by two members each. From studies included, outcome results for post-neonatal epilepsy, cerebral palsy, intellectual disability, developmental delay, mortality during and after the neonatal period and composite outcomes were extracted. A quality assessment of each study was performed.
In total, 5518 records were screened and 260 read in full text. Subsequently, 31 studies were included, containing cohorts of either mixed or homogenous etiologies. Follow-up time and gestational ages varied between studies. No meta-analysis could be performed due to the low number of studies with comparable outcomes and effect measures. Reported cumulative incidences of outcomes varied greatly between studies. For post-neonatal epilepsy the reported incidence was 5-84%, for cerebral palsy 9-78%, for intellectual disability 24-67%, for developmental delay 10-67% and for mortality 1-62%. Subgroup analysis had more coherent results and in cohorts with status epilepticus a higher incidence of post-neonatal epilepsy from 46 to 84% was shown.
The large variation of reported incidences for neurological outcomes and mortality found even when restricting to cohorts with electroencephalographically verified neonatal seizures indicates selection bias as a significant confounder in existing studies. Population-based approaches are thus warranted to correctly predict outcomes in this group.
系统评价脑电图证实的新生儿期后癫痫发作后神经发育结局和死亡率。
检索 Medline、Embase 和 Web of Science 数据库，筛选符合条件的研究。研究小组成员对所有摘要进行盲法筛选，并获得合格的报告，然后由两名成员分别进行全文筛选。从纳入的研究中，提取新生儿期后癫痫、脑瘫、智力障碍、发育迟缓、新生儿期和之后的死亡率以及复合结局的结果。对每项研究进行质量评估。
共筛选出 5518 条记录，并对 260 条记录进行了全文阅读。随后，纳入了 31 项研究，这些研究包含了混合或同质病因的队列。研究之间的随访时间和胎龄不同。由于具有可比结局和效应测量的研究数量较少，因此无法进行荟萃分析。报告的结局累积发生率在研究之间差异很大。新生儿期后癫痫的报告发生率为 5-84%，脑瘫为 9-78%，智力障碍为 24-67%，发育迟缓为 10-67%，死亡率为 1-62%。亚组分析结果更一致，在伴有癫痫持续状态的队列中，新生儿期后癫痫的发生率从 46%到 84%不等。
即使将研究限制在脑电图证实的新生儿癫痫发作队列中，报告的神经发育结局和死亡率的发生率差异很大，这表明选择偏倚是现有研究中的一个重要混杂因素。因此，需要采用基于人群的方法来正确预测该人群的结局。
