Authors :
Presenting Author: Varun Sampat, MD – Medical College of Wisconsin
Elham Abushanab, MD – Children's Hospital of Wisconsin; Samuel Adams, MD – Children's Hospital of Wisconsin; Jenna Jozwik, APNP – Children's Hospital of Wisconsin; Avantika Singh, MD – Children's Hospital of Wisconsin
Rationale: This study aims to guide counseling for neonates at high risk for infantile spasms following a Neonatal Intensive Care Unit (NICU) stay.
Methods: Patients with a diagnosis of infantile spasms between 2013-2022 were identified and those with history of NICU admission were included. Patients were identified through search of the electronic medical record system using ICD-10 codes. We reviewed the patients’ demographic data, physical exam at NICU discharge, EEG, and MRI data. If available, post-natal EEG data within three months was also reviewed. Known risk factors for IS after neonatal seizures were collected. These include risk factors recently reported in a prediction model: 1. Severely abnormal EEG or 3+ days with seizures on EEG, 2. Deep gray or brainstem injury on MRI, and/or 3. Abnormal tone on NICU discharge exam. (Glass et al., 2020)
Results: Three hundred thirty-six patients with ICD-10 code of infantile spasms in their chart were screened, of which 27 patients met inclusion criteria of prior NICU admission and development of infantile spasms. Seven patients (26%) who developed IS after NICU stay had history of neonatal seizures. Among patients with neonatal seizures, five of seven patients had two or more known risk factors listed in the prediction model described above. All patients with neonatal seizures and subsequent IS had at least one of the three known risk factors. In patients who did not have neonatal seizures (n=20), 50% (n=10) had abnormal NICU discharge exam and 40% (n=8) had abnormal EEG within three months of NICU discharge. 90% (n=18) had abnormal NICU discharge exam and/or abnormal EEG within three months of NICU discharge. Of the risk factors identified above, 11% (n=3) of the 27 patients included had all three risk factors, 19% (n=2) had two risk factors, and 48% (n=13) had one risk factor. Among patients who had none of the three previously identified risk factors but developed IS (n=6), EEG within three months of NICU discharge was abnormal in 50% (n=3).
Conclusions: Counseling for IS among high-risk neonates is essential at the time of NICU discharge, however it is not known who will benefit, particularly in the absence of neonatal seizures. Using a reverse approach, our study included patients who developed IS with a history of NICU admission to evaluate the findings of a recent prediction model for IS in neonates with seizures in the NICU. In the absence of neonatal seizures, presence of abnormal exam at NICU discharge and post-neonatal EEG within first three months of discharge can aid in identifying at-risk patients and provide early counseling. Early counseling will aid in earlier diagnosis, thus reducing lead time to treatment, which is known to improve outcomes for IS patients.
Funding: None