Abstracts

Neonatal seizures are considered an acute manifestation of brain injury and they are classified as undetermined epilepsies with both generalized and focal seizures.
Our goal was to evaluate neonatal risk factors, EEG findings and ictal semeiological characteristics of our newborns with neonatal seizures in order to identify which clinical variables were the most early predictive factors of poor neurodevelopmental outcome and of epilepsy. During a period of 6 years, thirty-five preterm (PT) and forty-one term infants (FT)consecutively admitted to the NICU of University of Parma, Italy, were recruited for this study according to the following criteria: presence of EEG-confirmed repetitive neonatal seizures and/or neonatal status epilepticus, need of chronic anticonvulsant therapy, more than three EEG performed during the neonatal period, several cerebral ultrasound examinations, at least one neuroimaging exams (cerebral CT and/or cerebral MRI) and neurological follow-up longer than nine-months. Independent variables considered included mood of delivering, gestational age, birth-weight, Apgar score at 1^st, 5^th and 10^th minute, needs for resuscitation and assisted ventilation for more than one minute soon after birth, aetiologic factors, onset, duration and type of seizures, ictal and interictal EEG activity. Clinical seizures without EEG correlates were not considered. Neurodevelopmental outcome was assessed at 44 weeks of post-conceptional age, and at the corrected age of 1, 3, 6, and 9 months. The neurodevelopmental outcome was classified as favorable or adverse. A favorable outcome was defined as normal neurologic development, whilst adverse outcome was identify as involvement resulting in death, cerebral palsy, developmental delay, epilepsy. The Student[rsquo]s t test for unpaired date was used to compare means of subcategories of patients, while nominal data were analysed using [chi]² test and, if significant, Fisher[rsquo]s exact test for 2-by-2 comparison was used. In all instances, a p value of less than 0.05 was considered to be significant. Ten of the 35 PT subjects and 6 of the FT infants had neonatal status epilepticus. Among the PT infants (one lost during follow-up): five were normal, nine had CP, seven presented CP and epilepsy, one had only epilepsy while twelve died. Twenty-two FT infants had a normal outcome, nine had cerebral palsy, 2 presented cerebral palsy and epilepsy, five were epileptic and three died. From our data severely abnormal background EEG activity (p[lt]0,01), low Apgar scores (p[lt]0,008), severely abnormal neurological examination at birth (p=0,013) and abnormal cerebral ultrasound scans (p[lt]0,001) were the most significant predictors of poor neurodevelopmental outcome. Furthermore, none of the infants with status epilepticus presented a normal outcome and they had a greater risk of subsequent epilepsy.