Abstracts

Neonatal seizures might represent a major symptom of preterm infants with severe involvement of the central nervous system. In a cohort of preterm infants with neonatal seizures we investigated the neurodevelopmental outcome at two years and the relationship with the Gestational Age (GA) and the birthweight. We studied the preterm infants consecutively admitted to the NICU of University of Parma between January 1999 and December 2003. Thirty-five infants with GA [le] 36 were selected following these criteria: a) repetitive neonatal EEG-confirmed seizures in the period through 44 weeks[apos] gestation, b) need of chronic anticonvulsant therapy, c) seizures confirmed by EEG registration before starting antiepileptic therapy, d) more than one EEG performed during the neonatal period with recording of ictal activity, e) at least one imaging examination (cerebral ultrasound and/or cerebral MRI), f) neurological follow-up at least at 2 years of post-conceptional age.The thirty-five infants were divided into two groups on the basis of their GA: Group I twenty infants born between 24 weeks to 29 weeks of GA, Group II fifteen infants born between thirty to thirty-six weeks of GA. Moreover, they were divided in two groups on the basis of their birthweight: subjects less than 1500 grams and subjects more than 1500 grams.
In all patients neonatal variables as type of delivering, birthweight, gestational age, Apgar score at 1^st, 5^th and 10^th minute, needs for resuscitation and assisted ventilation for more than one minute with positive pressure ventilation and oxygen soon after birth, arterial-blood pH, aetiologic factors, onset, duration and type of seizures, ictal and interictal EEG activity were analysed.
Neurodevelopmental outcome was assessed at 44 weeks of post-conceptional age, after 1 month from the discharge and at the corrected age of 6, 12, 18, 24 months. A favorable outcome was defined as normal neurological development, while adverse outcome was identified as involvement resulting in death, cerebral palsy, developmental delay, blindness, or deafness. The Student[apos]s t test for unpaired date was used to compare means of subcategories of patients, whereas nominal data were analysed using [chi]² test and, if significant, Fisher[apos]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. At the last follow-up 12 of preterm infants died (9 belonging to the Group I), 5 infants were normal, 17 presented cerebral palsy that was associated to epilepsy in seven, one had only epilepsy. Among them 13 had a severe developmental delay. The outcome was significantly adverse in preterms (18/22) with low birthweight (p[lt]0,02) and in the very early preterms (18/20) (p[lt]0.002). From our data, we found a strong association between neonatal seizures in preterm babies of very early GA and low birthweight with an adverse outcome at two years of age.