Seizures in Extremely Low Birth Weight Infants Are Associated with Adverse Outcome
Received 3 February 2010; received in revised form 30 March 2010; accepted 27 April 2010. published online 14 June 2010. Corrected Proof
Objective
To examine risk factors for neonatal clinical seizures and to determine the independent association with death or neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants.
Study design
A total of 6499 ELBW infants (401-1000 g) surviving to 36 weeks postmenstrual age (PMA) were included in this retrospective study. Unadjusted comparisons were performed between infants with (n = 414) and without (n = 6085) clinical seizures during the initial hospitalization. Using multivariate logistic regression modeling, we examined the independent association of seizures with late death (after 36 weeks PMA) or NDI after controlling for multiple demographic, perinatal, and neonatal variables.
Results
Infants with clinical seizures had a greater proportion of neonatal morbidities associated with poor outcome, including severe intraventricular hemorrhage, sepsis, meningitis, and cystic periventricular leukomalacia (all P < .01). Survivors were more likely to have NDI or moderate-severe cerebral palsy at 18 to 22 months corrected age (both P < .01). After adjusting for multiple confounders, clinical seizures remained significantly associated with late death or NDI (odds ratio, 3.15; 95% CI, 2.37-4.19).
Conclusion
ELBW infants with clinical seizures are at increased risk for adverse neurodevelopmental outcome, independent of multiple confounding factors.
aDivision of Neonatal-Developmental Medicine, Stanford University, Stanford, CA
bStatistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
cStatistics and Epidemiology Unit, RTI International, Rockville, MD
dDepartment of Pediatrics, Emory University School of Medicine, Atlanta, GA
eDepartment of Pediatrics, Case Western Reserve University, Cleveland, OH
fDepartment of Pediatrics, Wayne State University, Detroit, MI
gDepartment of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA
hDepartment of Pediatrics, Brown University, Providence, RI
iPregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
Reprint requests: Alexis S. Davis, MD, Instructor, Division of Neonatology, Stanford University School of Medicine and Lucile Packard Children's Hospital, 750 Welch Rd, Suite 315, Palo Alto, CA 94304.
Supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for the Neonatal Research Network's Generic Database Study and Follow-up Study. The authors declare no conflicts of interest.
∗ List of members of the Eunice Kennedy Shriver National Institue of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).
ABSTRACT