The Journal of Pediatrics
Volume 155, Issue 3 , Pages 318-323, September 2009

Clinical Neonatal Seizures are Independently Associated with Outcome in Infants at Risk for Hypoxic-Ischemic Brain Injury

  • Hannah C. Glass, MDCM

      Affiliations

    • Department of Neurology, University of California San Francisco, San Francisco, CA
    • Department of Pediatrics, University of California San Francisco, San Francisco, CA
    • Corresponding Author InformationReprint requests: Hannah C. Glass, University of California San Francisco, Department of Neurology, Box 0663, 521 Parnassus Avenue, C-215, San Francisco, CA 94143-0663.
    • ,
  • David Glidden, PhD

      Affiliations

    • Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA
    • ,
  • Rita J. Jeremy, PhD

      Affiliations

    • Department of Pediatrics, University of California San Francisco, San Francisco, CA
    • ,
  • A. James Barkovich, MD

      Affiliations

    • Department of Neurology, University of California San Francisco, San Francisco, CA
    • Department of Pediatrics, University of California San Francisco, San Francisco, CA
    • Department of Radiology, University of California San Francisco, San Francisco, CA
    • ,
  • Donna M. Ferriero, MD

      Affiliations

    • Department of Neurology, University of California San Francisco, San Francisco, CA
    • Department of Pediatrics, University of California San Francisco, San Francisco, CA
    • ,
  • Steven P. Miller, MDCM

      Affiliations

    • Department of Neurology, University of California San Francisco, San Francisco, CA
    • Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

Received 9 December 2008; received in revised form 2 February 2009; accepted 19 March 2009. published online 22 June 2009.

Objective

To examine whether neonatal seizures are associated with neurodevelopmental outcomes in infants with hypoxia-ischemia independent of the presence and severity of brain injury seen on magnetic resonance imaging (MRI).

Study design

We used multivariate regression to examine the independent effect of clinical neonatal seizures and their treatment on neurodevelopment in 77 term newborns at risk for hypoxic-ischemic brain injury. Clinical seizures were recorded prospectively, and high-resolution newborn MRI measured the severity of brain injury. The outcome measure was the Full-Scale Intelligence Quotient (FSIQ) of the Wechsler Preschool and Primary Scale of Intelligence-Revised and neuromotor score at age 4 years.

Results

After controlling for severity of injury on MRI, the children with neonatal seizures had worse motor and cognitive outcomes compared with those without seizures. The magnitude of effect varied with seizure severity; children with severe seizures had a lower FSIQ than those with mild/moderate seizures (P < .0001).

Conclusions

Clinical neonatal seizures in the setting of birth asphyxia are associated with worse neurodevelopmental outcome, independent of the severity of hypoxic-ischemic brain injury. Randomized controlled trials are needed to determine whether differences in seizure treatment can improve outcome.

CI, Confidence interval, EEG, Electroencephalography, FSIQ, Full-Scale Intelligence Quotient, MRI, Magnetic resonance imaging, SD, Standard deviation, SE, Spin-echo, WPPSI-R, Wechsler Preschool and Primary Scale of Intelligence-Revised

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 Supported by Grant UL RR024131-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH); the NIH Roadmap for Medical Research; and NIH Grant NS40117. H. G. is supported by National Institute of Neurological Disorders and Stroke Neurological Sciences Academic Development Award NS01692. The contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH. S.M. is supported by a Clinician Scientist award from the Canadian Institutes of Health Research and a Scholar award from the Michael Smith Foundation for Health Research. The authors report no conflicts of interest.

PII: S0022-3476(09)00320-5

doi:10.1016/j.jpeds.2009.03.040

Refers to article:

  • Do Seizures Contribute to Neonatal Hypoxic-Ischemic Brain Injury?

    Faye S. Silverstein
    The Journal of Pediatrics September 2009 (Vol. 155, Issue 3, Pages 305-306)

The Journal of Pediatrics
Volume 155, Issue 3 , Pages 318-323, September 2009

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