Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia

  • Seo, Sun Young (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Shim, Gyu Hong (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Chey, Myoung Jae (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • You, Su Jeong (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine)
  • Received : 2016.08.05
  • Accepted : 2016.10.11
  • Published : 2016.11.15
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Abstract

Purpose: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. Methods: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. Results: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. Conclusion: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.

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References

  1. Rei M, Ayres-de-Campos D, Bernardes J. Neurological damage arising from intrapartum hypoxia/acidosis. Best Pract Res Clin Obstet Gynaecol 2016;30:79-86. https://doi.org/10.1016/j.bpobgyn.2015.04.011
  2. Dudek FE, Ekstrand JJ, Staley KJ. Is neuronal death necessary for acquired epileptogenesis in the immature brain? Epilepsy Curr 2010;10:95-9. https://doi.org/10.1111/j.1535-7511.2010.01369.x
  3. Lai YH, Ho CS, Chiu NC, Tseng CF, Huang YL. Prognostic factors of developmental outcome in neonatal seizures in term infants. Pediatr Neonatol 2013;54:166-72. https://doi.org/10.1016/j.pedneo.2013.01.001
  4. Glass HC, Glidden D, Jeremy RJ, Barkovich AJ, Ferriero DM, Miller SP. Clinical neonatal seizures are independently associated with outcome in infants at risk for hypoxic-ischemic brain injury. J Pediatr 2009;155:318-23. https://doi.org/10.1016/j.jpeds.2009.03.040
  5. Scher MS. Neonatal seizures and brain damage. Pediatr Neurol 2003;29:381-90. https://doi.org/10.1016/S0887-8994(03)00399-0
  6. Limperopoulos C, Majnemer A, Rosenblatt B, Shevell MI, Rohlicek C, Tchervenkov C, et al. Association between electroencephalographic findings and neurologic status in infants with congenital heart defects. J Child Neurol 2001;16:471-6. https://doi.org/10.1177/088307380101600702
  7. Levine MS. Cerebral palsy diagnosis in children over age 1 year: standard criteria. Arch Phys Med Rehabil 1980;61:385-9.
  8. Kim HJ, Shin JI. A study of the correlation between BSID-III and KICDT for children with developmental delay. J Phys Ther Sci 2015;27:269-71. https://doi.org/10.1589/jpts.27.269
  9. Kim JH, Yum MS, Jeong SJ, Ko TS. Assessment of children with developmental delay: Korean infant and child development test (KICDT) and Korean Bayley scale of infant development-II (K- BSID-II). Korean J Pediatr 2009;52:772-7. https://doi.org/10.3345/kjp.2009.52.7.772
  10. Al-Macki N, Miller SP, Hall N, Shevell M. The spectrum of abnormal neurologic outcomes subsequent to term intrapartum asphyxia. Pediatr Neurol 2009;41:399-405. https://doi.org/10.1016/j.pediatrneurol.2009.06.001
  11. Massaro AN. MRI for neurodevelopmental prognostication in the high-risk term infant. Semin Perinatol 2015;39:159-67. https://doi.org/10.1053/j.semperi.2015.01.009
  12. Temko A, Doyle O, Murray D, Lightbody G, Boylan G, Marnane W. Multimodal predictor of neurodevelopmental outcome in newborns with hypoxic-ischaemic encephalopathy. Comput Biol Med 2015;63:169-77. https://doi.org/10.1016/j.compbiomed.2015.05.017
  13. Garfinkle J, Shevell MI. Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol 2011;15:222-9. https://doi.org/10.1016/j.ejpn.2010.11.002
  14. Garfinkle J, Shevell MI. Predictors of outcome in term infants with neonatal seizures subsequent to intrapartum asphyxia. J Child Neurol 2011;26:453-9. https://doi.org/10.1177/0883073810382907
  15. Soltirovska-Salamon A, Neubauer D, Petrovcic A, Paro-Panjan D. Risk factors and scoring system as a prognostic tool for epilepsy after neonatal seizures. Pediatr Neurol 2014;50:77-84. https://doi.org/10.1016/j.pediatrneurol.2013.08.010
  16. Srinivasakumar P, Zempel J, Trivedi S, Wallendorf M, Rao R, Smith B, et al. Treating EEG seizures in hypoxic ischemic encephalopathy: a randomized controlled trial. Pediatrics 2015;136:e1302-9. https://doi.org/10.1542/peds.2014-3777
  17. Abend NS, Wusthoff CJ. Neonatal seizures and status epilepticus. J Clin Neurophysiol 2012;29:441-8. https://doi.org/10.1097/WNP.0b013e31826bd90d
  18. Shah DK, Boylan GB, Rennie JM. Monitoring of seizures in the newborn. Arch Dis Child Fetal Neonatal Ed 2012;97:F65-9. https://doi.org/10.1136/adc.2009.169508
  19. van Rooij LG, Toet MC, van Huffelen AC, Groenendaal F, Laan W, Zecic A, et al. Effect of treatment of subclinical neonatal seizures detected with aEEG: randomized, controlled trial. Pediatrics 2010; 125:e358-66. https://doi.org/10.1542/peds.2009-0136
  20. Clancy RR, Legido A. Postnatal epilepsy after EEG-confirmed neonatal seizures. Epilepsia 1991;32:69-76. https://doi.org/10.1111/j.1528-1157.1991.tb05614.x
  21. Ortibus EL, Sum JM, Hahn JS. Predictive value of EEG for outcome and epilepsy following neonatal seizures. Electroencephalogr Clin Neurophysiol 1996;98:175-85. https://doi.org/10.1016/0013-4694(95)00245-6
  22. van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013;131:88-98. https://doi.org/10.1542/peds.2012-1297

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