Am J Perinatol 2019; 36(02): 191-199 DOI: 10.1055/s-0038-1667107
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Outcomes after Neonatal Seizures in Infants Less Than 29 Weeks' Gestation: A Population-Based Cohort Study
Hiroko Iwami
1
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
,
Tetsuya Isayama
1
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
,
Abhay Lodha
2
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
,
Rody Canning
3
Department of Pediatrics, Moncton Hospital, Moncton, New Brunswick, Canada
,
Ayman Abou Mehrem
2
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
,
Shoo K. Lee
1
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
4
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
,
Anne Synnes
5
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
,
Prakesh S. Shah
1
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
4
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
,
for the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators› Author AffiliationsFunding Although no specific funding has been received for this study, organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare and the CNFUN are supported by a Canadian Institutes of Health Research (CIHR) Team Grant (FRN87518) and in-kind support from Mount Sinai Hospital. Dr. Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Objective The aim of this study was to evaluate the association between neonatal seizure and neurodevelopmental impairment (NDI) at 18 to 24 months in extremely preterm neonates. The association between anticonvulsants use and NDI was also assessed.
Study Design In this retrospective cohort study of infants born at <29 weeks' gestation from the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases, we compared mortality and neurodevelopmental outcomes in infants who had neonatal seizures with those without seizures after adjusting for confounders.
Results Of the 2,762 eligible neonates, 133 (4.8%) had seizures. Infants who had seizures were of lower gestation (25.2 vs. 26.2 weeks) and birth weight (819 vs. 920 g) and had higher rates of adverse outcomes. Neonatal seizure was associated with higher odds of composite outcome of death or significant NDI (74 vs. 27%; adjusted odds ratio [OR]: 3.4; 95% confidence interval [CI]: 2.2–5.4). Death or significant NDI was higher in infants with seizures treated with anticonvulsants than those without treatment (89 vs. 70%); however, when adjusted for confounders, it was not significantly different (adjusted OR: 3.5; 95% CI: 0.83–14.6).
Conclusion Neonatal seizures were independently associated with higher odds of death or significant NDI at 18 to 24 months of age. Relationship of anticonvulsant and neurodevelopmental outcomes needs further studies.
*A complete list of non-author contributors appears in Appendix A.
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