Characterization of Death in Infants With Neonatal Seizures,Pediatric Neurology

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Characterization of Death in Infants With Neonatal Seizures
Pediatric Neurology ( IF 3.8 ) Pub Date : 2020-08-05 , DOI: 10.1016/j.pediatrneurol.2020.08.002
Monica E Lemmon ₁ , Sonia L Bonifacio ₂ , Renée A Shellhaas ₃ , Courtney J Wusthoff ₄ , Rachel G Greenberg ₅ , Janet S Soul ₆ , Taeun Chang ₇ , Catherine J Chu ₈ , Sara Bates ₉ , Shavonne L Massey ₁₀ , Nicholas S Abend ₁₁ , M Roberta Cilio ₁₂ , Hannah C Glass ₁₃ ,

Affiliation

Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Department of Pediatrics, Stanford University, Palo Alto, California.
Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
Department of Pediatrics, Stanford University, Palo Alto, California; Department of Neurology, Stanford University, Palo Alto, California.
Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pediatrics, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Department of Neurology, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.

Background

Neonatal seizures are associated with death and neurological morbidity; however, little is known about how neonates with seizures die.

Methods

This was a prospective, observational cohort study of neonates with seizures treated at seven sites of the Neonatal Seizure Registry. We characterized the mode of death, evaluated the association between infant characteristics and mode of death, and evaluated predictors of death or transfer to hospice.

Results

We enrolled 611 consecutive neonates with seizures, and 90 neonates (15%) died before hospital discharge at a median age of 11 days (range: 1 to 163 days); 32 (36%) died in the first postnatal week. An additional 19 neonates (3%) were transferred to hospice. The most common mode of in-hospital death was death after extubation amidst concerns for poor neurological prognosis, in the absence of life-threatening physiologic instability (n = 43, 48%). Only one infant died while actively receiving cardiopulmonary resuscitation. In an adjusted analysis, premature birth (odds ratio: 3.06, 95% confidence interval 1.59 to 5.90) and high seizure burden (odds ratio: 4.33, 95% confidence interval 1.88 to 9.95) were associated with increased odds of death or transfer to hospice.

Conclusion

In a cohort of neonates with seizures, death occurred predominantly after decisions to withdraw or withhold life-sustaining intervention(s). Future work should characterize how these decisions occur and develop optimized approaches to support families and clinicians caring for newborns with seizures.

中文翻译：

新生儿癫痫发作婴儿的死亡特征

背景

新生儿癫痫发作与死亡和神经系统疾病有关；然而，人们对癫痫发作的新生儿如何死亡知之甚少。

方法

这是一项前瞻性、观察性队列研究，对在新生儿癫痫发作登记处的七个地点治疗的癫痫发作新生儿进行。我们对死亡模式进行了表征，评估了婴儿特征与死亡模式之间的关联，并评估了死亡或转移到临终关怀的预测因素。

结果

我们连续招募了 611 名癫痫发作的新生儿，其中 90 名（15%）在出院前死亡，中位年龄为 11 天（范围：1 至 163 天）；32 (36%) 人在产后第一周死亡。另有 19 名新生儿 (3%) 被转移到临终关怀医院。最常见的院内死亡模式是在担心神经系统预后不良、没有危及生命的生理不稳定的情况下拔管后死亡 (n = 43, 48%)。只有一名婴儿在积极接受心肺复苏时死亡。在调整后的分析中，早产（比值比：3.06，95% 置信区间为 1.59 至 5.90）和高癫痫负荷（比值比：4.33，95% 置信区间为 1.88 至 9.95）与死亡或转移到临终关怀医院的几率增加有关.