Seizure Burden, EEG, and Outcome in Neonates with Acute Intracranial Infections: A Prospective Multicenter Cohort Study,Pediatric Neurology

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Seizure Burden, EEG, and Outcome in Neonates with Acute Intracranial Infections: A Prospective Multicenter Cohort Study
Pediatric Neurology ( IF 3.8 ) Pub Date : 2022-09-19 , DOI: 10.1016/j.pediatrneurol.2022.09.001
Nehali Mehta ₁ , Renée A Shellhaas ₂ , Charles E McCulloch ₃ , Taeun Chang ₄ , Courtney J Wusthoff ₅ , Nicholas S Abend ₆ , Monica E Lemmon ₇ , Catherine J Chu ₈ , Shavonne L Massey ₉ , Linda S Franck ₁₀ , Cameron Thomas ₁₁ , Janet S Soul ₁₂ , Elizabeth Rogers ₁₃ , Adam Numis ₁₄ , Hannah C Glass ₁₅

Affiliation

Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California.
Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia.
Department of Neurology, Stanford University, Palo Alto, California; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California.
Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.

Objective

To characterize association between seizure burden, electroencephalogram(EEG) background, and neurodevelopmental outcome among neonates with acute symptomatic seizures due to intracranial infection.

Methods

This secondary analysis was from a prospective, multicenter study of neonates enrolled in the Neonatal Seizure Registry with seizures due to intracranial infection. Sites used continuous EEG monitoring per American Clinical Neurophysiology Society guidelines. High seizure burden was defined a priori as ≥7 EEG-confirmed seizures. EEG background was categorized using standardized terminology. Primary outcome was neurodevelopment at 24-months corrected age using Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS). Secondary outcomes were post-neonatal epilepsy and motor disability.

Results

Twenty-seven of 303 neonates (8.9%) had seizures due to intracranial infection, including 16(59.3%) bacterial, 5(18.5%) viral, and 6(22.2%) unknown. Most neonates (n=23/27, 85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up the WIDEA-FS was, on average, 23 points lower in children with high compared to low seizure burden (95% CI [-48.4, 2.1], p=0.07). After adjusting for gestational age, etiology of infection, and presence of an additional potential acute seizure etiology, the effect size remained unchanged $(β$ = -23.8, p= 0.09); potential confounders were not significantly associated with the primary outcome. EEG background was not significantly associated with WIDEA-FS. All children with post-neonatal epilepsy (n=4) and motor disability (n=6) had high seizure burden, although the association between seizure burden and secondary outcomes was not significant.

Conclusion

High seizure burden may be associated with worse neurodevelopmental outcomes in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.

中文翻译：

急性颅内感染新生儿的癫痫发作负担、脑电图和结果：一项前瞻性多中心队列研究

客观的

旨在描述颅内感染引起的急性症状性癫痫发作新生儿的癫痫发作负担、脑电图 (EEG) 背景和神经发育结果之间的关联。

方法

该二次分析来自一项前瞻性多中心研究，研究对象是在新生儿癫痫登记处登记的因颅内感染引起癫痫发作的新生儿。根据美国临床神经生理学会指南，站点使用连续脑电图监测。高癫痫发作负荷被先验定义为脑电图确认的≥7 次癫痫发作。脑电图背景使用标准化术语进行分类。主要结果是使用 Warner 适应性和功能技能初始发育评估 (WIDEA-FS) 在 24 个月校正年龄时的神经发育。次要结果是新生儿后癫痫和运动障碍。

结果

303例新生儿中有27例（8.9%）因颅内感染引起惊厥，其中细菌性16例（59.3%），病毒性5例（18.5%），未知6例（22.2%）。大多数新生儿 (n=23/27, 85%) 至少有一次亚临床癫痫发作。在 23 名进行了 24 个月随访的儿童中，WIDEA-FS 与低癫痫发作负荷相比，高发作儿童平均低 23 分（95% CI [-48.4, 2.1]，p=0.07）。调整孕龄、感染病因和存在其他潜在急性癫痫发作病因后，效应量保持不变 $(β$ = -23.8，p = 0.09）；潜在的混杂因素与主要结果没有显着相关性。脑电图背景与 WIDEA-FS 没有显着相关性。所有患有新生儿后癫痫 (n=4) 和运动障碍 (n=6) 的儿童都有很高的癫痫发作负担，尽管癫痫发作负担与次要结局之间的关联并不显着。