Prediction of seizures in asphyxiated neonates: correlation with continuous video-electroencephalographic monitoring

BACKGROUND. After perinatal asphyxia, predicting which infants will develop significant hypoxic-ischemic encephalopathy and neonatal seizures remains a difficult task. High-risk markers (Apgar score, acidosis, nucleated red blood cells, and resuscitation) have been used to predict neonatal seizures with varying success. The "3 strikes" of Apgar score of METHOD. We recruited term infants with perinatal asphyxia. Continuous video electroencephalography was commenced soon after birth and continued for 24 to 72 hours. The abilities of high-risk markers to predict electroencephalographic seizurs, background electroencephalographic activity, and Sarnat grade were examined. RESULTS. Forty-nine infants were suitable for analysis. Electrographic seizures occurred in 11 of the 49 infants. Encephalopathy was scored by using Sarnat grade (6, severe; 18, moderate; 25, mild) and electroencephalographic findings (4 inactive, 4 major abnormalities, 16 moderate abnormalities, and 25 normal/mildly abnormal). Apgar score of CONCLUSION. After perinatal asphyxia, neither the condition at birth nor the degree of metabolic acidosis reliably predict neonatal seizures. www.pediatrics.org/cgi/doi/10.1542/peds.2005-1524 doi:10.15421peds.2005-1524 Key Words hypoxic-ischemic encephalopathy, video electroencephalography, neonatal seizures, seizure prediction Abbreviations PPV--positive predictive value BD--base deficit NRBC--nucleated red blood cell EEG--electroencephalographic HIE--hypoxic-ischemic encephalopathy Cl--confidence interval
AFTER PERINATAL ASPHYXIA, the occurrence of seizures remains a significant neurologic event. The outlook for long-term neurologic development is changed dramatically by the occurrence of clinical seizures, which place the [...]