P 1014. Neurodevelopmental Outcome in VLWB Preterm Infants with Neonatal Seizures Born between 2008 and 2011 at the Age of 2 Years

Background: Clinical and electrographic neonatal seizures are known risk factors for developmental delay in preterm infants (PIs) with gestational age (GA) <32 weeks especially in very low birth weight (VLBW) and critically ill PI. Outcome data of published studies are limited comparably due to heterogeneous design.

Objectives: Analysis of standardized neurodevelopmental findings (Bayley Scales of Infant Development II [BSID-II]) of VLBW PI with neonatal seizures in relation to perinatal risk factors at 2 years of age.

Methods: The retrospective monocenter study included 20 VLBW PI (m 9) with neonatal seizures of birth cohorts 2008 to 2011 with GA of <32 weeks (range: 24.1–30.3) and birth weight <1,500 g (range: 580–1,350). Diagnosis of neonatal seizures was confirmed with at least one interictal/ictal EEG.

In 8/20 patients (40.0%) intracranial bleeding (grade III a/o parenchymal hemorrhage, n = 3), in 18 (90.0%) respiratory distress syndrome, and in 5 (25.0%) neonatal sepsis have been diagnosed. Maternal risk factors were preeclampsia (5/20) and premature rupture of membranes (8/20).

Semiology was—modified according to Volpe (2008)—divided into motor (90%, 18/20) and subtle (10%, 2/20) seizures. Epileptiform discharges were present in all patients associated with suppression of background activity in 5/20 PIs. Neurodevelopmental outcome was evaluated at the age of 22 to 24 months including neurological examination and BSID-II. A subgroup of PI (n = 8) was examined with Griffith’s Scales of Mental Development (GS) at the age of 12 months followed by BSID-II at the age of 22 to 24 months.

Results: (Mean ± SD). Corrected age at BSID-II evaluation was 23.9 ± 2.7 months (range: 17.0–29.0). Mean MDI was 83 ± 18 (range: 50–112). While MDI was in normal range in 50% (10/20) of VLBW PI (98 ± 8, range: 88–112), 50% of VLBW PI showed MDI values below the age-appropriate range (MDI 67 ± 12, range: 50–84). All PIs evaluated with GS and BSID-II (n = 8) revealed an age-appropriate developmental profile at the corrected age of 12.1 ± 1.2 months (Eq. 92 ± 8, range: 79–105); however, at the age of 24 months, MDI was below normal range in 4/8 patients. Concerning potential neonatal risk factors, birth weight was significantly related to MDI (p < 0.05).

Conclusion: Present data on a homogenous group of VLBW PI with EEG-confirmed neonatal seizures confirm that the presence of neonatal seizures in VLBW PI is related to an increased risk of delayed cognitive development in toddlerhood. Neonatal risk factors are discussed in relation to the limited number of the study population.