PROGNOSIS FOLLOWING CLINICAL NEONATAL SEIZURES: RESULTS FROM A POPULATION BASED COHORT 14 YEARS LATER

Objective: To prospectively evaluate survival and neurodevelopmental outcome following neonatal seizures (NSz). Most recent population based data are from 1959–1962 and may not be generalizable to current neonatal populations.

Methods: We collected prospective data on all neonates (<44weeks gestation) with clinical NSz (=paroxysmal behaviors with high specificity for 'epileptic' seizures) from 1990–1995, targeting all live births in Newfoundland. Uniform video assisted training for standardized seizure recognition preceded the study (J Pediatr 1999;134:71). Follow-up data were analyzed 10–14 years later.

Results: Data were analyzed for 87/90 (61 term and 26 preterm).

* of survivors, † symptomatic epilepsy, LD=learning disorder
Outcome	Cohortn/N (%)	Termn (%)	Pretermn (%)	encephalopathyn	Etiologiesinfectionn	dysgenesisn	IVHn
Normal	30/87 (34)	27 (44)	3 (12)	10	6	0	1
Dead	21/87 (24)	10 (16)	11 (42)	13	3	4	4
Disability	36/87 (41)	24 (39)	12 (46)	15	7	5	3
Epilepsy*†	17/65 (26)	10 (20)	7 (47)	6	5	3	3
CP*	15/66 (23)	8 (16)	7 (47)	9	3	0	2
MR*	13/65 (20)	7 (14)	6 (40)	5	4	2	2
LD*	16/65 (25)	12 (24)	4 (27)	7	3	2	-

Conclusion: Preterm infants with seizures are at higher risk for death and impairment compared to term infants. The 12% normal outcome for preterm is lower than in most studies, possibly reflecting their outborn nature. The lower frequency of normal outcome compared to 47% from1959–1962 may primarily be due to reduction in hypocalcemic seizures. Cognitive deficits are present in 45% of survivors.