TY - JOUR
T1 - Seizure Burden, EEG, and Outcome in Neonates With Acute Intracranial Infections
T2 - A Prospective Multicenter Cohort Study
AU - Mehta, Nehali
AU - Shellhaas, Renée A.
AU - McCulloch, Charles E.
AU - Chang, Taeun
AU - Wusthoff, Courtney J.
AU - Abend, Nicholas S.
AU - Lemmon, Monica E.
AU - Chu, Catherine J.
AU - Massey, Shavonne L.
AU - Franck, Linda S.
AU - Thomas, Cameron
AU - Soul, Janet S.
AU - Rogers, Elizabeth
AU - Numis, Adam
AU - Glass, Hannah C.
N1 - Funding Information:
Disclosures: Dr. Mehta has no disclosures. Dr. Shellhaas receives research support from NIH, the Pediatric Epilepsy Research Foundation, and the University of Michigan. She receives royalties from UpToDate for authorship of topics related to neonatal seizures, serves as a consultant for the Epilepsy Study Consortium, and is an Associate Editor for Neurology. Dr. McCulloch has no disclosures. Dr. Chang has no disclosures. Dr. Wustoff has no disclosures. Dr. Abend has no disclosures. Dr. Lemmon receives salary support from NIH (K23NS116453). Dr. Chu receives research support from Biogen Inc, NIMH, and NINDS. She consults for Ovid Pharmaceuticals and Biogen Inc. Dr. Massey has no disclosures. Dr. Franck has no disclosures. Dr. Thomas receives research support through NIH and UCB. Dr. Soul has no disclosures. Dr. Rogers has no disclosures. Dr. Numis has no disclosures. Dr. Glass receives research support from NIH.
Funding Information:
Funding: This work was supported by the Patient-Centered Outcomes Research Institute, United States (grant number 2015C2-1507-31187).
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Limited data exist regarding seizure burden, electroencephalogram (EEG) background, and associated outcomes in neonates with acute intracranial infections. 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 seven or more 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 postneonatal 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. Twenty-three neonates (85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up, the WIDEA-FS score was, on average, 23 points lower in children with high compared with low seizure burden (95% confidence interval, [−48.4, 2.1]; P = 0.07). After adjusting for gestational age, infection etiology, and presence of an additional potential acute seizure etiology, the effect size remained unchanged (β = −23.8, P = 0.09). EEG background was not significantly associated with WIDEA-FS score. All children with postneonatal epilepsy (n = 4) and motor disability (n = 5) had high seizure burden, although associations were not significant. Conclusion: High seizure burden may be associated with worse neurodevelopment in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.
AB - Background: Limited data exist regarding seizure burden, electroencephalogram (EEG) background, and associated outcomes in neonates with acute intracranial infections. 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 seven or more 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 postneonatal 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. Twenty-three neonates (85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up, the WIDEA-FS score was, on average, 23 points lower in children with high compared with low seizure burden (95% confidence interval, [−48.4, 2.1]; P = 0.07). After adjusting for gestational age, infection etiology, and presence of an additional potential acute seizure etiology, the effect size remained unchanged (β = −23.8, P = 0.09). EEG background was not significantly associated with WIDEA-FS score. All children with postneonatal epilepsy (n = 4) and motor disability (n = 5) had high seizure burden, although associations were not significant. Conclusion: High seizure burden may be associated with worse neurodevelopment in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.
KW - Central nervous system
KW - Encephalitis
KW - Epilepsy
KW - Meningitis
KW - Neonates
KW - Neurocritical care
KW - Seizures
UR - http://www.scopus.com/inward/record.url?scp=85140074210&partnerID=8YFLogxK
U2 - 10.1016/j.pediatrneurol.2022.09.001
DO - 10.1016/j.pediatrneurol.2022.09.001
M3 - Article
C2 - 36270133
AN - SCOPUS:85140074210
SN - 0887-8994
VL - 137
SP - 54
EP - 61
JO - Pediatric Neurology
JF - Pediatric Neurology
ER -