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Irish Child Health Database - Peer Reviewed Papers

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

    Published in:

    Pediatrics, Vol: 118, Page: 41-6

    Publication Date:

    July 2006

    Aims & Objectives:

    The aim of this study was to examine if predictive values of high risk markers Apgar, acidosis and others - would be increased if early continuous electroencephalographic monitoring allowed accurate identification of all neonatal seizures

    Abstract:

    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 <5 at 5 minutes, pH <7.00, and need for intubation have been cited as having a positive predictive value of 80%. We examined whether the predictive values of these markers would be increased if early continuous electroencephalographic monitoring allowed us to accurately identify all neonatal seizures and to grade the encephalopathy. 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 seizures, 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 <5 at 5 minutes, pH <7.0, and the need for intubation had positive predictive values for neonatal seizures of 18%, 16%, and 21%, respectively. Combining these markers gave a positive predictive value of 25% and a negative predictive value of 77%. Substituting base deficit or lactate for pH in the 3-strikes model did not improve its predictive value. Apgar score of <5 at 5 minutes, nucleated red blood cells, and a base deficit less than -15 mEq/L showed some association with Sarnat grade. Only 5-minute Apgar score was significantly associated with both Sarnat grade and electroencephalographic grade. CONCLUSION: After perinatal asphyxia, neither the condition at birth nor the degree of metabolic acidosis reliably predict neonatal seizures.

    Authors:

    D. M. Murray; C. A. Ryan; G. B. Boylan; A. P. Fitzgerald; S. Connolly

    Study Type:

    Study Papers » Case Study » Descriptive Studies - Without a comparision

    Categories:

    neonatal seizures; encephalopathy

    International Classification:

    Neonatal seizures

    Keywords:


    Geography:

    Republic of Ireland (Southern (Cork) Ireland)