Research: Characteristics of Neonates with Cardiopulmonary Disease Who Experience Seizures: A Multi-Center Study

J Pediatr

. 2021 Oct 30;S0022-3476(21)01058-1. doi: 10.1016/j.jpeds.2021.10.058. Online ahead of print.

Characteristics of Neonates with Cardiopulmonary Disease Who Experience Seizures: A Multi-Center Study

Shavonne L Massey 1Hannah C Glass 2Renée A Shellhaas 3Sonia Bonifacio 4Taeun Chang 5Catherine Chu 6Maria Roberta Cilio 7Monica E Lemmon 8Charles E McCulloch 9Janet S Soul 10Cameron Thomas 11Courtney J Wusthoff 12Rui Xiao 13Nicholas S Abend 14Affiliations expand


Objective: To compare key seizure and outcome characteristics between neonates with and without cardiopulmonary disease (CPD).

Study design: The Neonatal Seizure Registry (NSR-1) is a multicenter, prospectively acquired cohort of neonates with clinical or EEG-confirmed seizures. CPD was defined as congenital heart disease, congenital diaphragmatic hernia, and exposure to extracorporeal membrane oxygenation. We assessed continuous electroencephalographic monitoring (cEEG) strategy, seizure characteristics, seizure management, and outcomes for neonates with and without CPD.

Results: We evaluated 83 neonates with CPD and 271 neonates without CPD. Neonates with CPD were more likely to have EEG-only seizures (40% vs. 21%, P <.001) and experience their first seizure later than those without CPD (174 vs. 21 hours of age, p<0.001), but they had similar seizure exposure (many-recurrent electrographic seizures 39% vs. 43%, p=0.27). Phenobarbital was the primary initial antiseizure medication (ASM) for both groups (90%), and both groups had similarly high rates of incomplete response to initial ASM administration (66% vs. 68%, p=0.75). Neonates with CPD were discharged from the hospital later (hazard ratio 0.34, 95%CI 0.25-0.45, p<0.001), although rates of in-hospital mortality were similar between the groups (hazard ratio 1.13, 95%CI 0.66-1.94, p=0.64).

Conclusion: Neonates with and without CPD had a similarly high seizure exposure, but neonates with CPD were more likely to experience EEG-only seizures and had seizure onset later in the clinical course. Phenobarbital was the most common seizure treatment, but seizures were often refractory to initial ASM. These data support guidelines recommending cEEG in neonates with CPD and indicate a need for optimized therapeutic strategies.

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