Prediction of outcome based on clinical seizure type in newborn infants

Objective: To determine whether the clinical features of neonatal seizures are of value in predicting outcome. Study design: Demographic features, clinical seizure types, etiologic Factors, and laboratory findings of all 77 patients with seizures admitted to our neonatal intensive care unit over a consecutive 7-year period were extracted from the medical records. Results: Twenty-three (30%) died; 59% of the survivors had abnormal neurologic examinations, 40% were mentally retarded, 43% had cerebral palsy, and 21% were epileptic at mean follow-up of 3.5 years. Compared with patients with other seizure types, those with subtle and generalized tonic seizures had a significantly higher prevalence of epilepsy (P = .04 and P = .01 respectively,); mental retardation (P = .02; P = .007), and cerebral palsy (P = .03; P = .002). Subtle seizures were, in addition, more likely to be associated with abnormalities on the neurologic examination at follow-up (P = .03). Similar outcome comparisons for those,with focal and multifocal clonic, focal tonic, and multifocal myoclonic seizures revealed no significant differences. However, patients with greater than or equal to2 seizure types were significantly more likely to have epilepsy (P = .02), mental retardation (P = .001), cerebral palsy (P =.001), and abnormal examinations (P = .05). Conclusions: Clinical semiology is predictive of outcome in neonates with seizures and suggests the presence of unique pathophysiologic processes for different seizure types.