Seizure Burden, EEG, and Outcome in Neonates With Acute Intracranial Infections: A Prospective Multicenter Cohort Study

Nehali Mehta; Renée A Shellhaas; Charles E McCulloch; Taeun Chang; Courtney J Wusthoff; Nicholas S Abend; Monica E Lemmon; Catherine J Chu; Shavonne L Massey; Linda S Franck; Cameron Thomas; Janet S Soul; Elizabeth Rogers; Adam Numis; Hannah C Glass

doi:10.1016/j.pediatrneurol.2022.09.001

Seizure Burden, EEG, and Outcome in Neonates With Acute Intracranial Infections: A Prospective Multicenter Cohort Study

Pediatr Neurol. 2022 Dec:137:54-61. doi: 10.1016/j.pediatrneurol.2022.09.001. Epub 2022 Sep 19.

Authors

Affiliations

¹ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California.
² Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
⁴ Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia.
⁵ Department of Neurology, Stanford University, Palo Alto, California; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
⁶ Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
⁷ Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
⁸ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
⁹ Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁰ Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California.
¹¹ Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
¹² Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
¹³ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
¹⁴ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
¹⁵ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California. Electronic address: hannah.glass@ucsf.edu.

PMID: 36270133
DOI: 10.1016/j.pediatrneurol.2022.09.001

Abstract

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.

Keywords: Central nervous system; Encephalitis; Epilepsy; Meningitis; Neonates; Neurocritical care; Seizures.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Child
Disabled Persons*
Electroencephalography
Epilepsy* / complications
Humans
Infant, Newborn
Motor Disorders* / complications
Prospective Studies
Seizures