신생아 경련의 원인과 신경 발달의 예후 인자 분석
Evaluation of Etiology and Prognostic Factors of the Developmental Outcome in Neonatal Seizures
Abstract
Purpose: The purpose of this study was to investigate the clinical features of neonatal seizures and to identify prognostic factors of neurodevelopmental outcome in term infants who experienced clinical seizures. Methods: A retrospective analysis was performed on 153 full term and preterm infants with seizures from January 2008 to December 2013. Binary logistic regression analysis was applied to assess risk factors associated with neurological adverse outcomes using variables that were found to be significant on univariate analysis. Results: During the study period, 102 term (66.7%) and 51 preterm infants (33.3%) were enrolled. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (24.5%) in term infants and intracranial hemorrhage (74.5%) in preterm infants. The most common type of seizure was the focal clonic seizure, but the generalized tonic seizure was more common observed in preterm than in term infants. Totally 39 out of 56 term infants with at least 12 months of neurologic follow-up showed normal outcomes compared with only one preterm infant with normal development. Prognostic factors related to adverse neurodevelopmental outcomes in term infants were perinatal history of fetal distress, etiology of hypoxic ischemic encephalopathy, a moderately or severely abnormal EEG, evidence of hypoxic ischemic encephalopathy on brain magnetic resonance imaging and the need for multiple antiepileptic drugs for seizure control. Conclusion: Preterm infants showed poor neurodevelopmental outcomes compared with term infants. The etiology of seizures, treatment response, neuroimaging and electroencephalographic findings were important in predicting the developmental outcome in term infants with seizures.