Symptomatic seizures in preterm newborns: a review on clinical features and prognosis

Carlotta Spagnoli, Raffaele Falsaperla, Michela Deolmi, Giovanni Corsello, Francesco Pisani

Research output: Contribution to journalReview article

Abstract

Neonatal seizures are the most common neurological event in newborns, showing higher prevalence in preterm than in full-term infants. In the majority of cases they represent acute symptomatic phenomena, the main etiologies being intraventricular haemorrhage, hypoxic-ischemic encephalopathy, central nervous system infections and transient metabolic derangements.Current definition of neonatal seizures requires detection of paroxysmal EEG-changes, and in preterm newborns the incidence of electrographic-only seizures seems to be particularly high, further stressing the crucial role of electroencephalogram monitoring in this population. Imaging work-up includes an integration of serial cranial ultrasound and brain magnetic resonance at term-equivalent age. Unfavourable outcomes following seizures in preterm infants include death, neurodevelopmental impairment, epilepsy, cerebral palsy, hearing and visual impairment. As experimental evidence suggests a detrimental role of seizures per se in determining subsequent outcome, they should be promptly treated with the aim to reduce seizure burden and long-term disabilities. However, neonatal seizures show low response to conventional anticonvulsant drugs, and this is even more evident in preterm newborns, due to intrinsic developmental factors. As a consequence, as literature does not provide any specific guidelines, due to the lack of robust evidence, off-label medications are often administered in clinical practice.
Original languageEnglish
Pages (from-to)115
JournalItalian Journal of Pediatrics
Volume44
Issue number1
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Newborn
  • Outcome
  • Prognosis
  • Seizures
  • Treatment

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