Abstracts

Rationale: Clinical events suggestive of seizures are common cause of neurological evaluation of neonates . Neonatal seizures can have variety of etiologies and semiologies . Many events are non-epileptic in nature.Prolonged V-EEG plays a key role in capturing and accurately classifying these events .Controversies surround treatment of seizure protocols .Overall mortality in neonatal seizures can be up to 20% whereas long term morbidity is seen in 20-46 % of cases .Methods: This is a retrospective review from jan 2008 to dec 2010 at Newark Beth Israel Medical Center level four nursery .This includes all neonates that underwent long term monitoring with standard neonatal montage and Spike and wave detection were used . All inpatient medical record and NICU discharge summaries , Neuroimaging and EEG reports were reviewed . Long term neurological morbidity was determined by review of high risk follow up clinic at or after one year of chronological age in study population , looking for presence of epilepsy , developmental delay and cerebral palsy. Results: Total of 2679 babies were brought to neonatal ICU . 161 Neonates , 85 male and 76 female had V-EEG for suspected seizures.105 term and 56 preterm infants . Of the 105 term infants , 26 infants showed focal spikes on V-EEG ,15/26 showed abnormal neuroimaging .19 infants showed clinical and electrographic seizures with 11/19 showing abnormal scan of brain .3 infants had both focal spkes and electrographic seizure 2/3 showed abnormal scan .17 infants showed encephalopathic pattern and burst suppression pattern , 12/17 showed abnormal neuroimaging .30/105 full term infants had normal EEG , 9/30 infants had abnormal scan.20 record were incomplete . Of the 56 preterm infants that had clinical suspicion of seizures, complete record of 46 obtained, 20/56 showed epiletic spkies , 11/20 of these infants had abnormal scan . 8 preterm infants showed both electrographic and clinical seizures with 4/8 showed abnormal scan . 2 preterm had both focal spiking and seizures and both had abnormal scan . 12/56 showed encephalopathic pattern or prominent burst suppression 7/12 had abnormal scan .4/56 preterm had normal EEG . Mortality 12 babies in this group .Morbidity with developmental delay , cerebral palsy and seizure was present in 90 patients 60 % of population. Total length of stay was 3100 days showing signifacant cost . Therapeutic hypothermia was undertaken in 28 term babies , half were transfers from other hospitals , VEEG abnormality was detected in 24/28 , MRI Brain abnormality found in 16/28 .Antiepileptic drugs given in 23/28 babies, 6 died . Conclusions: Neonatal seizure is worrisome feature approx 1.6 per thousand children in our high risk nursery with additional transfers .There is high cost with increase in length of stay , morbidity and mortality . There is high correlation of V-EEG abnormalities with abnormal scan of the brain , and significant morbidity.More accurate diagnosis and more aggressive treatment of seizures and control of hypoxia ischemia related seizures with therapeutic hypothermia may change the tide of unfortunate outcome .