Abstract
Background: Newborns with congenital heart disease have a high risk of seizures, associated to developmental delay, cerebral palsy, and epilepsy.In this study we analyzed the etiology of seizures, electroencephalographic findings and outcome of newborns with congenital heart disease and seizures.Methods: We retrospectively identified 29 newborns with congenital heart disease, who presented with at least one seizure during their admission to the Neonatal Intensive Care Unit of the Hospital Italiano.Results: All newborns had structural/metabolic seizures. Median gestational age was 38 weeks (30-40 weeks, four pre-term) and median birth weight was 3100 g. (range: 1200-4375). Neurological exam was normal in seven neonates (24%), fourteen had only one seizure and four developed status epilepticus. The EEGs were abnormal in 21 newborns (72%). Ten showed focal paroxysms, ten showed minimal alterations with low amplitude and one had a burst-suppression pattern.Nine newborns (31%) died, due to hemodynamic decompensation. They all had an abnormal EEG (p=0.027), an abnormal neurological exam (p: 0.05) and four presented status epilepticus. (p=0.0053).At six months, two more newborns died and two had refractory epilepsy. Of the 18 patients, six had a normal neurological exam. These 6 patients, had had a normal neonatal neurological exam before hospital discharge and four had had only one seizure. Of the six newborns, five had a normal EEG (p= 0.03).Conclusions: In this population we observed a high mortality and an adverse neurological outcome. Abnormal EEG, abnormal neurological exam and status epilepticus were significantly related to mortality.
Highlights
Newborns with congenital heart disease have a high risk of seizures associated with developmental delay, cerebral palsy, and epilepsy
Electro-clinical dissociation frequently makes the diagnosis difficult. This is more marked after administering antiepileptic drugs. Such differences make it troublesome to assess the prevalence of neonatal seizures, which has been reported to be 0.5-1.4% [1,2] interm newborns and 20-25% in preterm babies
The purpose of this study is to analyze the etiology, electroencephalographic (EEG) findings, neuroimaging, and neurological sequelae of newborns with congenital heart disease who presented with seizures during their neonatal intensive care unit admission
Summary
Newborns with congenital heart disease have a high risk of seizures associated with developmental delay, cerebral palsy, and epilepsy. Neonatal seizures are the most common clinical expression of central nervous system dysfunction in newborns and one of the most frequent neurological emergencies during this stage of life. They are usually the first sign of neurological involvement and an indicator of the risk of mortality and/ or neurological sequelae. Electro-clinical dissociation frequently makes the diagnosis difficult This is more marked after administering antiepileptic drugs. Such differences make it troublesome to assess the prevalence of neonatal seizures, which has been reported to be 0.5-1.4% [1,2] interm newborns and 20-25% in preterm babies
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