The features of clinical and electroencephalographic diagnosis of seizures in preterm infants
Keywords:
preterm infants, neonatal seizures, standard electroencephalographyAbstract
Neonatal seizures are the most common emergency paroxysmal conditions in patients of the neonatal intensive care units.The aim of the study: to determine clinical and electroencephalographic signs of seizures in preterm infants with paroxysmal conditions, taking into account gestational age at birth and post-menstrual age in the dynamics of treatment.
Materials and methods. Complex clinical and neurophysiological examination of 90 premature babies was conducted (group I – 29 children with gestational age 24–28 weeks, group II — 45 children with gestational age 29–32 weeks, group III — 16 children with gestation age 33–36 weeks).
Results. Preterm infants of the study groups had manifestations of combined perinatal pathology, among which the incidence of perinatal CNS lesions was 24.1% in group I, 33.3% in group II and 37.5% in group III. According to neuromonitoring data, electrographic (31%, 42% and 43.6%, p>0.05), clonic (24.1%, 20% and 25%, p>0.05) and sequential (10.3%), seizures predominate (9%, 12.5%, p>0.05). Dynamics of clinical and electroencephalographic examination of preterm infants according to the increase postmenstrual age showed a gradual decrease in the frequency of electroclinic seizures (in group I — from 89.7% to 3.4%, p<0.0001; in group II — from 60% to 7%, p<0.0001; in group III — from 75% to 6.3%, p=0.0001) and an increase in the frequency of electrographic seizures (from 6.9% to 44.9%, p=0.0011; from 15,6% up to 27%, p>0.05; from 6.3% to 44%, p>0.05). At the corrected age of 1.5–3 months postpartum, convulsions persisted only in 24.1% of cases of group I, in 15.5% of cases of group II and in 25% of group III, p>0.05) with the prevalence of electrographic seizures. Dynamic comprehensive neuromonitoring allowed for timely adjustment of anticonvulsant therapy, which increased the proportion of children without convulsions.
Conclusions. High frequency of seizures, as one of the main manifestations of paroxysmal conditions, preterm infants and long-term preservation of electrographic seizures during the first months of postpartum life determine the need for complex neuromonitoring with the inclusion of standard electroencephalography during the first 3 months of corrected age and objective age diagnosis, correction of therapeutic complex.
The children were examined after obtaining the written consent of the parents, following the basic ethical principles of scientific medical research and approval of the research program by the Commission on Biomedical Ethics of the Shupyk National Medical Academy of Postgraduate Education.
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