Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital.

OBJECTIVE: To describe the neurological outcome of newborns with seizures. METHOD: Cohort study with newborns prospectively followed. Perinatal characteristics and etiological screening were related to outcome in a regression model. RESULTS: During the study 3,659 newborns were admitted and 2.7% were diagnosed as having seizures. Hypoxic ischemic encephalopathy (51%) was the etiology more frequently associated to seizures and also to postneonatal epilepsy (53%). In the follow up 25 died during the acute neonatal illness and 9 during the first years of life, 19 were diagnosed as having post neonatal epilepsy, 35 had developmental delay and 11 an association among this two comorbidities. A significant association between abnormal postnatal EEG and neuroimaging to developmental delay (p=0.014, p=0.026) was observed. The group of newborns that had seizures presented an increased risk of developing epilepsy compared to newborns from the same cohort without seizures (19.3/100 vs. 1.8/100, p<0.001). CONCLUSION: In this study neonatal seizures predominated in term newborns with perinatal asphyxia an elevated perinatal mortality and post neonatal morbidity was observed. The follow up showed an increased risk for developing postnatal epilepsy and developmental delay.

Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital / Prognóstico neurológico de recém nascidos com crises convulsivas: estudo de coorte em hospital terciário

OBJECTIVE: To describe the neurological outcome of newborns with seizures. METHOD: Cohort study with newborns prospectively followed. Perinatal characteristics and etiological screening were related to outcome in a regression model. RESULTS: During the study 3659 newborns were admitted and 2.7 percent were diagnosed as having seizures. Hypoxic ischemic encephalopathy (51 percent) was the etiology more frequently associated to seizures and also to postneonatal epilepsy (53 percent). In the follow up 25 died during the acute neonatal illness and 9 during the first years of life, 19 were diagnosed as having post neonatal epilepsy, 35 had developmental delay and 11 an association among this two comorbidities. A significant association between abnormal postnatal EEG and neuroimaging to developmental delay (p=0.014, p=0.026) was observed. The group of newborns that had seizures presented an increased risk of developing epilepsy compared to newborns from the same cohort without seizures (19.3/100 vs. 1.8/100, p<0.001). CONCLUSION: In this study neonatal seizures predominated in term newborns with perinatal asphyxia an elevated perinatal mortality and post neonatal morbidity was observed.The follow up showed an increased risk for developing postnatal epilepsy and developmental delay.

OBJETIVO: Avaliar o prognóstico neurológico de neonatos com crises convulsivas. MÉTODO: Estudo prospectivo, realizado em coorte de neonatos provenientes de hospital terciário. As características clínicas perinatais e os resultados de exames complementares foram correlacionados com prognóstico através de modelo de regressão logística. RESULTADOS: Durante o estudo 3659 neonatos foram internados, sendo que 101 apresentaram crises convulsivas (2,7 por cento). A encefalopatia hipóxico-isquêmica foi a etiologia mais frequentemente associada às crises (51 por cento). O seguimento evidenciou 25 óbitos no período neonatal e 9 durante os primeiros anos de vida, 19 lactentes desenvolveram epilepsia, 35 atraso no desenvolvimento e 11 associação entre os dois desfechos. O modelo de regressão logística aplicado mostrou associação significativa entre EEG pós neonatal anormal e neuroimagem anormal com atraso no desenvolvimento (p=0,014, p=0,026). Os neonatos em estudo, quando comparados aos demais da mesma coorte, que não apresentaram crises convulsivas tiveram maior probabilidade de desenvolver epilepsia (19,3/100 vs. 1,8/100, p<0,001). CONCLUSÃO: Neste estudo em que ocorreu predomínio de crises neonatais em neonatos a termo com asfixia perinatal, foi observada alta mortalidade perinatal e morbidade. O seguimento neurológico evidenciou elevado risco de desenvolvimento de epilepsia e/ou atraso no desenvolvimento neuropsicomotor.

[Instructions from teaching hospital maternity wards to parents concerning the sleeping position of newborns]. / Orientações adotadas nas maternidades dos hospitais-escola do Brasil, sobre posição de dormir.

The prone sleeping position has been causally linked to sudden infant death syndrome (SIDS). This survey aimed to determine whether maternity hospitals in Brazil were promoting the prone sleeping position for newborns. Information was also collected on SIDS prevention messages. The study adopted a multicenter collaborative approach in hospitals with training in pediatrics, using questionnaires. Correctly completed questionnaires were received from 55 hospitals. The number of deliveries/year varied at the hospitals from 240 to 11,000 (median 2,750). The majority of hospitals encouraged the lateral (side) sleeping position in the normal care nurseries (44.4%) and at discharge (67%). In conclusion, the majority of hospitals surveyed are not promoting the supine sleeping position or any other intervention for SIDS prevention, although verbal information is provided to parents about breastfeeding (100%), immunization (100%), and smoking (85%).

Orientações adotadas nas maternidades dos hospitais-escola do Brasil, sobre posição de dormir / Instructions from teaching hospital maternity wards to parents concerning the sleeping position of newborns

The prone sleeping position has been causally linked to sudden infant death syndrome (SIDS). This survey aimed to determine whether maternity hospitals in Brazil were promoting the prone sleeping position for newborns. Information was also collected on SIDS prevention messages. The study adopted a multicenter collaborative approach in hospitals with training in pediatrics, using questionnaires. Correctly completed questionnaires were received from 55 hospitals. The number of deliveries/year varied at the hospitals from 240 to 11,000 (median 2,750). The majority of hospitals encouraged the lateral (side) sleeping position in the normal care nurseries (44.4) and at discharge (67). In conclusion, the majority of hospitals surveyed are not promoting the supine sleeping position or any other intervention for SIDS prevention, although verbal information is provided to parents about breastfeeding (100), immunization (100), and smoking (85).

Síndrome da morte subita do lactente: aspectos clínicos de uma doença subdiagnósticada / sudden infant death syndrome: clinical aspects an underdiagnosed disease

Objetivo: Conhecer as características socioepidemiológicas dos lactentes que foram a óbito por SMSL no nosso meio e estabelecer a prevalência desta síndrome como causa de mortalidade no primeiro ano de vida. Métodos: Estudo observacional, retrospectivo, descritivo, baseado na revisão de laudos de necropsia e na aplicação de questionário a familiares de lactentes que apresentaram óbito domiciliar nos anos de 1997 e 1998 em Porto Alegre. Resultados: Dos 335 óbitos ocorridos em lactentes 21 foram incluídos nos critérios que definem SMSL, mas nenhum deles teve essa causa registrada em sua declaração de óbito. O perfil dos óbitos por SMSL foi caracterizado por lactentes sem história prévia de apnéias ou qualquer doença aguda que justificasse o óbito. As mortes ocorreram principalmente nos meses frios (outono e inverno) e nenhum destes lactentes dormia em posição supina. As famílias possuím renda média de 3 salários mínimos, 71 por cento das mães eram tabagistas e 42 por cento fizeram uso de álcool durante a gestação. A prevalência de SMSL foi estimada em 6,3 por cento do total de óbitos, sendo que o coeficiente de mortalidade especifíco por essa causa foi de 4,5 óbitos em 10.000 nascidos vivos. Conclusões: O perfil clínico-epidemiológico de risco para SMSL apresentado pelas crianças que foram ao óbito por essa causa assemelha-se em diversos aspectos ao descrito na literatura internacional. Observa-se entretanto que a SMSL é subdiagnósticada no nosso meio, não constando das estatísticas oficiais de mortalidade infantil. Com isso, não são desenvolvidas campanhas para redução do risco a que as crianças estão expostas

[Sudden infant death syndrome: clinical aspects of an underdiagnosed disease] / Síndrome da morte súbita do lactente: aspectos clínicos de uma doença subdiagnosticada.

OBJECTIVES: To investigate the socio-epidemiologic characteristics of the victims of sudden infant death syndrome and to calculate its prevalence during the 1st year of life. METHODS: This is an observational, retrospective, and descriptive study based on the review of autopsy protocols and questionnaires applied to families that had cases of infants death during 1997 and 1998 in the city of Porto Alegre. RESULTS: From 335 infants who died, 21 were fulfilled SIDS criteria, although SIDS was not recorded as a cause of death on the death certificate. The infants had no previous apnea or acute disease that could justify the death. Death occurred predominantly in cold months (winter and autumn). None of the infants who died slept in supine position. Families had a low monthly income (3 minimum wages). Seventy one per cent the mothers were smokers and 42% used alcohol during the pregnancy. SIDS prevalence was estimated as 6.3% from the total number of deaths, and the specific mortality coefficient for SIDS was 4.5:10,000 live births. CONCLUSIONS: The profile identified for infants at risk is similar to that reported in the literature. However, since SIDS is often misdiagnosed in our community, it does not appear in the statistics about infant mortality. As a consequence, there have never been campaigns to reduce the risk of death due to this syndrome.