A scoring system for early prognostic assessment after neonatal seizures

Francesco Pisani, Francesco Pisani, Lisa Sisti, Stefano Seri

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The aim of this study was to devise a scoring system that could aid in predicting neurologic outcome at the onset of neonatal seizures.

METHODS: A total of 106 newborns who had neonatal seizures and were consecutively admitted to the NICU of the University of Parma from January 1999 through December 2004 were prospectively followed-up, and neurologic outcome was assessed at 24 months’ postconceptional age. We conducted a retrospective analysis on this cohort to identify variables that were significantly related to adverse outcome and to develop a scoring system that could provide early prognostic indications.

RESULTS: A total of 70 (66%) of 106 infants had an adverse neurologic outcome. Six variables were identified as the most important independent risk factors for adverse outcome and were used to construct a scoring system: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from “normal” to “severely abnormal.” A total composite score was computed by addition of the raw scores of the 6 variables. This score ranged from 0 to 12. A cutoff score of =4 provided the greatest sensitivity and specificity.

CONCLUSIONS: This scoring system may offer an easy, rapid, and reliable prognostic indicator of neurologic outcome after the onset of neonatal seizures. A final assessment of the validity of this score in routine clinical practice will require independent validation in other centers.
Original languageEnglish
Pages (from-to)e580-e587
Number of pages8
JournalPediatrics
Volume124
Issue number4
Early online date14 Jun 2009
DOIs
Publication statusPublished - Oct 2009

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Nervous System
Seizures
Apgar Score
Status Epilepticus
Neurologic Examination
Birth Weight
Anticonvulsants
Reference Values
Cohort Studies
Newborn Infant
Sensitivity and Specificity
Therapeutics

Keywords

  • apgar score
  • birth weight
  • central nervous system diseases
  • cohort studies
  • developmental disabilities
  • electroencephalography
  • female
  • humans
  • newborn
  • infant
  • premature infant
  • neonatal intensive care units
  • logistic models
  • male
  • mental disorders
  • multivariate analysis
  • neurologic examination
  • probability
  • prognosis
  • prospective studies
  • registries
  • risk assessment
  • seizures
  • severity of illness index
  • status epilepticus
  • time factors
  • transcranial doppler ultrasonography
  • neonatal seizures
  • neurodevelopmental outcome
  • preterm infants

Cite this

Pisani, Francesco ; Pisani, Francesco ; Sisti, Lisa ; Seri, Stefano. / A scoring system for early prognostic assessment after neonatal seizures. In: Pediatrics. 2009 ; Vol. 124, No. 4. pp. e580-e587.
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A scoring system for early prognostic assessment after neonatal seizures. / Pisani, Francesco; Pisani, Francesco; Sisti, Lisa; Seri, Stefano.

In: Pediatrics, Vol. 124, No. 4, 10.2009, p. e580-e587.

Research output: Contribution to journalArticle

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AB - OBJECTIVE: The aim of this study was to devise a scoring system that could aid in predicting neurologic outcome at the onset of neonatal seizures. METHODS: A total of 106 newborns who had neonatal seizures and were consecutively admitted to the NICU of the University of Parma from January 1999 through December 2004 were prospectively followed-up, and neurologic outcome was assessed at 24 months’ postconceptional age. We conducted a retrospective analysis on this cohort to identify variables that were significantly related to adverse outcome and to develop a scoring system that could provide early prognostic indications. RESULTS: A total of 70 (66%) of 106 infants had an adverse neurologic outcome. Six variables were identified as the most important independent risk factors for adverse outcome and were used to construct a scoring system: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from “normal” to “severely abnormal.” A total composite score was computed by addition of the raw scores of the 6 variables. This score ranged from 0 to 12. A cutoff score of =4 provided the greatest sensitivity and specificity. CONCLUSIONS: This scoring system may offer an easy, rapid, and reliable prognostic indicator of neurologic outcome after the onset of neonatal seizures. A final assessment of the validity of this score in routine clinical practice will require independent validation in other centers.

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