A scoring system for early prognostic assessment after neonatal seizures

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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.

Details

Original languageEnglish
Pages (from-to)e580-e587
Number of pages8
JournalPediatrics
Volume124
Issue number4
Early online date14 Jun 2009
DOIs
Publication statusPublished - Oct 2009

    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

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