Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants.

OBJECTIVE: To identify independent prognostic indicators and design a predictive scoring system for neurodevelopmental outcome for term infants who experienced clinical neonatal seizures.

STUDY DESIGN: Retrospective analysis of 120 term infants who experienced clinical neonatal seizures between July 1991 and June 2007 in a single academic pediatric neurology practice. Logistic regression analysis was applied to determine the independent prognostic indicators of an adverse outcome, which was defined as death, cerebral palsy, global developmental delay, and/or epilepsy. These indicators were then used to develop a scoring system.

RESULTS: A total of 53 infants had a normal outcome, 56 survived with one or more neurodevelopmental impairments (31 had cerebral palsy, 41 had global developmental delay, and 29 had epilepsy), and 11 died. Eleven variables were associated with adverse outcome on univariate analysis, but only method of delivery, time of seizure onset, seizure type, EEG background findings, and etiology were independent predictors on logistic regression analysis. A five-point scoring system was devised using these independent predictors with a sensitivity of 81.1% and a specificity of 84.0%.

CONCLUSIONS: In term infants, delivery via cesarean section, experiencing a seizure during the first 24 h of life, presenting with a seizure other than focal clonic, showing a moderately or severely abnormal EEG background, and having certain specific etiologies were the apparent major determinants for an adverse outcome.