신생아 경련으로 진단된 극소 저출생 체중아에서 경련 점수 체계와 신경학적 예후
Seizure Scoring System and Neurodevelopmental Outcomes in Very Low Birth Weight Infants with Neonatal Seizures
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목적: 임상적 신생아 경련이 있는 극소 저출생 체중아에서 경련 관련 임상적 인자들과 교정 연령 18-24개월의 신경발달학적 예후와의 연관성을 확인한다. 방법: 1999년부터 2011년까지 서울아산병원 신생아중환자실에 입원한 극소 저출생 체중아로 신생아경련으로 진단 후항경련제 치료를 받은 환자 중 다채널 뇌파를 시행하고 생후 24개월 이후까지 생존한 환자 25명을 대상으로 의무기록을 후향적으로 분석하였다. 기존 연구에서 알려진 신생아 경련의 점수 체계에서 선택된 변수인 경련의 시작시기, 간질 중첩증의 유무, 발작의 양상, 치료에 대한 반응 및 다채널 뇌파의 배경파 및 간질파에 대한 소견을 합산하여 0-8점의 범위로 하는 새로운 점수 체계를 고안하고 기타 향후 신경학적 발달에 영향을 주는 임상적 지표들을 조사하였다. 생후 18개월에서 24개월 사이의 신경 발달 정도를 기준으로 1-5단계로 구분하였으며 예후 양호군(1, 2)과 예후 불량군(3-5)으로 구분하여 위험요인을 분석하였다. 결과: 예후 불량군(n=14)은 예후 양호군(n=11)에 비하여 비정형 발작 또는 전신 강직 발작인 경우와 배경 뇌파의 이상소견이 있는 경우, 항경련제 치료에 대한 반응이 없는 경우가 유의하게 높았다. 경련 종합 점수 또한 예후 불량군(3.2±0.7)이 양호군(1.2±1.2)에 비해 유의하게 높았으며 1-5단계의 신경발달 정도와도 유의한 상관관계를 나타내었다(P<0.001). 다변수 분석상 비정상 뇌 자기공명영상 및 경련 점수는 신경학적 예후를 예측하는 유의한 위험요인이었다. 결론: 극소 저출생 체중아에서 발생한 신생아 경련에서 경련 점수화 체계는 신경학적 예후와 유의한 상관관계가 있으며 중요한 예측지표이다.
Abstract
Purpose: To evaluate the utility of seizure scoring system in the prediction of neurodevelopmental outcomes in very low birth weight (VLBW) infants who presented with neonatal seizures. Methods: A retrospective review was performed in VLBW infants who were treated with antiepileptic drugs (AED) for the control of neonatal seizures. A total of 25 infants who survived and were followed-up for at least 2 years of age were included. A new seizure scoring system (the composite score 0-8) was constructed by choosing the following variables: onset, response to the AED, presence of status epilepticus, seizure types and EEG findings including background activity and epileptiform discharges. Neurodevelopmental outcomes were graded from 1 to 5 based on the developmental status and the neurologic abnormalities assessed at 18 to 24 months of postconceptional age. Risk factor analyses for predicting unfavorable outcomes (grade 3-5) versus favorable outcomes (grade 1-2) were performed. Results: Compared to favorable outcome group (n=11), unfavorable outcome group (n=14) had higher incidence of subtle or generalized tonic-type seizures, the abnormal EEG background activity and poor response to AED. The composite seizure score was significantly higher in the unfavorable outcome group (3.2±0.7) than in the favorable outcome group (1.2±1.2) and it significantly correlated with the neurodevelopmental grading (P<0.001). In multivariate analysis, abnormal MRI findings at term and the composite seizure score were significant risk factors for unfavorable outcomes. Conclusion: In VLBW infants with neonatal seizure, the proposed seizure scoring system was a simple and useful predictor of long-term neurologic outcomes. Key Words: Neonatal seizure, Seizure scoring system, Very low birth weight infant, Neurodevelopmental outcome
참고문헌 (39)
- Davis AS, "Seizures in extremely low birth weight infants are associated with adverse outcome", J Pediatr, 157, pp.720~725 (2010)
- Sivaswamy L, "Approach to neonatal seizures", Clin Pediatr (Phila), 51, pp.415~425 (2012)
- 서은숙, "국내 신생아 경련에 대한 보고", Korean Journal of Pediatrics, 52(9), pp.957~963 (2009), 대한소아과학회
- 성인경, "신생아 경련의 예후", Neonatal medicine, 16(1), pp.18~24 (2009), 대한신생아학회
- 임수정, "만삭 신생아 경련의 추적 관찰: 신경발달 예후 관련인자", Neonatal medicine, 20(1), pp.97~105 (2013), 대한신생아학회
- Le Bihannic A, "Prognostic value of EEG in very premature newborns", Arch Dis Child Fetal Neonatal Ed, 97, pp.F106~F109 (2012)
- Pisani F, "Mortality risk after neonatal seizures in very perterm newborns", J Child Neurol, 27, pp.1264~1269 (2012)
- Glass HC, "Clinical neonatal seizures are independently associated with outcome in infants at risk for hypoxic-ischemic brain injury", J Pediatr, 155, pp.318~323 (2009)
- Pisani F, "A scoring system for early prognostic assessment after neonatal seizures", Pediatrics, 124, pp.e580~e587 (2009)
- Miller SP, "Seizure-associated brain injury in term newborns with perinatal asphyxia", Neurology, 58, pp.542~548 (2002)
- Ellison PH, "A scoring system to predict outcome following neonatal seizures", J Pediatr, 99, pp.455~459 (1981)
- Neubauer AP, "Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment", Eur J Pediatr, 167, pp.87~95 (2008)
- Brezan F, "Preterm screening by transfontanelar ultrasoundresults of a 5 years cohort study", Med Ultrason, 14, pp.204~210 (2012)
- Shah DK, "Electrographic seizures in preterm infants during the first week of life are associated with cerebral injury", Pediatr Res, 67, pp.102~106 (2010)
- Wikström S, "Early single-channel aEEG", EEG predicts outcome in very preterm infants, 2012, pp.101, 719~726
- El-Dib M, "Amplitude-intergrated electroencephalography in neonates", Pediatr Neurol, 41, pp.315~326 (2009)
- Volpe JJ, "Neurology of the newborn", pp.203~244 (2008), WB Saunders
- Bell MJ, "Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging", Ann Surg, 187, pp.1~7 (1978)
- Holmes GL, "Prognostic value of background patterns in the neonatal EEG", J Clin Neurophysiol, 10, pp.323~352 (1993)
- Pisani F, "Neonatal status epilepticus vs recurrent neonatal seizures: clinical findings and outcome", Neurology, 69, pp.2177~2185 (2007)
- Brunquell PJ, "Prediction of outcome based on clinical seizure type in newborn infants", J Pediatr, 140, pp.707~712 (2002)
- Olischar M, "Background patterns and sleep-wake cycles on amplitudeintegrated electroencephalography in preterms younger than 30 weeks gestational age with peri-", intraventricular haemorr hage, 2007, pp.96, 1743~1750
- Menache CC, "Prognostic value of neonatal discontinuous EEG", Pediatr Neurol, 27, pp.93~101 (2002)
- Bernes SM, "Evolution of neonatal seizures", Pediatr Clin North Am, 41, pp.1069~1104 (1994)
- Yıldız EP, "Evaluation of etiologic and prognostic factors in neonatal convulsions", Pediatr Neurol, 47, pp.186~192 (2012)
- Holden KR, "Neonatal seizure. I. correlation of prenatal and perinatal events with outcomes", Pediatrics, 70, pp.165~176 (1982)
- HellstrÖm-Westas L, "Amplitureintegrated EEG classification and interpretation in preterm and term infants", Neoreviews, 7, pp.e76~e87 (2006)
- Legido A, "Neurologic outcome after electroencephalographically proven neonatal seizure", Pediatrics, 88, pp.583~596 (1991)
- Scher MS, "Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae", Pediatrics, 91, pp.128~134 (1993)
- Freeman JM, "Neonatal seizure--diagnosis and management", J Pediatr, 77, pp.701~708 (1970)
- Mizrahi EM, "Characterization and classification of neonatal seizures", Neurology, 37, pp.1837~1844 (1987)
- Garfinkle J, "Predictors of outcome in term infants with neonatal seizures subsequent to intrapartum asphyxia", J Child Neurol, 26, pp.453~459 (2011)
- van Rooij LG, "Treatment of neonatal seizures", Semin Fetal and Neonatal Med, 18, pp.209~215 (2013)
- Maartens IA, "Neurodevlopmental outcome in full-term newborns with refractory neonatal seizures", Acta Paediatr, 101, pp.e173~e178 (2012)
- Clancy RR, "Postnatal epilepsy after EEG-confirmed neonatal seizures", Epilepsia, 32, pp.69~76 (1991)
- Hayakawa M, "Backgroud electroencephalographic activities of very preterm infants born at less than 27weeks gestation: a study on the degree of continuity", Arch Dis Child Fetal Neonatal Ed, 84, pp.F163~F167 (2001)
- Almubarak S, "Long-term clinical outcome of neonatal EEG findings", J Clin Neurophysiol, 28, pp.185~189 (2011)
- Clancy RR, "EEG in premature infants with intraventricular hemorrhage", Neurology, 34, pp.583~590 (1984)
- Watanabe K, "Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants", Brain Dev, 21, pp.361~372 (1999)