When seizures occur in newborns, it can greatly increase the risk of death, as well as neurodevelopmental disability. Because of this, the seizures often receive aggressive treatment. The causes for many of the seizures can vary substantially based on whether they are term infants or pre-term infants. They could be caused due to a range of issues, and sometimes, they are not noticed when they first occur.
Uncertainty often surrounds the best ways to treat seizures in infants, and whether the tradeoffs of using certain methods vs. the effects of seizures are worth it.
A randomized trial funded by the National Health and Medical Research Council of Australia found that when neonates were admitted into newborn intensive care units, “treating purely electrographic seizures in addition to those that were clinically evident made little difference in death or severe disability outcomes at two years.”
They looked at a clinical treatment-only group, as well as a group that received electrographic and clinical treatment. They discovered that the outcomes between these groups did not have a significant difference.
What Did the Study Entail?
The researchers studied NICU patients who gestated for at least 356 weeks and who were admitted with encephalopathy. They also only included those who were less than 48 hours old. The recruitment started in March of 2012 and ended in January of 2016.
They said that it ended before they had initially intended because the trial was progressing slowly and there was a “loss of equipoise” at some of the sites due to a publication released in 2015 that suggested treatment of all electrographic seizures was beneficial.
To be included in the study, patients had to have neonatal encephalopathy, hypoxic-ischemic injury, or suspected neonatal seizures from any cause. For neonatal encephalopathy patients, it included coma, stupor, and depressed mental states.
There were 86 newborns who were in the first group that included electrographic and clinical seizures and where both “electrographic and clinically evident seizures were treated, with the EEG screen visible.” There were another 86 patients in the clinical seizures group, where only clinically evident seizures were treated, and the EEG screen was covered. An MRI was used to determine the brain injury score.
What Was the Outcome?
The outcome was determined at two years old as either “death; severe disability defined as scores in any developmental domain more than 2 standard deviations below the Australian mean assessed with Bayley Scales of Neonate and Toddler Development, 3rd edition.”
The researchers also said, “In this randomized control trial, there was little evidence of a difference in mortality or morbidity at 2 years of age between an electrographic seizure group and clinical seizure group however, our study was underpowered”, and that “There was little evidence of a difference in secondary outcomes, including time to suck feeds, seizure burden, or brain injury score.”
The limitations of the trial should be noted. The researchers were not able to conduct the study the way they wanted to because recruitment was stopped early. They also said that it was underpowered. One of the other potential issues with the study was the fact that they used 1-2 channel EEG representation (aEEG) different from full-channel cEEG, which limits generalizability for settings using the more resource-intensive cEEG monitoring.”
What does this mean? Even though it may appear as though there is no significant difference in the outcome, more research should be conducted in this specific area and with proper cEEG monitoring. It doesn’t mean that the results will be different, but it can help to paint a better, more accurate picture.