Published online September 14, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e580-e587 (doi:10.1542/peds.2008-2087)
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ARTICLE

A Scoring System for Early Prognostic Assessment After Neonatal Seizures

Francesco Pisani, MDa, Lisa Sisti, MDa and Stefano Seri, MD, FRCPb

a Child Neuropsychiatric Unit, University of Parma, Parma, Italy
b School of Life and Health Sciences, Clinical Neurophysiology Unit, Aston University, Birmingham, United Kingdom

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.

Key Words: neonatal seizures • neurodevelopmental outcome • newborns • preterm infants

Abbreviations: EEG—electroencephalography • GA—gestational age • ROC—receiver operating characteristic • AUC—area under the curve • NPV—negative predictive value • PPV—positive predictive value • IVH—intraventricular hemorrhage • CI—confidence interval

Accepted May 29, 2009.


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