신생아 경련과 관련된 요인들과 예후와의 관계

Correlation of neurologic outcome with neonatal seizure associated clinical correlators

During the neonatal period, as at laster ages, seizures are a symptom of an acute disturbance of the brain. Seizures in the newborn are less well organized than in older infants and children, and a variety of atypical fits may occur as an isolated manifestation of convulsive activity. Apnea in known to be one of the more common phenomena of an atypical neonatal seizures represent a high risk for neonatal death or neurodevelopmental sequelae for both preterm and fullterm infants. The purpose of the present report was to describe electroclinical features of neonatal seizures and their relation the developmental outcome. To study the clinical prognosis of the neonatal seizure, we carried out a retrospective review on medical records of 36 neonates who were admitted to the Dept. of Pediatrics, Tae jon Eul Ji General Hospital between September 1992 and July 1994. The results from the study are summarized as follows 1) Male to female ratio were 1.8:1. The onset of 11cases of neonatal seizure appeared within 24hours of life, 14cases in 2nd-3rd days. Two-third of neonatal seizure occurred within 3rd day of life. 2) The most frequent cause of neonatal seizure was hypoxic ischemic encephalopathy(30%) and hypocalcemia(24%), and followed by hypoglycemia(17%), sepsis(8%), hypernatremia(6%), intracranical hemorrage. Herpes simplex encephalitis in order of frequency. The most favorable outcome resulted from neonates with hypocalcemia(handicap-:3 of 11:27%) and the worst outcome resulted from neonates with intracranial hemorrhage(handicap-:100%) and hypoxic ischemic encephalpathy(handicap-:12 of 15:80%). 3) The most frequent type of neonatal seizure was subtle(28%) and focal clonic type(28%), followed by general tonic type(17%) and multifocal clonic type in order of frequency. The patients with subtle seizure and general tonic seizure had an unfavorable outcome. The rate of neurologic handicap was 80% in subtle seizure and 67% in general tonic seizure. 4) The result of EEG finding was normal (18%) and abnormal(82%). In abnormal EEG finding. 10(35.7%) of 28 patients with moderately to markedly abnormal EEG backgrounds had an unfavorable prognosis and the incidence of neurologic handicap was 90%(9 of 10). 5) The Apgar score at 5min was recorded in 25cases(69%) and 56%(13 of 25) of neonates had scores of 6 or less : birth asphyxia. 77% of birth asphyxia developed neonatal seizure in the first three days. Therefore, the five minute Apgar score in neonates who had seizure was highly associated(P<0.05)with neurologic handicap and a good predictor of death or significant neurologic sequelae. 6) The follow-up results were that 14cases(38.8%) showed normal behavioral states and 17 cases (47.2%) showed neurologic sequelae which were cerebral palsy in 6cases(35.3%) and neurodevelopmental delay in 11cases(64.7%).