The clinical features of paroxysmal conditions in preterm infants
DOI:
https://doi.org/10.15574/PP.2020.82.47Keywords:
preterm infants, epileptic paroxysmal conditions, non-epileptic paroxysmal conditions, apnea, Sandifer's syndrome, benign myoclonus of infants, obstructive sleep apnea syndromeAbstract
Preterm infants are at a much higher risk of developing unexpectedly events during the first year of life, such as paroxysmal conditions. Paroxysmal conditions may be visible manifestations of major epileptic or non-epileptic neurological disease. Neonatal seizures are the most common emergency paroxysmal condition in children at neonatal intensive care units. Non-epileptic paroxysmal events are often misdiagnosed and treated as epilepsy.
Purpose — to determine clinical features of paroxysmal conditions in preterm infants of different gestational age (GA).
Materials and methods. A single-center prospective study included the study of clinical features paroxysmal conditions of 105 preterm infants. The study group I consisted of 32 children a GA of 24–28 weeks, group II — 52 children GA 29–32 weeks, group III — 21 children GA 33–36 6/7 weeks. The children underwent comprehensive neuromonitoring, including a polysomnographic study.
Results. The results of the study showed a decrease in the frequency of diagnosis of epileptic paroxysmal events (in group I — 68.8%, in group II — 57.7%, in group III — 52.4%) and an increase in the frequency of non-epileptic paroxysms (6.3%, 13.5% and 19.0% respectively) in preterm infants with increasing gestational age. Among the epileptic paroxysmal conditions prevailed electrographic seizures (group I — 31%, group II — 42%, group III — 43.6%), clonic convulsions (24.1%, 20%, and 25%, respectively) sequential (14%, 20%, 6.3% respectively) and tonic (10.3%, 9% and 12.5% respectively) convulsions. Non-epileptic paroxysmal conditions with impaired alertness level of consciousness were presented by pathological apnea at children with respiratory disorders syndrome (group I — 25%, group II — 17.3%), bronchopulmonary dysplasia (53.1% and 11.5%, respectively) pneumonia (group I — 28.1%, group II — 23.1%, group III — 9.5%). Non-epileptic paroxysmal conditions without disturbance of consciousness during wakefulness were represented by Sandifer's syndrome (I group — 6.3%, II group — 5.8%), clinical and polysomnographic signs of which were apnea (obstructive, mixed), episodes of hypopnoe with desaturation and bradycardia during motor paroxysms that are combined in time with acidity disorders in the esophagus during pH measurement. Non-epileptic paroxysmal conditions during sleep were represented by benign infant myoclonus (group II — 1.9%), obstructive sleep apnea syndrome (group II — 1.9%, group III — 4.7%).
Conclusions. Most preterm infants with perinatal pathologies, regardless of gestational age, are at increased risk for paroxysmal conditions. This necessitates indepth neuromonitoring of premature infants, including polysomnographic study. Complex neuromonitoring provides an opportunity to diagnose paroxysmal conditions in a timely manner, to perform differential diagnostics of various types of paroxysms, to define criteria for discharge at home and to provide recommendations for respiratory monitoring in the follow-up.
The research was carried out in accordance with the principles of the Helsinki Declaration. The children were examined after obtaining the written consent from the parents, in compliance with the basic ethical principles of scientific medical research and approval of the research program by the Commission on Biomedical Ethics of the Shupyk National Medical Academy of Postgraduate Education.
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