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.
References
Belousova ED, Ermakov AYu (2007). Differenczial`ny`j diagnoz e`pilepsii. Moskva: Pul`s: 262.
Volkova OK, Kalina AV, Karpovich GS i dr. (2019). Nee`pilepticheskij mioklonus mladenchestva i rannego detstva (nablyudenie 33 paczientov). Nevrologiya, nejropsikhiatriya, psikhosomatika. 11 (2): 42–45. https://doi.org/10.14412/2074-2711-2019-2-42-45
Dobryanskyj DO. (2011). Pochatkova dopomoga gly`bokonedonoshenym dityam pislya narodzhennya — suchasni priorytety. Neonatologiya, xirurgiya ta pery`natal`na medycyna. 1: 108–112.
MOZ Ukrayiny. (2014). Epilepsiyi u ditej. Unifikovany`j klinichny`j protokol pervy`nnoyi, ekstrenoyi, vtory`nnoyi (specializovanoyi) ta trety`nnoyi (vy`sokospecializovanoyi) medy`chnoyi dopomogy`. Nakaz Ministerstva oxorony` zdorov'ya Ukrayiny` vid 17.04.2014 r. No. 276.
Palchik AB, Ponyatishin AE. (2015). Neepilepticheskie paroksizmy u grudnykh detej. — Moskva: MEDpress-inform: 136.
Pokhylko VI, Traverse GM, Czvirenko SM ta in. (2016). Peredchasno narodzheni dity: suchasnyj poglyad na postnatal`nu adaptaciyu ta stan zdorov'ya u rann`omu vici. Visny`k problem biologiyi i medycyny. 1 (2): 22–27.
Rogova OA, Tatochenko VK, Bakradze MD. (2017). Sindrom Sandifera. Doktor. Ru. 15 (144): 30–34.
Shunko YeYe, Pyasetska NM, Sirenko OI, (2015). Adaptation features of preterm newborns delivered on 340/7 — 366/7 gestation weeks. ISSN 1992–5913. Sovremennaya pediatriya. 7 (71): 35–38. https://doi.org/10.15574/SP.2015.71.35
Shunko YeYe. (2014). Strategichni napryamky medychnoyi dopomogy novonarodzhenym v Ukrayini. Neonatologiya, xirurgiya ta perynatal`na medycyna. 3 (13): 11–14.
Yablon OS, Vlasenko YuD. (2014). Nadzvychajno mala masa pry narodzhenni — katamnez yakosti zhyttya. Neonatologiya, xirurgiya ta perynatalna medycyna. 4 (2): 62–68. https://doi.org/10.24061/2413-4260.IV.2.12.2014.5
Aicardi J. (2009). Diseases of the Nervous System in Childhood. Part VII. Parohysmal Disorders. Mac Keith Press: 581–697.
Behrman RE, Butler AS. (2007). Preterm Birth: Causes, Consequences, and Prevention. Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Washington (DC): National Academies Press: 790.
Blackmon LR, Batton DG, Bell EF et al. (2003). Apnea, sudden infant death syndrome, and home monitoring. Pediatrics. 4 (111): 914. https://doi.org/10.1542/peds.111.4.914.
Caraballo RH, Capovilla G, Vigevano F et al. (2009). The spectrum of benign myoclonus of early infancy: Clinical and neurophysiologic features in 102 patients. Epilepsia. 50 (5): 1290–1291. https://doi.org/10.1111/j.1528-1167.2008.01994.x; PMid:19175386.
Carbone T, McEntire B, Kissin D et al. (2008). Absence of an Increase in Cardiorespiratory Events After Diphtheria-Tetanus-Acellular Pertussis Immunization in Preterm Infants: A Randomized, Multicenter Study. Pediatrics. 121 (5): 1085–1090. https://doi.org/10.1542/peds.2007-2059; PMid:18450851.
Charnay DJ, Antisdel-Lomaglio JE, Zelko FA et al. (2016). Congenital Central Hypoventilation Syndrome: Neurocognition Already Reduced in Preschool-Aged Children. 149 (3): 809–815. doi: https://doi.org/10.1378/chest.15-0402; PMid:26378991.
Cross J. (2009). Pitfalls in the diagnosis and differential diagnosis of epilepsy. Paediatrics and Child Health. 19 (5): 199–202. https://doi.org/10.1016/j.paed.2009.02.003.
Darnall RA. (2010). The role of CO2 and central chemoreception in the control of breathing in the fetus and the neonate. Respiratory Physiology & Neurobiology. 173 (3): 201–212. https://doi.org/10.1016/j.resp.2010.04.009; PMid:20399912 PMCid:PMC2988425.
DeMeo SD, Raman SR, Hornik CP et al. (2015). Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants. JAMA Pediatr. 169 (8): 740–745. https://doi.org/10.1001/jamapediatrics.2015.0418; PMid:26030302 PMCid:PMC4523398.
DeWolfe CC. (2005). Apparent Life-Threatening Event: A Review. Pediatr Clin N Am. 52 (4): 1127–1146. https://doi.org/10.1016/j.pcl.2005.05.004; PMid:16009260.
Dravet C, Bureau M, Roger J. (1986). Benign Myoclonus of Early Infancy or Benign Non-Epileptic Infantile Spasms. Neuropediatrics. 17: 33–38. https://doi.org/10.1055/s-2008-1052496; PMid:3960282
Eichenwald EC; Committee on Fetus and Newborn. (2016). Apnea of Prematurity. Pediatrics. 137 (1): e20153757. https://doi.org/10.1542/peds.2015-3757; PMid:26628729.
Furck AK, Richter JW, Kattner E. (2009). Very low birth weight infants have only few adverse events after timely immunization. Journal of Perinatology. 30: 118–121. https://doi.org/10.1038/jp.2009.112; PMid:19710678.
Glass HC, Shellhaas RA, Tsuchida TN et al. (2017). Seizures in preterm neonates: a multicenter observational cohort study. Pediatr Neurol. 72: 19–24. https://doi.org/10.1016/j.pediatrneurol.2017.04.016; PMid:28558955 PMCid:PMC5863228.
ILAE. (2020). Epilepsy imitators. URL: https://www.epilepsydiagnosis.org/epilepsy-imitators.html.
Kabakus N, Kurt A. (2006). Sandifer Syndrome: A continuing problem of misdiagnosis. Pediatrics International. 48: 622–625. https://doi.org/10.1111/j.1442-200X.2006.02280.x; PMid:17168985.
Kinsbourne M. (1964). Hiatus hernia with contortions of the neck. Lancet. 16 (1): 1058–1061. https://doi.org/10.1016/S0140-6736(64)91264-4
Kostiukova D, Shunko Ye, Babintseva A, Konchakovska T. (2019). The features of clinical and electroencephalographic diagnosis of seizures in preterm infants. ISSN 2663–7553. Modern pediatrics. Ukraine. 8 (104). https://doi.org/10.15574/SP.2019.104.9. https://med-expert.com.ua/publishing-activity/sovremennaya-pediatriya-ukraine/sovremennaja-pediatrija-ukraina-%E2%84%96-8-2019.
Midlina I. (2020). Diagnosis and management of Sandifer syndrome in children with intractable neurological symptoms. Eur J Pediatr. 179 (2): 243–250. https://doi.org/10.1007/s00431-019-03567-6; PMid:31925500 PMCid:PMC6971150.
Nalbantoglu B, Metin DM, Metin A. (2013). Sandifer's Syndrome: a Misdiagnosed and Mysterious Disorder. Iran J Pediatr. 23 (6): 715–716.
Orivoli S, Facini C, Pisani F. (2015). Paroxysmal nonepileptic motor phenomena in newborn. Brain Dev. 37 (9): 833–839. https://doi.org/10.1016/j.braindev.2015.01.002; PMid:25687201.
Pranzatelli MR. (2003). Myoclonus in childhood. Seminars in Pediatric Neurology. 10 (1): 41–51. https://doi.org/10.1016/S1071-9091(02)00008-6.
Pressler RM, Cilio MR, Mizrahi EM et al. (2017). The ILAE Classification of Seizures & the Epilepsies: Modification for Seizures in the Neonate. Proposal from the ILAE Task Force on Neonatal Seizures, Epilepsia. URL: https://www.ilae.org/guidelines/definition-and-classification/neonatal-seizure-classification.
Sharma PB, Baroody F, Gozal D et al. (2011). Obstructive Sleep Apnea in the Formerly Preterm Infant: An Overlooked Diagnosis. Front Neurol. 2: 73. https://doi.org/10.3389/fneur.2011.00073; PMid:22144976 PMCid:PMC3226060.
Tatli B, Guler S. (2017). Non epileptic paroxysmal events in childhood. Turk Pediatri Arc. 52 (2): 59–65. https://doi.org/10.5152/TurkPediatriArs.2017.4588; PMid:28747835 PMCid:PMC5509124.
Downloads
Published
Issue
Section
License
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.