新生儿惊厥临床分析及预后随访

目的 分析新生儿惊厥的病因、临床特点、再发惊厥及影响其预后的因素.方法 对 2014年2月至2017年2月西安交通大学第二附属医院普通儿科住院的>28天且新生儿期发生过惊厥的患儿20例进行回顾性分析,并对其进行为期1~36个月的随访,回顾分析其临床特点及预后.结果 对20例新生儿惊厥患儿进行病史采集,结果表明,引起新生儿惊厥的首要病因为缺氧缺血性脑病,占35%;发作类型以微小发作为主,占45%;新生儿期惊厥患儿有孕产高危因素者7例,有惊厥家族史者2例,影像学异常者10例,脑电图异常者14例;对20例新生儿惊厥进行长期随访, 12例出现不同程度运动及智力发育落后;12例出现癫痫发作,其中10例患儿发作减少<50%,药物控制效果不佳,诊断为药物难治性癫痫.对可能影响预后的高危因素进行统计学分析,结果显示,新生儿期影像学异常及脑电监测结果异常对预后评估无统计学意义(P>0.05),考虑可能与样本量较小有关.结论 新生儿惊厥病因以缺氧缺血性脑病为主.新生儿惊厥可继发癫痫及发育落后,且通常治疗效果不佳.因此,对新生儿惊厥预后应作出早期判断及干预.

Clinical analysis and follow-up of neonatal convulsion

Objective To explore the etiology, clinical characteristics, recurrence and prognostic factors of neonatal convulsions.Methods Twenty neonates older than 28 days with neonatal convulsions hospitalized in pediatric department in Second Affiliated Hospital of Xi'an Jiaotong University from February 2014 to February 2017 were retrospectively evaluated and then followed for 1 to 36 months.Their clinical characteristics and prognosis were retrospectively analyzed.Results Histories of 20 cases of neonatal convulsions were collected, and results showed that primary cause of neonatal convulsion was hypoxic ischemic encephalopathy (HIE), accounting for 35%.Major seizure type was subtle seizure, accounting for 45%.Seven cases of neonatal convulsions had pregnancy risk factors and 2 had family history of convulsion.Ten cases were found abnormal in imagining examination.Electroencephalogram (EEG) results of 14 cases were abnormal.Long term follow-up of 20 cases of neonatal convulsions revealed that 12 patients had motor and intellectual development delay at different degrees, and 12 cases had seizures.Among them, 10 cases had less than 50% of reduction on attack rate, showing poor drug control effect and were diagnosed as refractory epilepsy.Statistical analysis on prognostic risk factors showed that neonatal imaging and EEG monitor abnormalities had no statistical significance in prognosis evaluation (P>0.05), which was considered to be associated with small sample size.Conclusion The most common cause of neonatal convulsions is hypoxic ischemic encephalopathy, and neonatal convulsion has possibility of secondary epilepsy and development delay with poor treatment effect, so early detection and intervention for neonatal convulsion is necessary.