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Minerva Pediatrica 2013 August;65(4):399-410


language: Italian

Neonatal asphyxia: neurologic outcome

Allemand A., Stanca M., Sposato M., Santoro F., Danti F. R., Dosi C., Allemand F.

Dipartimento di Pediatria e Neuropsichiatria Infantile, Università di Roma “La Sapienza”, Roma, Italia


Aim: The neonatal asphyxia is recognized as an important cause of morbidity and mortality during the pediatric age. The objective of this study was to evaluate the correlation between some neonatal variables and neurological outcome at two years of life in infants with asphyxia, in order to produce a correct prognosis and to grant a rapid and targeted therapy.
Methods: We have recruited 63 patients whose history and neuroimages suggested a neonatal asphyxia, and we have analysed their clinical- instrumental parameters every three months until two years of life. A correlation study was carried out in order to find a statistical significance indicated by p-value < 0,05. The correlation was made by means of Chi-square and ANOVA (analysis of variance) test.
Results: Only one patient developed isolated epilepsy, 17 developed CP associated to epilepsy (14 of them were term infants, 3 were preterm); 25 patients, 13 term and 12 preterm, developed only CP; 20 patients, 11 preterm and 9 term infants, developed a psychomotor delay. The most severe clinical picture (CP associated with epilepsy) appeared in 12 infants of adequate weight and in 5 LBW children; the CP appeared in 14 NW patients, 5 LBW, 4 VLBW and 2 ELBW. Psychomotor delay was developed by 8 NW children, 2 LBW and 10 ELBW. Most patients with severe CP presented severe neurological symptoms at birth. Moderate CP involved those who had a mild neurological or systemic symptoms. Furthermore an association emerged between early epilepsy and CP onset and their severity.
Conclusion: Neonatal seizures are not related to an increased risk to develop epilepsy. Epilepsy alone is a rare event and it usually complicates CP picture. Most subject with both epilepsy and CP are term infants with adequate weight. Preterm VLBW infants have a greater risk to develop a psychomotor delay. Clinical conditions at birth are related to CP severity (several neonatal neurological signs are the greater risk factors). Severely pathological neonatal EEG (background activity) is related to CP severity and an early symptomatic epilepsy onset is related with both epilepsy and CP severity.

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