Seizure Severity and Treatment Response in Newborn Infants with Seizures Attributed to Intracranial Hemorrhage

Objective: We sought to characterize intracranial hemorrhage (ICH) as a seizure etiology in infants born term and preterm. For infants born term, we sought to compare seizure severity and treatment response for multisite vs single-site ICH and hypoxic–ischemic encephalopathy (HIE) with vs without ICH. Study design: We studied 112 newborn infants with seizures attributed to ICH and 201 infants born at term with seizures attributed to HIE, using a cohort of consecutive infants with clinically diagnosed and/or electrographic seizures prospectively enrolled in the multicenter Neonatal Seizure Registry. We compared seizure severity and treatment response among infants with complicated ICH, defined as multisite vs single-site ICH and HIE with vs without ICH. Results: ICH was a more common seizure etiology in infants born preterm vs term (27% vs 10%, P <.001). Most infants had subclinical seizures (74%) and an incomplete response to initial antiseizure medication (ASM) (68%). In infants born term, multisite ICH was associated with more subclinical seizures than single-site ICH (93% vs 66%, P =.05) and an incomplete response to the initial ASM (100% vs 66%, P =.02). Status epilepticus was more common in HIE with ICH vs HIE alone (38% vs 17%, P =.05). Conclusions: Seizure severity was greater and treatment response was lower among infants born term with complicated ICH. These data support the use of continuous video electroencephalogram monitoring to accurately detect seizures and a multistep treatment plan that considers early use of multiple ASMs, particularly with parenchymal and high-grade intraventricular hemorrhage and complicated ICH.