Neurological outcomes and mortality after neonatal seizures with electroencephalographical verification. A systematic review.

AIM: To conduct a systematic review of post-neonatal neurological outcomes and mortality following neonatal seizures with electroencephalographical verification. METHODS: The databases Medline, Embase and Web of Science were searched for eligible studies. All abstracts were screened in a blinded fashion between research team members and reports found eligible were obtained and screened in full text by two members each. From studies included, outcome results for post-neonatal epilepsy, cerebral palsy, intellectual disability, developmental delay, mortality during and after the neonatal period and composite outcomes were extracted. A quality assessment of each study was performed. RESULTS: In total, 5518 records were screened and 260 read in full text. Subsequently, 31 studies were included, containing cohorts of either mixed or homogenous etiologies. Follow-up time and gestational ages varied between studies. No meta-analysis could be performed due to the low number of studies with comparable outcomes and effect measures. Reported cumulative incidences of outcomes varied greatly between studies. For post-neonatal epilepsy the reported incidence was 5-84%, for cerebral palsy 9-78%, for intellectual disability 24-67%, for developmental delay 10-67% and for mortality 1-62%. Subgroup analysis had more coherent results and in cohorts with status epilepticus a higher incidence of post-neonatal epilepsy from 46 to 84% was shown. CONCLUSION: The large variation of reported incidences for neurological outcomes and mortality found even when restricting to cohorts with electroencephalographically verified neonatal seizures indicates selection bias as a significant confounder in existing studies. Population-based approaches are thus warranted to correctly predict outcomes in this group.

Validation of central nervous system-induced seizures and other neurological variables in the Swedish Neonatal Quality Register.

AIM: We sought to validate neurological variables and relevant International Classification of Diseases, Tenth Revision (ICD-10) codes in the Swedish Neonatal Quality (SNQ) Register. METHODS: Register data were collected for 351 neonates, born between January 2009 and December 2016, who were treated at a neonatal unit in the Stockholm region on 385 occasions. They were eligible if the check-box for central nervous system (CNS)-induced seizures was ticked. The Register data, including relevant ICD-10 codes, were validated by checking the patients' electronic medical charts. RESULTS: Most of the neonates were born at term (76%) and weighed >2500 g (80%). The variable CNS-induced seizures had a positive predictive value of 46%. The ICD-10 diagnosis P90.9A had a positive predictive value of 90%. This comprises seizures validated with electroencephalography, amplitude-integrated electroencephalography or continuous function monitoring. The majority of the associated neurological variables in the Register had positive predictive values above 85%. CONCLUSION: When the check-box was ticked for central nervous system-induced seizures, most of the neurological variables in the Register had high validity. However, the CNS-induced seizures variable per se had a lower positive predictive value. Future SNQ Register-based studies of such neonatal seizures should also include ICD-10 P90.9A.

First evaluation of the paediatric version of the Swedish rapid emergency triage and treatment system shows good reliability.

AIM: To investigate the reliability of Retts-p, Rapid emergency triage and treatment system-paediatric, with regard to inter-rater and intra-rater agreement. METHOD: Twenty nurses responsible for triaging both children and adults at the Emergency Department, Östersund County Hospital, Sweden, were randomly selected to take part in the study. The nurses were asked to use the Retts-p triage system to retrospectively assess the written case reports on 40 paediatric cases, aged from 6 month to 17.5 years, who attended the Emergency Department in 2010 with surgical, orthopaedic and medical symptoms. Using the information provided regarding appearance, symptoms, previous medical history and vital signs, the nurses selected the most appropriate Emergency Symptoms and Signs algorithm and placed the child in one of the five triage categories. Two test rounds were performed, 3 months apart, using the same cases, to study both the inter-rater and intra-rater agreement for the priority level and the triage algorithm chosen by the triage nurses. RESULTS: Good to very good agreement were shown for both inter-rater (quadratic κw 0.86, 95% CI 0.85-0.87) and intra-rater testing (quadratic κw 0.92, 95% CI 0.88-0.96). CONCLUSION: Retts-p provided good to very good reliability in this first evaluation study of the triage system.

Subcutaneous adipocytes from obese hyperinsulinemic women with polycystic ovary syndrome exhibit normal insulin sensitivity but reduced maximal insulin responsiveness.

BACKGROUND: Polycystic ovary syndrome (PCOS) has a high prevalence in women and is often associated with insulin resistance and hence with aspects of the so-called metabolic syndrome. METHODS: Ten women diagnosed with PCOS were consecutively included (aged 21-39 years, average 30.2 +/- 1.9 years; body mass index 28.4-42.5 kg/m2, average 37.5 +/- 1.7 kg/m2 (mean +/- s.e.)). Adipocytes were isolated from the subcutaneous fat and, after overnight incubation to recover from insulin resistance due to the surgical cell isolation procedures, they were analyzed for insulin sensitivity. RESULTS: The patients with PCOS exhibited marked clinical hyperinsulinemia with 3.6-fold higher blood levels of C-peptide than a healthy lean control group (1.7 +/- 0.2 and 0.5 +/- 0.02 nmol/l respectively, P < 0.0001). The patients with PCOS also exhibited 2.4-fold higher concentrations of serum triacylglycerol (2.1 +/- 0.3 and 0.9 +/- 0.06 mmol/l respectively, P < 0.0001), but only slightly elevated blood pressure (118 +/- 12/76 +/- 6 and 113 +/- 7/72 +/- 6 mmHg respectively, P = 0.055/0.046). However, insulin sensitivity for stimulation of glucose transport in the isolated adipocytes was indistinguishable from a non-PCOS, non-diabetic control group, while the maximal insulin effect on glucose uptake was significantly lower (2.2 +/- 0.2- and 3.8 +/- 0.8-fold respectively, P = 0.02). CONCLUSIONS: Subcutaneous adipocytes from patients with PCOS do not display reduced insulin sensitivity. The findings show that the insulin resistance of PCOS is qualitatively different from that of type 2 diabetes.

Glucose transport is equally sensitive to insulin stimulation, but basal and insulin-stimulated transport is higher, in human omental compared with subcutaneous adipocytes.

Excess visceral fat has been found to correlate more closely with morbidity than subcutaneous fat. We found that isolated adipocytes from omental fat of nondiabetic women expressed significantly more of the insulin-regulated glucose transporter glucose transporter 4 protein and exhibited a higher basal and insulin-stimulated rate of glucose transport, at all concentrations of insulin, than subcutaneous adipocytes from the same individuals. In contrast, dose-response relationships for insulin stimulation of glucose transport demonstrated identical sensitivity to insulin in adipocytes from the 2 locations. The results demonstrate that there is no relative insulin resistance to stimulate glucose uptake in visceral compared with subcutaneous fat cells.