Clinicoetiological profile and outcome of neonatal seizures

Abstract

Background: Neonatal seizures are abnormal electrical discharge in the central nervous system of neonates, usually manifesting as stereotyped muscular activity or automatic changes. This study aims to determine the, clinical types, etiological factors and developmental outcome of neonatal seizures. Methods: It is a prospective study conducted in NICU of PBM Hospital, Bikaner, India. Total 1278 neonates were admitted, out of which 150 had seizures. Details of history, examination and investigations were recorded on predesigned performa. Cases were followed at 6 months of age for developmental outcome. Results: Intramural and extramural incidence of seizures was 1.42% and 10.16% respectively. Incidence in extreme low birth weight, very low birth weight and in low birth weight was 29.41%, 26.71% and 10.73% respectively. Male preponderance with male to female ratio was 1.73:1. 96 (64%) neonates born to primi and 54 (36%) were born to multiparous mother. Most common type of neonatal seizure is subtle 95 (63.33%) followed by generalized tonic 29 (19.33%), multifocal clonic 15 (10%), focal tonic and focal clonic 4 (2.67%) each and myoclonic 3 (2%). Most common cause of neonatal seizures is perinatal asphyxia 80 (53%) followed by metabolic causes 24 (16%), infections 15(10%), intracranial hemorrhage in 7 (4.66%), meconium aspiration syndrome (MAS) 5 (3.33%), bilirubin encephalopathy and polycythemia 2 (1.33%) each and 12 (8%) had undetermined etiology. Conclusions: Most common type of neonatal of neonatal seizure is subtle, most common cause is perinatal asphyxia. Excellent outcome was seen in seizures due to electrolyte imbalance, MAS, neonatal septicemia, bronchopneumonia and polycythemia. Worst outcome was with HIE (Hypoxic ischemic encephalopathy) grade III and encephalitis.