Abstract
IntroductionNeonatal seizures are the most common manifestation of neurological disorders in newborn period. It is an important determinant of outcome as well. This study aims to delineate the etiological profile and neurodevelopmental outcome of neonatal seizure. It is also aimed to identify the predictors of neurodevelopmental outcome in survivors.
 MethodsWe recruited consecutively 117 neonates with clinically proven seizures admitted in XXXXX hospital, between February 2014 to February 2016. All of them underwent neurological diagnostic testincluding complete blood count, electrolytes, EEG, CSF analysis, neuroimaging depending upon the etiology of seizure in newborn period. After discharge, all infant with neonatal seizure underwent regular neurological examination at least 3 times within first year of life. We tested prognostic value of adverse outcome including developmental delay, post neonatal seizure, vision and hearing impairment.ResultsDuring the study period among total 954 neonates admitted in NICU and neonatal ward, 117 (12.26%) developed clinical seizures. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy 69(59%), followed by infection 20 (17.09%) and metabolic disturbances collectively constituted 16(13.7%). The outcomes were mortality 16(13.7%), post neonatal seizure 18(15.4%), developmental delay 31(26.5%), vision impairment 19(16.2%) and hearing impairment 26 (22.2%).Low Apgar score at 1 minute (p=0.03), low Apgar score at 5 minute (p=0.001), early onset seizure (p<0.001), intractable seizure (p<0.001)and more than one drug used for seizure control (p=0.001) were early prognostic factors for adverse outcome.Key words: hypoxic ischemic encephalopathy, Apgar score, seizure, developmental delay
Highlights
Neonatal seizure is the most common manifestation and an important determinant of outcome of neurological disorders in newborn period
Newborns included in the study were neonates with seizures admitted in the Neonatal Intensive Care Units (NICU) of Dhulikhel Hospital from February 2014 to February 2016
We found statistically significant relationship between low Apgar scores (0-3) at one and five minutes, early onset seizure (
Summary
Neonatal seizure is the most common manifestation and an important determinant of outcome of neurological disorders in newborn period. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (n=69, 59%), followed by infection (n=20, 17.09%), and metabolic disturbances (n=16, 13.7%). Conclusion: Birth asphyxia followed by infection and transient metabolic disturbance were common etiologies for neonatal seizures. Neonatal seizures are usually an acute manifestation of disturbance of the developing brain and common in the early weeks of life. Several prognostic factors for adverse outcome of seizure are well known, namely brain immaturity, abnormal cranial ultrasonography (USG) findings, low Apgar score, early onset of seizure or prolonged duration of seizure.[5] Neonates with seizures are at an increased risk of mortality, and the survivors are at risk of neurological sequelae as developmental delay, epilepsy and cognitive impairment. Establishing risk factors that might predict outcome of newborn with seizure would be helpful in planning long term follow up and health assistance to these children
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