Cause Of Neonatal Seizures Research Articles

Common Causes of Neonatal Seizure among Neonates Admitted to Neonatal Care Unit at Al Ramadi Teaching Hospital for Maternity and Children

Neonatal seizures are the transient occurrence of signs and symptoms due to an abnormal excessive or synchronous neuronal activity in the neural cells causing paroxysmal electro clinical changes. Neonates are at high risk for seizures as compared to other age groups. The aim of this study was to identify the common causes that lead to neonatal seizure during the period from first of October 2020 to the end of July 2021using history, physical examination, and investigations in Al Ramadi teaching hospital for maternity and children. The total number of neonates diagnosed as neonatal seizure during the period of study in Al Ramadi teaching hospital for maternity and childhood was 64 cases. Total number of admissions to neonatal care unit was 4102 so the prevalence in neonatal care unit was 15.6 per 1000 live births. 30 (47.1 %) cases were diagnosed as perinatal asphyxia, 18 (28 %) cases were diagnosed as metabolic, 6 (9.4 %) cases were diagnosed as infections, seizures, 4 (6.3%) cases were diagnosed as intracranial hemorrhage, 3(4.6%) cases were diagnosed as CNS malformation, while 3 cases (4.6 %) were Unknown etiology. 38 (59.3%) of studied neonatal seizures were male, while 26 (40.7%) were female. Male to female ratio was (1.4:1). 37 (57.8%) were term babies (≥37 gestational age), while 27 (42.2%) were preterm babies (<37 gestational age). 41 (64%) of studied neonatal seizure cases were born by normal vaginal delivery, while 23 (36%) of cases were born by caesarian section delivery. The most common cause of neonatal seizure was perinatal asphyxia followed by metabolic causes then infection, intracranial hemorrhage, CNS malformations and unknown causes. Male are more common than female. In term neonates more common than preterm and in normal vaginal delivery more than cesarean section.

Identifying Metabolic Diseases That Precipitate Neonatal Seizures.

Although a rare cause of neonatal seizures, inborn errors of metabolism (IEMs) remain an essential component of a comprehensive differential diagnosis for poorly controlled neonatal epilepsy. Diagnosing neonatal-onset metabolic conditions proves a difficult task for clinicians; however, routine state newborn screening panels now include many IEMs. Three in particular-pyridoxine-dependent epilepsy, maple syrup urine disease, and Zellweger spectrum disorders-are highly associated with neonatal epilepsy and neurocognitive injury yet are often misdiagnosed. As research surrounding biomarkers for these conditions is emerging and gene sequencing technologies are advancing, clinicians are beginning to better establish early identification strategies for these diseases. In this literature review, the authors aim to present clinicians with an innovative clinical guide highlighting IEMs associated with neonatal-onset seizures, with the goal of promoting quality care and safety.

Neonatal Seizures and Neurodevelopmental Outcome

Background: Neonatal period is the most vulnerable time for the occurrence of seizures. There are various etiological factors of neonatal seizures and increasing evidence suggests that neonatal seizures are associated with adverse neurodevelopment outcomes. The aim of the study is to determine of causes of neonatal seizures with outcome during management and long-term post-natal outcome. Methods: This prospective study conducted in Rangpur Mother and Children Hospital from 1st July to 2017 to 30th June 2022. Term newborn babies admitted in NICU with convulsion were the samples. A prepared and pretested “Protocol” containing Part-A and Part-B was used - Part-A in neonatal intensive care unit and Part-B in the attached Disability Research Center. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200-201

Retracted Article: Neonatal Hypoglycemia: Oral Dextrose Gel and Tahneek Practice

AbstractIn this article, we reviewed the use of oral dextrose gel in neonatal hypoglycemia (NH) and examined tahneek practices from past to present to draw attention to the importance of tahneek for newborn infants. NH, a common metabolic problem, is one of the most common causes of neonatal seizures. A universal approach to diagnosis and management of NH is still lacking. Although oral dextrose gel is the recommended first-line treatment for the management of NH, it may cause a hyperinsulinemic response. Date is an essential high-energy food with a low glycemic index. Tahneek, rubbing of chewed date on the soft palate of the neonate immediately after delivery, has been performed for over 1,400 years because it is one of the Prophet Muhammad's (Sallallahu Alayhi Wa Sallam) sunnahs. It has been noted that tahneek may be alternative to dextrose gel for prophylaxis and treatment of NH; however, no clinical study has been published about this subject according to the best of our knowledge. We think that tahneek practice is more effective, and safer option than oral dextrose gel because of low glycemic index of date. We also believe that tahneek practice has many benefits for newborn infants, because dates have antioxidant, antimicrobial, and anti-inflammatory properties. Randomized controlled studies, including large series, should be conducted about effects of tahneek practice on newborns.

A protocol for systematic review and meta-analysis on the burden of neonatal seizures in Nigeria

Neonatal seizures are a significant contributor to neonatal morbidity and mortality in Nigeria and the magnitude of the burden is unknown. A comprehensive systematic review is needed to determine the pooled magnitude and causes of neonatal seizures in Nigeria since the true estimate is yet to be determined. Therefore, this study aims to develop a protocol to assess the burden and causes of neonatal seizures in Nigeria.
 A search strategy is developed using MeSH terms, text words, and entry terms. Nine databases will be searched including Pub- Med, African journals online, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Psych Info, Web of Science, Scopus, and Research Gate. Only observational studies, retrievable in the English language and conducted in Nigerian neonates will be included. The primary outcome of this study is the pooled prevalence of neonatal seizures in Nigeria. The secondary outcomes include the seizure types, causes, method of detection, and outcome in the neonates. Screening of identified studies will be done in End Note version 20 and duplicates removed, before exporting to Microsoft 365 excel sheet for data extraction by independent reviewers. Studies will be assessed for methodological, clinical, and statistical heterogeneity and if required, a meta-analysis will be done. Stata 16 IC will be used for data analysis. Various subgroup analyses will also be done. A funnel plot will be used for the assessment of publication bias. Results will be presented in tabular formats, narrative synthesis, and regression plots.
 The data from this review will reveal the pooled prevalence of neonatal seizures in Nigeria. It will create an avenue for discussion on the types, causes, and outcome of neonatal seizures. The findings will also enable discussions on how to address the causes of neonatal seizures in Nigeria and provide evidence for policy recommendations to reduce morbidity and mortality resulting from neonatal seizures in Nigeria.
 Trial registration number: This protocol is registered in PROSPERO with registration number CRD42020220097.

Pearls & Oy-sters: Genetic Epilepsy: An Important Cause of Neonatal Seizures in Infants With Complex Congenital Heart Disease.

Genetic epilepsies, such as KCNQ2 gene variants, although uncommon, are potential causes of neonatal seizures in infants with complex congenital heart disease (CHD). KCNQ2-related seizures commonly present as tonic posturing with autonomic changes and a distinctive amplitude-integrated EEG (aEEG) pattern with increase in amplitude, immediately followed by background suppression. Seizures are typically refractory to commonly used antiepileptics in this age group and respond best to sodium channel blockers such as carbamazepine and fosphenytoin. We report the cases of 2 neonates with complex CHD who presented with seizures secondary to KCNQ2 gene variation and discuss how early recognition of clinical and EEG features led to early treatment and improved seizure burden. When investigating the etiology of neonatal seizures in the perioperative complex cardiac infant, genetic etiologies such as KCNQ2 variants should be considered, particularly in the absence of clinical examination and neuroimaging features consistent with brain injury. These 2 cases highlight the importance of a precision medicine approach using clinical examination and seizure semiology, bedside aEEG monitoring, genetic testing, and targeted treatments to improve patient care and outcomes.

Efficacy and Utilization Patterns of Anti-Epileptic Drugs in the Management of Neonatal Seizures: A Comparative Exploration.

Management of neonatal seizures with available limited guidelines across different gestation can cause long-term neurological and cognitive impairment. To compare utilization and observe the efficacy of anti-epileptic drugs in the treatment of neonatal seizures. The association of hypoxic-ischemic encephalopathy with NS and the etiology of HIE were also determined. A retrospective cohort study was conducted at a tertiary care hospital for a period of one year. It was approved by IEC prior to initiation. Neonates admitted for seizure management and perinatal asphyxia with hypoxic-ischemic encephalopathy were included in the study. Both term and preterm 267 neonates from January 2014 to July 2018 were retrospectively analyzed. The drugs with the fastest seizure resolution, least recurrence, and readmission rates were considered efficient. Phenobarbitone, levetiracetam, and phenytoin were compared as they were commonly prescribed. Inpatient medical records and hospital databases served as sources of information. Phenobarbitone was commonly utilized, followed by phenytoin and levetiracetam. The commonly prescribed combination was phenobarbitone (first-line agent) and phenytoin (second-line agent). Phenobarbitone immediately resolved seizures (97, 75.1%) and had the least cases of seizure recurrences (53, 41.1%) and readmissions (20, 15.5%), making it most efficient. The best second-line agent was phenytoin, with the least seizure recurrence (4, 8.51%), least readmissions (7, 14.8%), and fastest resolution (25, 53.1%). Levetiracetam was an efficient third-line agent. Hypoxic-ischemic encephalopathy was the most observed cause of neonatal seizures. Phenobarbitone was observed as the most utilized and efficient anti-epileptic drug, followed by phenytoin and levetiracetam. Owing to limitations in this study, there is an alarming need for standardized clinical trials to establish thorough guidelines.

Brain CT Scan, Sonography and EEG Findings in Neonates with Seizure.

ObjectivesThis study aimed to determine the frequency of different types, causes, and abnormal findings of brain computed tomography scan (CT scan) and ultrasonography (US) and multichannel- electroencephalography (EEG) in neonates with seizure. The ability of brain CT scan was also compared with US in terms of detecting the underlying causes of neonatal seizures.Materials & MethodsIn this cross-sectional retrospective study, the medical records of 90 neonates younger than 28 days with the definite diagnosis of seizure were reviewed. The data were analyzed using SPSS 22 through descriptive and Exact fisher tests.ResultsTotally, 90 newborns (M: F = 1.5:1) with mean age of 63.11 ± 32.8 days were enrolled. 35.5% of newborns were born before the 37th week of pregnancy. In this study, 45.6% of EEG findings, 22% of brain CT scan findings, and 12.5% of US findings were abnormal. The automatisms (38.9%) and benign idiopathic neonatal seizure (70.7%) were the most common seizure type and cause respectively. The hypoxic Ischemic encephalopathy was the most common abnormal finding (30%) in brain CT scan.ConclusionsGiven the accuracy of EEG in detection of brain pathologies, where available, all neonatal seizures should be initially confirmed using EEG. Radiologic investigations (CT scan, US) off the head/ cranium should be done to detect the cause of neonatal seizure. The capacity of brain CT scan to detect underlying causes of neonatal seizures is more than US.

INCIDENCE AND RISK FACTORS OF NEONATAL SEIZURES IN LOW BIRTH WEIGHT NEONATES BORN IN RURAL TERTIARY CARE CENTRE.

BACKGROUND: To study the incidence and risk factors of neonatal seizures in low birth weight neonates born in rural tertiary care centre. METHODS: This is a prospective observational study. It was carried out in neonatal division of department Of pediatrics MMIMSR, Mullana. The study included 200 low birth weight neonates born during the study period. RESULTS: Out of 200 neonates the incidence of neonatal seizures was 4%. According to weight distribution 181(90.5%) were LBW(2499gm - 1500gm) , 14(7%) were VLBW(1499gm-1000gm) , 5(2.5%) were ELBW(<1000gm) and the incidence of neonatal seizure among LBW was 3.31% , VLBW 7.1% and ELBW 20%. The incidence of neonatal seizure among term was 3.09% and preterm was 4.95%. The most common cause of neonatal seizure was birth asphyxia (37.5%) followed by meningitis (25%), hypocalcemia(12.5%), intracranial hemorrrhage(12.5%) and RDS(12.5%). CONCLUSION: Low birth weight and preterm deliveries are at higher risk for morbidity during and after the birth. Early referral of high-risk pregnancies to the tertiary care centers will greatly reduce the incidence of neonatal seizures in neonates. The incidence increases as birth weight and gestation decreases in neonates. The co morbidities causing hypoxic damage and other CNS insults should be controlled at the earliest to avoid occurance of seizures in neonates.

Clinical profile, etiology, type and outcome of neonatal seizures: a hospital-based study

Background: Our study was undertaken to study the etiological factor, clinical profile, types and outcome of newborn with neonatal seizures (NNS).Methods: Our study was hospital based prospective study was done in Sheri Kashmir institute of medical sciences (SKIMS) Bemina from April 2013 to April 2015 in NICU, after obtaining ethical clearance from institutional ethical committee. All neonates fulfilling inclusion criteria were included in our study.Results: In our study, 80 neonates with seizures were included in our study, among them 48 were males and 32 were females. Majority of neonates (57.5%) developed seizures during first 72 hours of life due to birth asphyxia. Commonest types of neonatal seizures observed in our study were subtle observed in 46 cases, followed by tonic (21.2 %), clonic (14.9 %) and mixed (6.2%) seizures. Birth asphyxia was commonest cause (57.5%) of NNS, sepsis with meningitis (18.7%) followed by hypoglycemia (13.7%) and hypocalcemia (5%). Cases of birth asphyxia were associated with higher mortality (58.3%) as compared to cases with metabolic seizures.Conclusions: From our study we conclude that commonest cause of neonatal seizure was birth asphyxia occurring within 72 hours of birth. Sepsis and meningitis were also common infections resulting in neonatal seizure, while as hypoglycaemia and hypocalcemia were common biochemical abnormalities leading to NNS. Early identification and treatment are likely important for long-term outcomes in acute symptomatic seizure.

Cerebrospinal Fluid Ion Analysis in Neonatal Seizures

BackgroundThere is a gap of knowledge regarding cerebrospinal fluid (CSF) ion concentrations in normal and pathological states, particularly during the neonatal period. We aim to compare CSF ion concentrations in newborns with different causes of neonatal-onset epilepsy (NOE) and acute symptomatic seizures (ASS) and controls, to examine their usefulness for diagnostic purposes. MethodsA descriptive retrospective study was conducted from January 2019 to June 2020 in a tertiary hospital. We analyzed CSF K+, Na+, Cl−, and Ca2+ concentrations in frozen samples from patients with neonatal seizures (NS) secondary to NOE and ASS (neonatal arterial ischemic stroke [NAIS] and hypoxic-ischemic encephalopathy). As the control group, we selected CSF samples from newborns who had undergone CSF analysis as part of the diagnostic workup and in whom central nervous system infections had been ruled out, without signs of dehydration, gastroenteritis, or history of seizures. ResultsSixty-eight newborns were included, 16 with NOE, 13 with ASS, and 39 without NS (control group). In comparison with the control group, [K+]CSF was lower in patients with KCNQ2-related epilepsy (P = 0.007), other causes of NOE (P = 0.010), and NAIS (P = 0.002). Changes in [Na+]CSF, [Cl−]CSF, and [Ca2+]CSF were less consistent among subgroups. ConclusionsHere we report for the first time ionic imbalances in the CSF of neonates with NOE and NAIS. No differences were observed between newborns with different causes of NS. Further studies should be undertaken to investigate the physiopathology behind these changes and their impact on biological function.

Refractory Yet Transient Neonatal Hypocalcemia Due to Hitherto Undiagnosed Asymptomatic Maternal Hyperparathyroidism: A Case Report

Hypocalcemia is one of the common causes of neonatal seizures and can result in significant morbidity. Among the multitude of etiologies, hypoparathyroidism as a consequence of maternal hyperparathyroidism is an uncommon one. We describe a neonate who presented with hypocalcemic seizures with relative hypoparathyroidism that unmasked a previously undiagnosed and asymptomatic maternal hyperparathyroidism, and explore the difficulties encountered in the management. Despite initial recalcitrance of hypocalcemia to therapy, parathyroid suppression was transient and recovered completely in few months.

Hypophosphatasia as a rare cause of neonatal seizures

Severe forms of hypophosphatasia due to loss-of-function in the ALPL gene may present with diverse neurological problems including pyridoxine-responsive seizures. We present a short report of pyridoxine-responsive neonatal seizures. Due to severe osteopenia with unmeasurable levels of alkaline phosphatase, targeted genetic screening was performed and two pathogenic variants in the gene for the nonspecific alkaline phosphatase confirmed the diagnosis of hypophosphatasia. We would like to emphasize the importance of considering infantile hypophosphatasia in the differential diagnosis of pyridoxine-responsive seizures with concomitant low alkaline phosphatase level and bone pathology, especially with the new treatments becoming available in the future.

TO STUDY CLINICAL PRESENTATION AND TIME OF ONSET OF SEIZURE IN TERM AND PRETERM NEONATES AND THE BIOCHEMICALABNORMALITY IN SEIZURES IN TERM AND PRETERM NEONATES.

INTRODUCTION: Seizure is dened as paroxysmal involuntary disturbance of brain function. It may manifest as impairment or loss of consciousness, abnormal motor activity, behavioural abnormality, sensory disturbance or autonomic dysfunction. Any abnormal, repetitive and stereotypic behaviour in neonates should be evaluated as possible seizure. Neonatal seizures is a common neurological problem with a frequency range from 0.95 to 3.5/1000 live births. AIMS & OBJECTIVES:To assess the importance of biochemical abnormalities in neonatal seizures and to evaluate clinical presentation & time of onset of seizures in term and preterm neonates. MATERIAL & METHODS: A total of 90 neonates presenting with seizures admitted to NICU of National Institute of Medical Sciences & Research, Jaipur from conducted from 1st January 2019 till 30 th June 2020 were enrolled in the study. Detailed antenatal, natal, postnatal history along with detailed examination was done. Baseline characteristics of convulsing neonate including sex, gestational age, birth weight, head circumference & length were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded i.e. age at onset of seizures, duration of seizure, number and type of seizure. Relevant investigations including biochemical parameters were done immediately after baby had seizures and before instituting any specic treatment. Etiology of neonatal seizures and associated biochemical abnormalities were diagnosed. RESULTS: In the present study, out of 90 neonates studied, 64 were full term of which 49(76.5%) were AGAand 15(23.5%) were SGA, whereas 26 cases were preterm. The male: female ratio is 1.3:1. Most neonatal seizures occur in rst 3 days of life, i.e. 60 %. Most of them occurred on rst day of life (34%). Birth asphyxia was the cause of neonatal seizures in 82 % neonates who developed seizures on day-1 of life. Birth asphyxia and septicemia are common cause of neonatal seizures in our study, followed by pure metabolic disturbances 20 %. In pure metabolic seizures, hypoglycemia (47.8%) is most common more in preterm babies (55%) followed by hypocalcemia. In cases of non- metabolic seizures, which showed associated biochemical abnormalities, hypoglycemia was most common abnormality 24 of 52 cases (46.15%). 12 cases (52.1%) are associated with birth asphyxia and 11 cases (47.9%) are associated with septicemia. CONCLUSION: Biochemical abnormalities are common in neonatal seizures and often go unrecognized. These abnormalities may signicantly contribute to seizure activity correction of these abnormalities may play a signicant role in seizure control. Hence, a biochemical work up is necessary for all cases of neonatal seizures.

Neonatal Rotavirus-Associated Leukoencephalopathy Is One of the Main Causes of Fifth-Day Fits.

Our province recently experienced an outbreak of neonatal rotavirus-associated leukoencephalopathy. This study aimed to verify whether rotavirus-associated leukoencephalopathy constituted fifth-day fits, which prevailed in Europe and Australia between the 1970s and mid-1980s. Of 118 full-term neonates who were admitted between 2008 and 2017 due to seizures, those who fulfilled the following criteria for fifth-day fits were included: healthy full-term neonates prior to seizures; absence of perinatal asphyxia; seizure onset during 4-6 days of age; and no known cause of neonatal seizures. Overall, 54 patients (45.8%) met the criteria for fifth-day fits. Of them, 44 patients (81.5%) also had rotavirus-associated leukoencephalopathy. The mean annual incidence of fifth-day fits was 5.4 cases, which peaked in 2012-2013 (13 cases) and became zero in 2017. Fifth-day fits with rotavirus-associated leukoencephalopathy accounted for 37.2% of neonatal seizures, which peaked at 70.6% in 2012, and gradually reduced to zero in 2017. Concordance of clinical features between rotavirus-associated leukoencephalopathy and fifth-day fits and their epidemic-like features suggest that rotavirus-associated leukoencephalopathy is one of the main causes of fifth-day fits.

Metabolic and Electrolyte profile in Birth Asphyxia

Introduction: The definition of birth asphyxia is given by the ACOG, AAP includes the existence of 3factors: Metabolic or mixed acidemia (pH<7) which is determined by umbilical cord arterial bloodsamples. The major causes of neonatal seizures are Hypoxic-ischemic encephalopathy (HIE), whichrepresents about 50% of the causes of neonatal seizures. Metabolic abnormalities, infection,intracranial hemorrhage, developmental anomalies, and other like inborn errors of metabolism areother causes of neonatal seizures. Material and Methods: A cross-sectional study. This is ahospital-based prospective study conducted at Nehru Hospital, BRD Medical College, Gorakhpur (UP)in the Neonatal Intensive Care Unit of the pediatric department. This study was conducted from July2018 to July 2019. Result: Prevalence of Hypocalcemia was 7.6%, Prevalence of hypernatremia was1.3%, Out of 315 patients 32 (10.2%) patients expired and 283 (89.8%) was successfullydischarged. Conclusion: No association between Hypocalcemia and Hypomagnesemia Prevalence ofhyponatremia was 6.3% and no association between hyponatremia and Hypomagnesemia. Theprevalence of hypernatremia was 1.3% and there was no association between hypernatremia andHypomagnesemia.

Prevalence of Biochemical Abnormalities in Neonatal Seizures in Term and Preterm Neonates

Background: The most vulnerable period of life to develop seizures is the neonatal period. These events very often signify serious damage or malfunction of the immature developing central nervous system. Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Biochemical abnormalities are commonly observed in neonates who are admitted in neonatal intensive care unit with seizures. Early recognition and treatment of biochemical disturbances is essential for optimal management and satisfactory long-term outcome.
 Objective: To assess clinical types and importance of biochemical abnormalities in neonatal seizures and to evaluate clinical type & time of onset of seizures in term and preterm neonates.
 Methods: A prospective observational study, where 100 neonates presenting with seizures admitted to neonatal intensive care unit of Jagadguru Jayadeva Murugarajendra Medical College, Davangere, from September 2015 to August 2017 were enrolled in the study. The detailed history along with clinical examination, baseline characteristics of convulsing neonate were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded. The relevant biochemical investigations were done immediately after baby had seizures and before instituting any specific treatment. The descriptive statistics such as mean and standard deviation (SD) for continuous variables, frequencies and percentages were calculated for categorical variables. The association between gestational age and other categorical variables were analyzed using chi-square test of independence. The comparison of mean of various quantitative variables was analyzed using ANOVA test. Etiology of neonatal seizures and associated biochemical abnormalities were diagnosed.
 Results: In the present study, out of 100 neonates studied, 64 were full term of which 49(76.5%) were appropriate for gestational age and 15(23.5%) were small gestational age, whereas 36 cases were preterm. Most neonatal seizures occur in first 3 days of life, i.e. 59%. Most of them occurred on first day of life (34%). Birth asphyxia was the cause of neonatal seizures in 82.35% neonates who developed seizures on day-1 of life. Birth asphyxia and septicemia are common cause of neonatal seizures in our study (38 cases each), followed by pure metabolic disturbances 19%. In pure metabolic seizures, hypoglycemia (47.8%) is most common more in preterm babies (55%) followed by hypocalcemia. In cases of non- metabolic seizures, which showed associated biochemical abnormalities, hypoglycemia was most common abnormality 23 of 52 cases (44.2%). 12 cases (52.1%) are associated with birth asphyxia and 11 cases (47.9%) are associated with septicemia. Subtle seizures were most common type of seizures in our study, followed by focal clonic, multifocal clonic, generalized tonic, subtle with GTC and subtle with clonic.
 Conclusion: Biochemical abnormalities are common in neonatal seizures and often go unorganized. These abnormalities may significantly contribute to seizure activity correction of these abnormalities work up is necessary for all cases of neonatal seizures.

Genetic Etiologies of Neonatal Seizures.

Neonates presenting with seizures are frequently assessed and managed by neonatologists in the NICU. Although hypoxic-ischemic encephalopathy and infection are common underlying causes of neonatal seizures, many patients with neonatal epilepsy will have an identifiable genetic etiology. Often these cases will be evaluated in collaboration with a geneticist. The categories of genetic causes of neonatal seizures include 1) structural brain malformations; 2) inborn errors of metabolism; 3) syndromic; and 4) nonsyndromic, single gene. Evaluation of these patients involves a comprehensive history and examination, followed by appropriate investigations and diagnostic genetic testing. Components of the diagnostic process will vary based on the clinical suspicion and differential diagnoses. In certain cases, syndromic surveillance for evaluation of other congenital anomalies may be recommended. Determination of the underlying genetic diagnosis, when present, will have important implications for treatment. Targeted therapies are currently available for specific genetic syndromes, and outcomes may improve with earlier initiation of therapy. Certain genetic diagnoses may also have guideline-based management involving screening for other manifestations of the disorder.

Study of Clinical Profile of Neonatal seizures in a NICU of Rural Central India

Seizures are common neonatal illness amongst neurological disorders. The study was conducted to determine the clinical profile of neonatal seizures. A hospital based prospective observational study was undertaken in the NICU of a rural set up in central India. A total of 82 neonates admitted with seizures or who developed seizures later during the stay in NICU were subject population of the study. Of 82 neonates with seizures, the overall mean for duration of stay was 14.34 (±10.41) days and the interquartile range was 1-32 days and male predominance. Majority of neonates included were extramural deliveries (62.19%). The distribution of neonates in the study according to their gestational age, birth weight, route of delivery & MSAF was found to be statistically insignificant (p Value >0.05). The vaginal route of delivery was more common than the caesarean section among neonates with seizures in the study. The overall mortality rate was 17.07% (14/82) .In most of the cases, the causes of neonatal seizures were present. Birth asphyxia was the main etiology identified. The antenatal services and intrapartum monitoring is important.

Etiology and Immediate Outcome of Neonatal Convulsions : A Hospital Based Study

Background: Neonatal seizures are the most common manifestation ofneurological disorders in the newborn period and an important determinant ofoutcome To evaluate the causes and immediate outcome in hospital of neonatalconvulsions.
 Materials and methods: This hospital based prospective study was conducted inSpecial Care Neonatal Unit (SCANU) Department of Paediatrics and Child HealthBangabandhu Memorial Hospital (BBMH) USTC, including 30 neonates sufferingfrom convulsion from 1 to 28 days of age during the period of 1st July to 30thOctober, 2003.
 Results: Twenty-four (80%) cases were under 5 days age, 4 (13.33%) cases wereranged 6 to 15 days age. The mean age of the patients was 3 days. 18 (60%)babies were male and 12 (40%) were female. Male:female ratio was 1.5:1.Twenty (66.67%) babies had normal body weight (2500-4000 g). Maternalcomplications during pregnancy were present in 10 (33.33%) cases. Convulsionwas present in all 30 (100%) cases. Depressed primitive reflexes were found 16(53.33%) cases, cyanosis in 5 (16.67%) cases, fever in 7 (23.33%) cases. Subtleseizures were present in 16 (53.33%) cases, focal clonic and focal tonic seizureswere present in 7 (23.33%) and 4 (13.33%) cases, respectively. Generalized tonicseizures were present in 3 (10%) cases and none (0%) cases had myoclonicseizure. Onset of convulsion in relation to age revealed that 13 (43.33%) caseshad convulsion before 24 hours of age, 10 (33.33%) developed convulsionbetween 1-3 days of age, 5 (16.67%) and 2 (6.67%) had convulsion between 4-7days and 8-21 days of age respectively. Commonest cause of neonatalconvulsion was found to be Hypoxic-Ischaemic Encephalopathy (HIE). It wasfound in 17 (56.67%) patients. Hypoglycaemia as primary metabolic cause wasfound in 4 (13.33%) patients, and septicaemia was found in 3 (10%) patients.Eighteen (60%) cases stayed in hospital for 7-10 days, out of which 16 (53.33%)were cured and 2 (6.67%) died. Three (10%) cases stayed in hospital for 4-5days, all of them were cured, Two (6.67%) cases stayed in hospital for 3 daysand among them 1 (3.33%) died and another was cured and discharged onrequest. Five cases (16.67%) stayed for 11-14 days in hospital, out of them 3(10%) were cured and 2 (6.67%) expired. Only 1 case (3.33%) stayed for morethan 14 days and died at day 20. The mortality rate in this study is 20%.
 Conclusion: The most common cause of neonatal seizure was HIE (56.67%).Other causes of neonatal convulsions are septicaemia, meningitis, primarymetabolic disorders like hypoglycaemia and hypocalcaemia, intraventricularhaemorrhage and some causes are still unknown. Mortality due to neonatalconvulsion is still very high, and in this series, it was found to be 20 percent.Survival while staying in hospital occurred in 24 (80%) cases.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 8-14