Incidence Of Neonatal Seizures Research Articles

Neonatal seizures during extra corporeal membrane oxygenation support.

To evaluate EEG monitoring during neonatal ECMO and to identify any correlations between seizure detection to abnormal neuroimaging.Eight-year, service evaluation of neonates who received at least one continuous EEG (cEEG) whilst on ECMO at Great Ormond Street Hospital. Pearson's chi-square test and multivariate logistic regression analysis were used to assess clinical and EEG variables association with seizures and neuroimaging findings.Fifty-seven neonates were studied; 57 cEEG recordings were reviewed. The incidence of seizures was 33% (19/57); of these 74% (14/19) were electrographic-only. The incidence of status epilepticus was 42%, (8/19 with 6 neonates having electrographic-only status and 2 electro-clinical status. Seizures were detected within an hour of recording in 84%, (16/19). The overall mortality rate was 39% (22/57). Seizure detection was strongly associated with female gender (OR 4.8, 95% CI: 1.1-20.4, p = 0.03), abnormal EEG background activity (OR 2.8, 95% CI: 1.1-7.4, p = 0.03) and abnormal EEG focal features (OR 23.6, 95% CI: 5.4-103.9, p = 0.001). There was a strong association between the presence of seizures and abnormal neuroimaging findings (OR 10.9, 95% CI: 2.8-41.9, p = 0.001). Neonates were highly likely to have abnormal neuroimaging findings in the presence of severely abnormal background EEG (OR 9.5, 95% CI 1.7-52.02, p = 0.01) and focal EEG abnormalities (OR 6.35, 95% CI 1.97-20.5, p = 0.002)Conclusion: The study highlights the importance of cEEG in neonates undergoing ECMO. An association between seizure detection and abnormal neuroimaging findings was described. What is Known: • Patients on ECMO are at a higher risk of seiures. • Continuous EEG monitoring is recommended by the ACNS for high risk and ECMO patients. What is New: • In this cohort, neonates with sezirues were 11 times more likely of having abnromal neuroimaging findings. • Neonates with burst suppressed or suppressed EEG background were 9.5 times more likely to have abnormal neuroimaging findings. What does this study add? • This study reports a 33% incidence of neonatal seizures during ECMO. • Neonates with seizures were 11 times more likely to have an abnormal brain scan. • The study captures the real-time approach of EEG monitoring. • Recommended cEEG monitoring should last at least 24h for ECMO patients. • This is the first study to assess this in neonates only.

Clinical and Electrophysiological Evaluation of Neonatal Seizures

Neonatal seizures are the most prevalent and distinctive sign of neurologic dysfunction in early-life. In spite the recent advances in medical care and technology in newborn intensive care units (NICU), it remains an important clinical issue of diagnosis, treatment, and prognosis. This was a retrospective, observational cohort study of neonates with seizures treated in the Ondokuz Mayıs University Faculty of Medicine NICU. Demographics of the babies, risk factors and etiology of seizure, type of clinical seizure, electroencephalographic and radiological findings, and anti-seizure treatments were recorded. The incidence of neonatal seizures was 4.5% in NICU admissions. Seventy-two babies with seizures included, 69,4% were diagnosed with electroclinical seizures. The most common seizure types were clonic (35.8%) and motor automatisms (32.8%). Perinatal asphyxia/hypoxic ischemic encephalopathy (HIE) (29.2%) was the most common etiological factor, whereas hypoglycemia was the most common metabolic problem (15.3%). Eighty-one percent of seizures due to HIE were observed in the first 48 h. Hyperbilirubinemia (kern icterus), hypocalcemia, and idiopathic neonatal convulsions were observed after the first 48 h. Abnormal findings were detected in 76.4% of electroencephalographies obtained during the neonatal period. Phenobarbital was the first-line therapy in 98.6% of babies, and 83.3% of the infants were seizure-free with phenobarbital. Seizures are common in the neonatal period and may be associated with significant brain damage. Seizures appear as an important symptom of the underlying pathology and not as a disease.

Incidence of Neonatal Seizures in China Based on Electroencephalogram Monitoring in Neonatal Neurocritical Care Units

Neonatal seizures pose a significant challenge in critical care, and continuous video electroencephalography (cEEG) monitoring holds promise for early detection of seizures. However, large-scale data on the incidence of neonatal seizures and monitoring systems in China are lacking. To determine the incidence of neonatal seizures in infants with high risk in China. A large, cross-sectional multicenter study was conducted from January 2017 to December 2018 in the neonatal intensive care units (NICUs) of 7 tertiary medical centers in China. Neonates with high risk were included, and cEEG monitoring was conducted. Data were collected between January 1, 2017, and January 31, 2020. The data were analyzed between January 2021 and January 2022. The incidence of neonatal seizures, categorized by etiology, and seizure burden. A total of 20 310 neonates with high risk were included (10 495 [51.7%] male; mean [SD] postmenstrual age, 37.7 [3.7] weeks), and seizures were observed in 3423 infants (16.9%). The highest proportion of seizures was attributed to acute neonatal encephalopathy (1448 [42.3%]). The incidence of seizures decreased with postmenstrual age and birth weight, with the highest occurrence observed in neonates with postmenstrual age of less than 28 weeks (237 of 879 [27.0%]) or birth weight of less than 1.0 kg (269 of 914 [29.4%]). Preterm infants had a higher proportion of moderate and severe seizure burdens compared with full-term infants (moderate severity: 248 of 1199 [20.7%] vs 454 of 2224 [20.4%]), but no significant differences were observed in etiology. Seizure burden was highest with genetic syndromes (49 of 188 [26.1%]), central nervous system malformations (33 of 127 [26.0%]), and inborn errors of metabolism (27 of 113 [23.9%]). During hospitalization, 7.8% of neonates with seizures died (267 neonates), with 81.3% of these cases having a moderate or severe seizure burden (217 neonates). Mortality was generally higher in preterm vs full-term infants (98 of 1199 [8.2%] vs 169 of 2224 [7.6%]) and increased with the severity of seizure burden (217 of 267 neonates with moderate or severe burden [81.3%]). This cross-sectional study of neonatal seizures underscores the substantial burden seizures pose to high-risk infants with brain injury in China, particularly those who are born prematurely or who have congenital conditions.

STUDY OF CLINICAL AND ETIOLOGICAL PROFILE OF NEONATAL SEIZURES IN TERTIARY CARE HOSPITAL

Introduction: Neonatal seizure is defined as paroxysmal electrical discharge from the brain. The immature brain seems more prone to seizures. The in-cidence was found to increase with decreasing gestation and birth weight- preterm neonates (20.8 vs. 8.4 per 1000 live-births) while very low birth weight neonates had more than 4-fold higher incidence (36.1 per 1000 live-births). Objective: The study was conducted to estimate the incidence, etiological factor, time of onset, clinical types, and biochemical abnormalities among the different types of neonatal seizures. Methods: This is a hospital based prospective observational study con-ducted in NICU, Department of Pediatrics, SMIMER during the period of January 2020 to March 2021. Results: Total patients with neonatal seizures were 90 in our study. Inci-dence of neonatal seizures in our study was 1.1%. Incidence was higher in pre-term neonates (4.8%) and more in males (56.67%). Incidence of neona-tal seizures was higher in LBW babies (4.3%) and more common in SGA babies (51.11%). Incidence among vaginal delivered babies was 0.9%, LSCS was 1.7% and forceps was 1.1%. Birth asphyxia (41.1%) was the most common cause of all neonatal seizures followed by hypoglycemia (17.8%), neonatal meningitis/septicemia (14.5%), hypocalcemia (12.2%), ICH (7.8%). Subtle seizures (44.4%) were the commonest type of seizure followed by tonic (38.9%), focal clonic (11.1%), multifocal clonic (5.6%). 33.3% of neo-natal seizures occurred in < 24hrs & 40% in 24-72 hrs. The most common biochemical abnormality was hypoglycemia (17.8%) followed by hy-pocalcemia (12.2%). Conclusion: Incidence of neonatal seizures was 11.1/1000 live births (1.1%) & more common in preterm, LBW & LSCS deliveries. Birth asphyxia was the most common cause and subtle seizures were the most common type of seizure. Subtle seizures were more common in 24-72 hours of life. Most common biochemical abnormality was hypoglycemia followed by hy-pocalcemia.

Neonatal Seizures in the U.S. National Inpatient Population: Incidence and Outcomes

Background: Seizures is the most frequent neurological manifestation in the neonatal period. Incidence of neonatal seizures has not been well described in literature in relationship with gestational age (GA). Also, the impact of seizures on neonatal mortality has not been quantified. Objective: This study aims to determine:1) The incidence of neonatal seizures in different GA groups from <24 weeks to …

Seizures in newborn infants without hypoxic ischemic encephalopathy – antenatal and labor-related risk factors: a case-control study

Objective: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).Methods: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994–2013 and Uppsala for 2003–2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.Results: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8–16.5); previous caesarean section (AOR: 4.8; 1.5–15.0); and assisted fertilization (AOR: 6.8; 1.3–35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8–17.7); preterm birth (AOR: 13.5; 3.7–48.9); and head circumference >37 cm (AOR: 6.9; 1.4–34.8).Conclusions: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.Rationale: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7–48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

Lissencephaly– a rare cause of neonatal seizures

The most prominent feature of neurologic dysfunction in the neonatal period is seizures. The incidence of neonatal seizures is 0.5-3 per 1000 live births in term infants and 11-13% in premature babies. Although common causes of neonatal seizures comprises HIE, IVH, Sepsis, Hypoglycaemia, Hypocalcaemia etc. Sometimes rare causes like Neuronal migration syndrome can cause seizures in newborn. Lissencephaly is a smooth cerebrum with lack of convolutions of brain caused by defective neuronal migration during 12- 24 weeks of gestation. These Babies generally presents with seizures, developmental delay, difficulty in swallowing and short life span due to respiratory problems. Hereby we present a case of Lissencephaly as a cause of neonatal seizure disorder.

Incidence of neonatal seizures, perinatal risk factors for epilepsy and mortality after neonatal seizures in the province of Parma, Italy.

Information about the incidence of neonatal seizures (NS) is scarce. Previous studies relied primarily on a clinical diagnosis of seizures. This population-based, retrospective study evaluated the incidence of electroencephalography (EEG)-confirmed seizures in neonates born in the province of Parma and the perinatal risk factors for mortality and epilepsy. All neonates with suspected seizures or with medical conditions at high risk for seizures from the study area were recorded in the neonatal intensive care unit (NICU) of the Parma University Hospital. NS were EEG confirmed. Perinatal risk factors for mortality and epilepsy after NS were evaluated with Cox's proportional hazards models. In a 13-year period, 112 patients presented with NS: 102 newborns had electroclinical seizures (46 full-term and 56 preterm), whereas 10 presented only electrical seizures. The incidence was 2.29/1000 live births (95% confidence interval [CI] 1.87-2.72), with higher rates in preterm neonates (14.28/1000 in preterm vs 1.10/1000 in full-term infants). The incidence increased with decreasing gestational age (31-36weeks of gestation: 5.01/1000, 28-30: 54.9/1000, and <28: 85.6/1000) and with decreasing birth weight (≥2500g: 1.19/1000, <1000g: 127.57/1000). Twenty-eight patients (25%) died, 16 (14.3%) had a diagnosis of epilepsy, 33 (29.5%) had cerebral palsy, and 39 (34.8%) had a developmental delay. Among the perinatal risk factors considered, the multivariate analysis showed an association between a 5-minute Apgar score of 0-7 and etiology with increased mortality and between female gender and status epilepticus with epilepsy. The incidence of NS is inversely associated with gestational age and birth weight. The etiology and a low Apgar score are strongly related to mortality; female gender and status epilepticus are risk factors for the development of epilepsy.

معدل انتشار تشنجات حديثي الولادة في الأطفال اليمنيين - دراسة معتمدة على المستشفى.

الخلفية: التشنج هو مشكلة عصبية مشتركة في الأطفال الصغار، ينظر أساسا في فترة حديثي الولادة. وكانت تشنجات حديثي الولادة دائما موضوع اهتمام بسبب حدوثها العالمي. ويساهم بشكل كبير في اعتلال المواليد والوفيات وخاصة في البلدان النامية بما في ذلك اليمن. وهناك عدد متنوع من الظروف تكون قادرة على التسبب في النوبات في فترة الوليد. الأهداف : دراسة لتحديد نمط، حدوث ونتائج التشنجات لحديثي الولادة. التصميم : دراسة وصفية مستقبلية. الإعداد : وحدة طب الأطفال، مستشفى السلام، صعدة، اليمن. إطار الحالة: جميع الأطفال حديثي الولادة الملاحظ عليهم التشنجات أثناء رقودهم في المستشفى بين يوليو 2013 - أغسطس 2015 . الطريقة: أجريت دراسة مراقبة مستقبلية مستندة إلى المستشفى في وحدة طب الأطفال مستشفى السلام على مدى عامين (يوليو 2013 - أغسطس 2015)، تم قبول جميع الولدان أقل من 28 يوماً من العمر مع مراقبة الحركات الغير طبيعية (التشنجات) في هذه الوحدة. تم أخذ تاريخ مفصل لفترة ما قبل الولادة والولادة وبعد الولادة وفحص الطفل. ثم أجريت تحقيقات ذات صلة بما في ذلك الفحوصات الكيميائية الحيوية. تم تحليل البيانات باستخدام جهاز نظام الإحصاء لنظام التشغيل ويندوز الإصدار10 . النتائج: بينت النتائج أن من بين 1732 من الأطفال المرقدين حديثي الولادة، كان 62.6 في المائة من الذكور و 37.4 في المائة من الإناث. وكانت نسبة معدل حدوث نوبات التشنج للولدان في هذه الوحدة 68 لكل 1000حالة رقود ومن أصل 1732 رقود لحديثي الولادة، 118 (6.8٪) كانت لديهم تشنجات. ومن بين هؤلاء 86 (72.9٪) قد ولدوا خارج المستشفى .كان معدل إصابة الأطفال حديثي الولادة في وحدة طب الأطفال بمستشفى السلام بالتشنجات كان لديهم وزن أعلى مقارنه بالمواليد من غير تشنجات ، ومن أصل 118 مولود مع تشنجات كانت 74 (62.7٪) اعتبر لديهم الاختناق الوليدي، 14 (11.9٪) التهاب السحايا، 12 (10.2٪) نقص السكر في الدم، 4 (3.4٪) نقص عنصر الكالسيوم في الدم و 14 (11.9٪) أسباب غير مشخصة. وكان من بين 118 مولود 84 (71.2٪) لديهم تشنجات دقيقة وعامة. وقد توفي 54 مولود مع تشنجات (45.8٪) مقارنة مع 262 من 1614 طفل دون تشنجات (16.2٪). وكان المواليد مع التشنجات والاختناق الوليدي أو من المواليد خارج المستشفى كانت لديهم مخاطر الموت أعلى (59.5٪ و 48.8٪) على التوالي. الاستنتاج: اختناق الولادة كان السبب الرئيسي للأطفال الذين يعانون من التشنجات. وجميع التشنجات في ال 24 ساعة الأولى من الحياة كانت مصاحبة للاختناق الوليدي. وكانت التشنجات المتبوعة للعدوى تميل إلى أن تحدث في أي عمر بعد 24 ساعة من الحياة. وبالعرض الرئيسي للأطفال مع التشنجات كانت تلك التشنجات دقيقة وعامة. وكانت نسبة ارتفاع معدل الوفيات بين الأطفال المواليد خارج المستشفى أعلى من المواليد بداخل المستشفى.

Incidence and outcome of neonatal seizures at a tertiary care hospital

Background: Seizures are associated with poor neuro developmental outcome if not diagnosed early and treated properly. During newborn period, seizures indicate underlying neurological disease. Neonatal seizures lead to increased morbidity and mortality usually found in neonatal intensive care unit. The objective of this study was to evaluate incidence and outcome of neonatal seizures.Methods: Present study was hospital based prospective study conducted among 117 neonates of 0-28 days of age at a tertiary care hospital for a period of one year. The data like history, clinical examination and investigation findings was recorded in the pre-designed, pre-tested, semi structured questionnaire.Results: The incidence of neonatal seizures was higher in male neonates. Subtle types of seizures were the commonest type of seizures. In term neonates, the birth asphyxia was the most common cause of neonatal seizures. The incidence of intra-ventricular hemorrhage (IVH) was significantly higher in preterm than term neonates. Out of biochemical abnormalities, the hypocalcemia was the most common cause of the neonatal seizures. Common causes of neonatal deaths in our center were severe birth asphyxia, intra-ventricular hemorrhage (IVH), septicemia and meningitis. Conclusions: Most of the causes of neonatal seizures are preventable by good perinatal care and early interventions while metabolic seizures need a sharp vigilance and early suspicion.

Clinicoetiology profile of neonatal seizures in tertiary care Level II neonatal intensive care unit

Objective: To study the incidence, etiology, and pattern of neonatal seizures and its relationship with age of onset, gestation, and other obstetrical factors. Design: Prospective observational descriptive study. Setting: Level II neonatal intensive care unit of a Government Medical College Hospital. Participants: 72 neonates with neonatal seizures admitted at our hospital and developed seizures before 28 days of life. Results: The incidence of neonatal seizure was 11.93/1000 live births. The seizures were more common in male babies and in term newborns (72%). Half of the babies with neonatal seizures were low birth weight (LBW), but seizures were significantly more in appropriate for gestation age in comparisons to small for gestation age babies. Seizure frequency was not different in babies born intramural or extramural and also in deliveries conducted by doctors, nurses, or TBAs. Subtle seizures were the most common pattern observed in both term and preterm newborns (38.9%) followed by generalized tonic (22.3%). Birth asphyxia was most common etiology followed by meningitis in our study. Conclusion: Birth asphyxia meningitis, hypocalcemia, and hypoglycemia are common etiology, and the majority present within the first 72 h of life. All the high-risk newborns (asphyxiated or LBW) should be monitored at least 72 h of birth for seizures.

Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007–2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (<37 weeks) and infants weighing under 2500 g. Hospital VBACS were the reference. Women with a planned home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4–20.39, p<.0001) and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13–24.29, p<.0001). Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

Expert systems for fetal assessment in labour

BACKGROUND: Cardiotocography (CTG) records the fetal heart rate in relation to maternal uterine contractions and is one of the most common forms of fetal assessment during labour. Despite guidelines for CTG interpretation, substantial inter- and intra-observer variation in interpretation has been reported among maternity care providers. Misinterpretation of CTG readings can lead to poor decisions, which can result in unnecessary intervention or delay or withholding of necessary intervention. Expert systems (ESs) represent a type of applied artificial intelligence, which can assist in complex clinical decision-making and potentially serve as a mechanism to improve interpretation of fetal heart rate tracings. OBJECTIVES: To evaluate the effectiveness of continuous or intermittent CTG monitoring during labour with an ES compared with (1) continuous or intermittent CTG monitoring during labour without an ES or (2) intermittent auscultation with a Pinard stethoscope or hand-held Doppler ultrasound device. Outcomes of interest included incidence of perinatal mortality, caesarean delivery, operative vaginal birth, fetal blood sampling, artificial rupture of amniotic membranes, oxytocin augmentation of labour, maternal satisfaction with labour, neonatal seizures, fetal acidaemia, hypoxic ischaemic encephalopathy, admission to neonatal special care and/or neonatal intensive care unit and an Apgar score less than seven at five minutes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 October 2014), Open Grey (6 October 2014) ProQuest Dissertation & Theses Database (6 October 2014) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing continuous or intermittent CTG monitoring during labour with an ES with continuous or intermittent CTG monitoring without an ES were eligible for this review. Trials comparing continuous or intermittent CTG monitoring during labour with an ES with intermittent auscultation with a Pinard or hand-held Doppler were also eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility and quality of the trials as well as extracted data to ensure accuracy. The authors of included trials were contacted to clarify aspects of the study design that were not clearly reported in the original trial publications. MAIN RESULTS: No studies comparing CTG monitoring during labour with an ES to intermittent auscultation were identified.Two randomised controlled trials comparing CTG monitoring during labour with an ES versus CTG without an ES were identified and included in the qualitative synthesis of results, but only one trial (n = 220) provided data for quantitative analysis. Both trials were classified as low risk of bias.There was no strong evidence that CTG with an ES has an effect on the incidence of caesarean delivery (risk ratio (RR) 0.61; 95% confidence interval (CI) 0.35 to 1.04) when compared with CTG with fetal blood sampling.There was no strong evidence supporting a reduction in the incidence of neonatal seizures (RR 0.33; 95% CI 0.01 to 8.09) or fetal acidaemia (RR 0.50; 95% CI 0.09 to 2.67) in women monitored using a CTG with an ES versus a CTG without an ES. Overall perinatal mortality could not be ascertained for this trial since data on early neonatal deaths were unavailable. Although fetal deaths were recorded, no fetal deaths occurred in either arm of the trial, and thus no risk estimates could be derived.There was no strong evidence supporting a reduction in the incidence of forceps-assisted vaginal birth (RR 0.50; 95% CI 0.05 to 5.43), hypoxic ischaemic encephalopathy (RR 0.33; 95% CI 0.01 to 8.09), admission to the neonatal intensive care unit (RR 0.40; 95% CI 0.08 to 2.02) or an Apgar less than seven at five minutes (RR 0.50; 95% CI 0.13 to 1.95).The trial did not report on artificial rupture of amniotic membranes,oxytocin augmentation of labour ormaternal satisfaction with labour. AUTHORS' CONCLUSIONS: Two trials met the inclusion criteria for this review but one trial did not provide data for any of this review's outcomes. The single trial that did contribute data was underpowered to evaluate the association between CTG monitoring with an ES and the primary outcomes of interest. No recommendations for clinical practice can be made at this time. Adequately powered trials are necessary before the impact of ESs for fetal assessment in labour can be determined.

To study the incidence, etiology and EEG profile of neonatal seizures: a prospective observational study from India

Aim: To study the incidence, etiology and electroencephalography (EEG) profile of neonatal seizures and also to study the correlation between clinical picture and EEG appearance. Type of study: Prospective observational cohort study. Study duration: September 2011 to April 2013. Inclusion and exclusion: Seizures within first 28 d of life and seizures documented by doctors. Population: Neonates admitted in intensive care unit: intramural (4412) and extramural (1900) admissions (all together 6312). Materials and methods: One hundred and seventy-two neonates with seizures were enrolled. All the neonates were evaluated with necessary investigation, ultrasound head and CT scan. All the neonates underwent EEG as early as possible with neonatal stabilization. The etiology of neonatal seizures, CT scan and ultrasound head, characteristic of the EEG and neonatal mortality were noted. Results: The incidence of neonatal seizure was 0.77% in the intramural and 7.3% among the extramural neonates. The incidence of seizures in term newborn was 0.7% and in preterm was 1.1%. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (HIE) followed by hypocalcemia. The predominant seizure type was multifocal (51%) followed by subtle seizure (43%). There was an EEG abnormality in 72% of the total EEG with varied patterns. The mortality rate in the cohort was 15% with HIE being the most common cause. Conclusion: Most common cases of neonatal seizure were HIE and with the most common type being multifocal. EEG was abnormal in the majority of the neonates with various pattern of abnormality.

Pharmacology Review

The incidence of neonatal seizures is 3.5/1,000 live births. (1) The clinical manifestations are very diverse and not always easy to recognize. Amplitude-integrated electroencephalography (aEEG), a method for continuous monitoring of brain function used increasingly in neonatal intensive care units, (2) may aid in recognition of neonatal seizures. Apart from being able to detect abnormal brain activity, aEEG also enables immediate and continuous evaluation of the effect of anticonvulsive treatment. aEEG often reveals electrographic discharges without clinical manifestations, especially following initiation of drug therapy for clinical seizures. (3)(4) Continuation of electrographic seizures without a clinical correlate is referred to as “uncoupling.” (3) Several studies have shown that the success rate of the most commonly used anticonvulsant drugs, phenobarbitone and phenytoin, frequently is disappointing in neonates. (5) Lidocaine is an effective drug for second- or third-line treatment of neonatal seizures not responding to traditional anticonvulsant therapy. (6)(7)(8) In this article, we review the effectiveness and safety of lidocaine and discuss the clinical value of routine measurements of drug concentrations because of the pharmacokinetic and pharmacodynamic properties of lidocaine. We hypothesize the effects of therapeutic hypothermia on lidocaine drug disposition and response. Lidocaine is used widely as a local anesthetic for pain prevention and as a type 1b antiarrhythmic agent for short-term control of ventricular arrhythmias. In 1948, the drug was synthesized as an amide derivative of the anesthetic cocaine. Lidocaine acts as a central nervous system depressant with sedative, analgesic, and anticonvulsant properties. Scandinavia has a long therapeutic tradition of using lidocaine for the treatment of severe neonatal seizures. Hellstrom-Westas and associates (7) showed in 1988 that lidocaine was effective in most patients suffering clinically suspected epileptic seizures that persisted in spite of phenobarbital and diazepam administration. In a second study, they determined the …

NEONATAL SEIZURE: ETIOLOGY AND TYPE

Objective Neonates, for many reasons, are at particular risk for the development of seizures, which are a strong predictor of later morbidity and mortality in infants. We undertook this study to determine the incidence, etiologic distribution and neonatal seizure type in neonates with hospital admission over a period of 4 years. Materials and Methods This, a retrospective study of newborns admitted in hospital with a diagnosis of neonatal seizures, was conducted over a 4 year period between March 2001 and March 2005. Data were obtained from hospital records was analyzed using the Chi-square test. Results Of 4541 newborns, admitted to hospital, during the study period, seizures occurred in 110 neonates. The incidence of neonatal seizures was 2.4%; the causes of neonatal seizure were Hypoxic-Ischemic Encephalopathy (HIE) - 36.4%, infections -19.1%, metabolic abnormalities - 7.3%, Intra Cranial Hemorrhage (ICH) - 2.7%, structural disorders - 1.8% and in 32.7% of cases, the cause was unknown. Subtle seizures (39.1%) were the most common type of seizures; and the other types were myoclonic (17.3%), clonic (10.0%), Tonic (7.3%), Generalized Tonic Clonic Seizures (GTCS) (12.7%) and in 13.6% of cases the type of seizure was not mentioned. Mortality rate was 13.6%. Conclusion Health care workers and parents need to be made aware of subtle seizures and the importance of timely and appropriate treatment to decrease any further complications.

Clinico-etiological and EEG profile of neonatal seizures

To evaluate clinical, etiological and EEG profile of neonatal seizures. In all the neonates enrolled in the study baseline information recorded was sex, gestational age, weight, ponderal index etc. Clinical profile of seizure episode included age at onset of seizure, type and duration of seizure, associated autonomic changes, medication given, response time to medication and possible cause. Relevant maternal history including antenatal and peripartum history was recorded. Relevant history and examination of newborn were noted. Essential investigations done in all subjects included blood glucose, serum calcium, serum sodium and arterial pH. USG cranium and EEG were done at earliest in all the subjects wherever feasible. Additional investigations were done as guided by history, physical examination and essential investigations. Ninety babies with clinical seizures were enrolled into the study over one year period with an overall incidence of 1.17% (0.69% in term babies and 6.14% in preterm babies). Abnormal EEG's were found in one third cases out of 60 EEG's done in 90 babies. 26.7% of babies with perinatal asphyxia had abnormal EEG's (8/30). While 60% of babies with HIE II had abnormal discharges, background activity was suppressed in 66.66% EEG's in babies with HIE III. Overall incidence of neonatal seizures was 11.7/1000 live births, majority being preterm very low birth weight babies before 5 days of life. Perinatal asphyxia was responsible in 44.44% babies followed by metabolic abnormalities (23.33%). EEG abnormalities were present in 33.34% babies.

Pharmacology Review

Immediate management of seizures includes stabilization, identification of the cause and specific treatment, and if needed, administration of an antiepileptic drug (AED) to prevent seizure recurrence. AED therapy is divided into standard (traditional) and alternative therapies. Alternative therapies include vitamins or cofactors specific for certain inborn errors of metabolism. Part 1 of this two-part Pharmacology Review examines some basic neonatal seizure concepts and the standard therapies (phenobarbital, phenytoin, fosphenytoin, and benzodiazepines); Part 2 reveiws alternative therapies and when to stop treatment. Seizures represent the most specific indication of neonatal neurologic insults. (1)(2) The incidence of neonatal seizures ranges from 1 to 5:1,000 live births. (2) It is vital to recognize neonatal seizures, determine their cause, and treat them because if they continue, they could interfere with supportive functions, such as respirations and feeding, and cause brain damage. (1)(2) Although seizures in an older child may be idiopathic or genetic, most neonatal seizures have a specific cause. In the series by Mizrahi and Kellaway, (3) the most common cause was hypoxic-ischemic encephalopathy (32%), followed by intracranial hemorrhage (17%), central nervous system infection (14%), infarction (7%), metabolic abnormalities (6%), inborn errors of metabolism (3%), and unknown (10%). The clinical manifestations of seizures may differ in the neonate compared with the older child and may not be as obvious. Volpe classified neonatal seizures as subtle or fragmentary seizures (more common in the preterm infant), clonic (focal or multifocal), tonic (focal or generalized), and myoclonic (focal, multifocal, or generalized). (1)(2) The generalized tonic-clonic seizure is unusual in the newborn, but it may be seen in genetic epilepsies. Electroencephalography (EEG) may be useful for confirming neonatal seizures when they are suspected. However, not all seizures have an EEG correlate, which makes diagnosis difficult. Mizrahi and Kellaway categorized seizures as …

Incidence of neonatal seizures in Harris County, Texas, 1992-1994.

This study estimated the incidence of clinical neonatal seizures among infants born between 1992 and 1994 in Harris County, Texas, a county with a large and ethnically diverse population. Infants with neonatal seizures were ascertained from four sources: hospital discharge diagnoses, birth certificates, death certificates, and a study of neonatal seizures conducted concurrently with this study at a large tertiary care center in Houston, Texas. There were 207 cases of clinical neonatal seizures among 116,048 live births (an incidence of 1.8 per 1,000 live births). The incidence was highest among infants weighing less than 1,500 g (19/1,000) and decreased as birth weight increased. There was no significant difference in incidence by ethnicity. Twenty-six percent of the seizures (54/207) occurred after the infants had been discharged from the hospital where they were born. The incidence of neonatal seizures in Harris County was lower than the incidence reported recently for Fayette County, Kentucky, for 1985-1989 (3.5/1,000) and for Newfoundland, Canada, for 1990-1995 (2.5/1,000), but was higher than the incidence estimated for Rochester, Minnesota, for 1935-1984 (1/1,000).

Febrile convulsions with focal sharp waves: A subgroup of benign partial epilepsies of childhood with multifactorial etiology

Studies on the prognosis of febrile convulsions (FC) have scarcely considered the heterogeneity of FC and its relationship to the risk and the variable nature of subsequent afebrile seizures. Meaningful study of this issue requires a sample of FC children that is as homogeneous as possible. One such FC subgroup is children with focal sharp waves (shw) in the electroencephalogram (EEG) of a type characteristic of benign partial epilepsies (5%–10% of all FC children). Because the incidence of FC is elevated in children with benign partial epilepsy, the question arises whether these entities have certain pathogenetic mechanisms in common. Because only children with long-term follow-up are suitable for a study of these problems, the results obtained here allow no quantitative inferences regarding prognosis. Inclusion criteria were: 1) FC as the first seizure symptom; 2) focal shw characteristic of benign partial epilepsy; 3) first EEG before the fifth year of life; 4) at least four EEGs between the second and the eighth year of life. One-hundred and twenty-eight children were ascertained. Duration of follow-up ranged from 1–33 years. A positive family history of seizures was found in 34% of probands. The incidence of neonatal seizures was remarkably elevated (6%). Prolonged FC and FC with focal symptoms were significantly overrepresented. Long lasting FC (>60 minutes) were associated with an occipital location of the shw. Fifty-nine children suffered subsequent afebrile seizures or epilepsy (selected material): idiophathic partial epilepsy (58%); idiopathic generalized epilepsy (12%); severe epilepsies (22%), usually with intractable complex partial seizures. The latter were clearly associated with FC lasting longer than 1 hour. In 91% of the patients generalized genetic EEG patterns like generalized spikes and waves, photoparoxysmal response, and theta rhythms were eventually detected. Among the shw findings, precentral (70%) and occipital (50%) foci predominated. Of 69 investigated siblings focal shw were detected in 14%. Febrile convulsions with focal shw represent a multifactorial disorder. The combined action of five factors seems relevant: 1) a hereditary impairment of brain maturation (represented by the shw-EEG trait); 2) a genetic anomaly expressed by photoparoxysmal response; 3) a genetic cortical hypersynchronization (theta rhythms); 4) the generalized spike wave abnormality; and 5) a genetic predisposition to FC that is represented by a high incidence of FC in relatives but is not expressed specifically in the EEG. Subsequent epilepsies are idiopathic (mostly partial) or the consequence of FC lasting more than 1 hour.