Neonatal seizures and outcome in a NICU of a tertiary care hospital of Andhra Pradesh-an two year study

Abstract

Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The present study was undertaken to delineate the various aspects of neonatal seizures, with special reference to etiology, clinical spectrum, and outcome in the Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital.Methods: A prospective cross sectional study was conducted in an NICU of a tertiary care hospital with 65 neonates in the study group for a period of 2 years. Gestational age assessment is done by modified Ballard’s scoring system and detailed neurological assessment was done. Antenatal history of mother, demographic data, and clinical history of neonate was noted and evaluated. Laboratory investigations were done and results noted and outcome was recorded.Results: Subtle seizure was the commonest (40%) clinical seizures in our study followed by tonic (21.5%). Tonic seizures were common in preterm and in full term subtle seizures. Babies with myoclonic seizures had 100% mortality. Hypoxic ischemic encephalopathy was the commonest cause (41.5%) of mortality in our study. The worst outcome was with CNS malformation (50%). A total of 10 deaths were recorded (15.4%) with maximum association in cases with history of onset 7 days (100%).Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Seizures may interfere with cardio-respiratory function and nutrition and may have detrimental effects on cerebral development. Global cerebral hypoxia-ischemia is the most common etiology of neonatal seizures, followed by intracranial bleed, hypoglycemia, septicemia, hypocalcemia, BE, CNS malformations.

Neonatal Seizures in Iraq: Cause and Outcome

“…These findings were consistent with the previous reports (Alcover-Bloch et al 2004;Ehrenstein et al 2007;Glass et al 2009). Moreover, the lower birth weight was a great risk factor for neonatal seizures (Lanska et al 1995;Nagaram et al 2017). Most of our neonates had seizures during the first week of life, consistent with the previous report (Galanopoulou 2015).…”

“…Infection was a second risk factor (37.93%). Many previous reports indicated that infection has an important impact on survival and neurodevelopmental consequences (Göpel et al 2006;Shah et al 2008), particularly sepsis and meningitis (de Jonge et al 2010), while other studies regarded metabolic disturbances as a second cause of neonatal seizures (Tekgul et al 2006;Nagaram et al 2017). The higher incidence of infection in our study may be due to poor antenatal care with resultant obstetrical problems, such as maternal prolonged rupture of membranes, dirty delivery settings, and missed management of other maternal conditions, which were previously mentioned (Göpel et al 2006;de Jonge et al 2010).…”

“…Based on our results; we estimated that low birth weight (< 2,500 g), poor maternal antenatal care, and perinatal asphyxia which requires a respiratory resuscitation (positive pressure and/or mechanical ventilation) were at great risk of death that may occur up to 2 months after discharge from the hospital. Other investigators indicated that early onset of seizures was a predictor of poor prognosis of neonatal seizures (Ortibus et al 1996;Nagaram et al 2017). More extensive studies in different parts of the world may be required to emphasize on this important issue of mortality prediction.…”

“…Seizures are the most common clinical disorder of the central nervous system (CNS) during neonatal period with a global incidence of 1-5% (Nagaram et al 2017). Clinical seizures are described as a paroxysmal difference in neurological function, either in one or all of behavioral, autonomic, and motor functions.…”