Abstract

Background: Seizures are the most important indicator of significant neurological dysfunction in neonatal period. The incidence of neonatal seizure in India is around 1.8-3.5/1000 live births. The clinical diagnosis of neonatal seizure is very challenging as a high proportion of these seizures are subclinical. Without early diagnosis and treatment they lead to death and poor neurodevelopmental outcomes.

Objective: To identify different types of neonatal seizures and to determine the natural history, etiology, time of onset and short term outcome of seizures among neonates admitted to NICU of HI-Tech Medical College and Hospital, Bhubaneswar.

Methods: This prospective study was conducted in the NICU of HI-Tech Medical College and Hospital, Bhubaneswar. It was done from November 2017 to October 2019. All the neonates developing clinically identifiable seizures were included in the study. A detailed antenatal history, evidence of fetal distress, APGAR score, baseline data like gender, birth weight, gestational age and type of delivery was noted in a predesigned format. Etiology, time of onset and type of seizure was also noted and outcome was described in terms of number of deaths and neonates discharged with or without anti-epileptic drugs.

Results: Out of 1096 neonates admitted to NICU during the study period 81(7.4%) developed seizure. 35 out of 732(4.7%) inborn and 46 out of 364(12.6%) outborn neonates had seizure. Male to female and term to preterm ratio was 1.25:1 and 3.2:1 respectively. Mean birth weight was 2483+/- 806 gms. 24 Out of 81 neonates were delivered by emergency LSCS. Antenatal history showed 18 had preeclampsia, 4 had diabetes mellitus, 2 had chorioamnionitis, 1 had abruption placentae and 1 had past history of unexplained neonatal death. 69 out of 81(85.2%) had onset of seizure within 72 hrs. Most common cause of seizure was perinatal asphyxia 42 out of 81(51.8%) followed by metabolic abnormality 20 out of 81(24.7%) and meningitis 15 out of 81(18.5%). Other causes included 2 cases of neural tube defects, 1 had Intra cranial haemorrhage and 1 was polycythemic. Most common cause of metabolic abnormality was hypocalcemia followed by hypoglycaemia. Most common cause of early onset neonatal seizure (<72hrs) was perinatal asphyxia followed by metabolic abnormality. Subtle seizure was the commonest type of seizure in 51.8% cases followed by clonic seizure in 24.7% cases. Other type of seizures were tonic and myoclonic. 53 out of 81(65.4%) were discharged without medication, 18 out of 81(22.2%) were discharged with medication and 10 out of 81(12.3%) died. Most common cause of death was perinatal asphyxia (4 out of 10). Other causes of death included galactosemia, meningitis, intracranial hemorrahge and neural tube defects.

Conclusion: Perinatal asphyxia was the most common cause of neonatal seizure and it is associated with high morbidity and mortality. In case of metabolic abnormality early detection and proper intervention leads to good outcome.

Keywords: Neonatal seizure, perinatal asphyxia.