Evaluation of Adverse Outcome Predictors in Neonatal Seizure: A Longitudinal Study from a Tertiary Centre of Eastern India

Introduction: Neonatal seizures are common but can be manifestations of serious underlying disorders and sometimes have a grave prognosis. Predictors for adverse outcomes are important for early referral and advanced interventions. Aim: To study the incidence and factors associated with neonatal seizure and to determine the predictors of adverse outcomes. Materials and Methods: This was a longitudinal study, conducted from April 2020 to March 2021 at a Rural Medical College (Midnapore Medical College and Hospital, West Bengal) in Eastern India. All the admitted newborns (N=143) in the Special Newborn Care Unit (SNCU), who had clinically evident seizures, were included in the study. Data were collected regarding the perinatal history, gestational age, type of delivery, birth weight, APGAR score at 1 and 5 minutes, and need for resuscitation at birth. The onset of the seizure, seizure type, investigation findings, possible aetiological diagnosis, and final outcome was noted. The management of neonatal seizures was as per the institutional protocol. Babies were followed up for a minimum of 28 days or throughout their hospital stay till discharge/death. The outcome was categorised into two categories: ‘favourable’ when there was a normal neurological examination and ‘unfavourable’ when there was any neurological impairment or death. Statistical analyses were performed using the Statistical Package for Social Sciences software version 25 (SPSS Inc., Chicago, IL, USA). Risk factors were determined by analysing outcomes using simple and multivariate logistic regression analysis. The p-values less than 0.05 were considered as statistically significant. Results: A total of 143 newborns had seizures out of 3126, making the incidence of neonatal seizures 4.57%. Males outnumbered females. Total 64.33% were preterm. Five minutes APGAR score <7 was noticed in 44.75%. The most common type was subtle seizure. Advanced resuscitation manoeuvre was required for 46.8% cases whereas mechanical ventilation was required in 11.88%. The most common aetiology was birth asphyxia (46.15%), and the cranial ultrasound showed Hypoxic Ishchaemic Encephalopathy (HIE) changes in 30.77% of cases. Multiple logistic regressions revealed only four factors, namely, preterm delivery (OR 5.82), need for extensive resuscitation manoeuvre (OR 6.21), presence of status epilepticus (OR 3.49) and abnormal cranial ultrasound (OR 1.02) to be the independent risk factors for unfavourable outcome. Conclusion: Clinical diagnosis of neonatal seizure could be useful in resource poor centers, where video-Electroencephalogram (EEG) is not available. Premature delivery, need for extensive resuscitation, presence of status epilepticus and abnormal cranial ultrasound were associated with poor short-term outcome

An Observational Study on Neonatal Seizures in a Tertiary Care Hospital

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 objective of this study was to observe neonatal seizures in a Tertiary Care Hospital. Methods: This study was a hospital-based, prospective, observational study conducted in the sick new born care unit of department of pediatrics in a tertiary care hospital from March 2017 to February 2018. Out of 2654 admitted neonates, 234 notates having symptom of seizures were included in the study after informed consent from the mother of the neonate. The data like history, clinical examination and investigation findings was recorded in the pre-designed, pre-tested, semi structured questionnaire. Template was generated in MS excel sheet and analysis was done on SPSS software. Results : The incidence of neonatal seizures was higher in male neonates. Subtle types of seizures were the commonest type of seizures. out of 234 neonates, 68 (29.06%) were preterm while 166 (70.94%) were term neonates. Out of 68 term neonates, 26 (38.23%) neonates had subtle seizures, 16 (23.52%) neonates had focal clonic seizures. Out of 166 term neonates, 56 (33.73%) neonates had subtle seizures, 42 (25.30%) neonates had focal clonic seizures. Almost 68 (29.05%) developed seizures within 24 hours, 84 (35.91%) neonates had seizures between 25-48 hours, 54 (23.08%) neonates developed seizures between 2-7 days and 28 (11.96%) neonates developed seizures after 7 days. Common causes of neonatal deaths in our center were severe birth asphyxia, intra-ventricular hemorrhage (IVH), septicemia and meningitis. Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. 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