Etiological Profile of Neonatal Seizures and Prognostic Factors for Adverse Outcome: A Single Center Prospective Study
Abstract
Introduction: Neonatal seizure is the most common manifestation and an important determinant of outcome of neurological disorders in newborn period. This study aims to delineate the etiological profile and neurodevelopmental outcome of neonatal seizures and also to identify predictors for adverse outcome.
Methods: One hundred and seventeen neonates with clinically proven seizures admitted in Dhulikhel Hospital from February 2014 to February 2016 were recruited. All of them underwent necessary neurological diagnostic tests. The survivors were followed up for at least three times within the first 18 months of life. Prognostic value of factors for adverse outcomes were analyzed with Chi square test and binary logistic regression analysis.
Results: Among a total of 954 neonates admitted, 117 (12.26%) developed clinical seizures. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (n=69, 59%), followed by infection (n=20, 17.09%), and metabolic disturbances (n=16, 13.7%). The outcomes were mortality (n=16, 13.7%), post neonatal seizure (n=18, 15.4%), developmental delay (n=31, 26.5%), vision impairment (n=19, 16.2%) and hearing impairment (n=26, 22.2%). Low Apgar scores at one minute (p=0.03) and five minutes (p=0.001), early onset seizure (p<0.001), and more than one drug used for seizure control (p=0.001) were early prognostic factors for adverse outcome.
Conclusion: Birth asphyxia followed by infection and transient metabolic disturbance were common etiologies for neonatal seizures. Low Apgar scores at one and five minutes, early onset seizure, multiple episodes of seizures and requirement of multiple anti-epileptics to control seizures were found to be significant predictors for adverse neurodevelopmental outcome.
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Mwaniki M, Mathenge A, Gwer S, Mturi N, Bauni E, Newton CR, Berkley J, Idro R. Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization. BMC medicine. 2010 Dec;8(1):16. PMID: 20136524 DOI: 10.1186/1741-7015-8-16 [Publisher Full Text]
Jensen FE. Developmental factors in the pathogenesis of neonatal seizures. Journal of Pediatric Neurology. 2009 Jan 1;7(1):5-12. PMID: 20191097 DOI: 10.3233/JPN-2009-0270[Publisher Full Text]
Sabzehei MK, Basiri B, Bazmanoun H The etiology, clinical type, and short outcome of seizures in newbornshospitalized in Besat Hospital/Hamadan/Iran. Iranian journal of child neurology. 2014;8(2):24-28. PMID: 24949047 [Publisher Full Text]
Marzoki JM. Clinco-Biochemical Profile Of Neonatal Seizures. AL-QADISIYAH MEDICAL JOURNAL. 2010;6(10):161-74. [Publisher Full Text]
Silverstein FS, Jensen FE. Neonatal seizures. Annals of neurology. 2007 Aug;62(2):112-20. PMID: 17683087 DOI: 10.1002/ana.21167[Publisher Full Text]
van der Heide MJ, Roze E, van der Veere CN, ter Horst HJ, Brouwer OF, Bos AF. Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period. Early human development. 2012 Jan 1;88(1):33-8. PMID: 21835564 DOI: 10.1016/j.earlhumdev.2011.06.012
Ballard JL, Novak KK, Diver MA. A simplified method for diagnosis of gestational age in the newborn infant. Journal of Pediatrics 1979; 95:769-774.
Faiz N, Malik M, Azam M, Afzal U. Etiology and type of neonatal seizures. Annals of Pakistan Institute of Medical Sciences 2009;5(2):77-86.
Alyasiri AA. Etiology and short outcome of neonatal seizures in Babylog gynecology and pediatrics teaching hospital. Medico Research Chronicles 2015;2(1)30-40
Talebian A, Jahangiri M. Rabiee M, MasoudiAlavi N, Akbar H, Sadat Z. The etiology and clinical evaluations of neonatal seizures in Kashan, Iran. Iranian journal of child neurology. 2015;9(2):29. PMID: 26221160 [Publisher Full Text]
G Sahana, B Anjaiah. Clinical profile of neonatal seizures. International journal of medical and applied sciences2014; 3(1):21-7.
Loman AM, ter Horst HJ, Lambrechtsen FA, Lunsing RJ. Neonatal seizures: aetiology by means of a standardized work-up. european journal of paediatric neurology. 2014 May 1;18(3):360-7. PMID: 24630570 DOI: 10.1016/j.ejpn.2014.01.014
Nunes ML, Martins MP, Barea BM, Wainberg RC, Costa JC. Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital. Arquivos de neuro-psiquiatria. 2008 Jun;66(2A):168-74. PMID: 18545776 DOI: 10.1590/S0004-282X2008000200005[Publisher Full Text]
Lai YH, Ho CS, Chiu NC, Tseng CF, Huang YL. Prognostic factors of developmental outcome in neonatal seizures in term infants. Pediatrics & Neonatology. 2013 Jun 1;54(3):166-72. PMID: 23597533 DOI: 10.1016/j.pedneo.2013.01.001 [Publisher Full Text]
Pisani F, Sisti L, Seri S. A scoring system for early prognostic assessment after neonatal seizures. Pediatrics. 2009 Oct 1;124(4):e580-7. PMID: 19752080 DOI: 10.1542/peds.2008-2087 [Publisher Full Text]
EchandÃa CA, Ruiz JG. Low Apgar score and neonatal seizures: neuromotor development at 1 year age. Colombia Médica. 2006 Mar;37(1):21-30.
Pisani F, Piccolo B, Cantalupo G, Copioli C, Fusco C, Pelosi A, Tassinari CA, Seri S. Neonatal seizures and postneonatal epilepsy: a 7-y follow-up study. Pediatric research. 2012 Aug;72(2):186-93. PMID: 22580721 DOI: 10.1038/pr.2012.66[Publisher Full Text]
Biswas AK, Goswami SC, Baruah DK, Tripathy R. The potential risk factors and the identification of hearing loss in infants. Indian Journal of Otolaryngology and Head & Neck Surgery. 2012 Sep 1;64(3):214-7. PMID:22998022 DOI: 10.1007%2Fs12070-011-0307-6 [Publisher Full Text]
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