An Observational Study on Neonatal Seizures in a Tertiary Care Hospital

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 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.