An observational study to assess the Clinico-etiological profile of term neonates presented with seizures

Abstract

Background: Neonatal seizures are the most common neurological dysfunction in the neonatal period. Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Aim: The aim was to study the clinic-etiological profile of neonatal seizure in term neonates in Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. Material and methods: This prospective study was done the Department of Pediatric, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for one year. Total 120 term neonates with clinically identifiable seizures before 28 days of life were include in this study. Diagnosis of HIE was based on history, physical examination, Apgar score, arterial blood gas, brain MRI brain or cranial sonography. Diagnosis of neonatal infection was based on clinical manifestations, sepsis screening tests and blood culture, CSF analysis. Results: In the present study, 120 neonates with chief complaints of seizures were included.  64  (53.33%)  were  males  and  56 (46.67%)  were females. 77 (64.17%) neonates  were between 37 to 39weeks of gestation, while 43 (35.83%) neonates were between 40 to 41 weeks of gestation. 66 neonates had vaginal delivery and 54  neonates were delivered by cesarean section. Onset of seizure was day 1 in 39 (32.5%),  day 2  in 31 (25.83%), and day 3 of life in 13 (10.83%) neonates. The most common type of seizure seen was focal clonic type (n=41, 34.17%); followed by subtle seizures (n=38, 31.67%), myoclonic (n=24, 20%), focal tonic (n=5, 4.17%), multifocal (n=8, 6.67%), and generalized tonic clonic type (n=4, 3.37%). Among the studied population, perinatal asphyxia was identified as the most common cause of neonatal seizure (n=42, 35%). This was followed closely by septicemia (n=29, 24.17%). Other significant causes identified were hypocalcemia (n=13, 10.83%), hypoglycemia (n=10, 8.33%), hyperbilirubinemia (n=8, 6.67%),    intracranial    hemorrhage    (n=4,    3.33%)    brain malformations (n=6, 5%). While, 6 (5%) neonates had hypomagnesaemia and 2 (1.67%) neonate had seizures due to lignocaine injection. Conclusion: Perinatal asphyxia is the most common cause of neonatal seizures among term neonates in our setup. The other causes followed in order are septicemia, metabolic (hypoglycemia, hypocalcemia, hypomagnesemia and hyperbilirubinemia), intracranial hemorrhages and brain malformations.

Keywords: Hypoglycaemia, Hypocalcaemia, Intracranial haemorrhage, Non-metabolic seizures, Primary metabolic.