¹Associate Professor, ²Assistant Professor, Department of Peadiatrics, BKL Walawalkar Trust Rural Medical Collage, Sawarde  Ratangiri,   INDIA.

Email: drsantoshkulkarni@gmail.com, doeshuk23@gmail.com

RESULTS

During study period 74 neonates satisfying study criteria were evaluated. Majority of neonates were male (59.5 %), had birthweight less than 2.5 kg (40.5 %), delivered vaginally (63.5 %), delivered at outside hospital (62.2 %).

Table 1: Baseline characteristics

Subtle seizures (48.6 %) was most common type of seizure observed in present study, followed by focal clonic (25.7 %), multifocal clonic (14.9 %), tonic (6.8 %) and myoclonic (4.1 %).

Table 2: Type of Seizures

Birth asphyxia (37.8 %) was most common etiology noted. Other causes were meningitis (14.9 %), hypoglycemia (9.5 %), hypocalcemia (6.8 %), kernikterus (6.8 %), ICH (5.4 %), stroke (4.1 %) and idiopathic (9.5 %).

Table 3: Etiology wise distribution

Mean hospital stay was 8.4 ± 2.7 days. Enteral feeds were started after 3.7 ± 3.4 days admission. In some patients ventilator support (18.9 %) and inotrope support (12.2 %) was required. Most patients were discharged uneventfully (83.8 %), 5.4 % took discharge against medical advice. Mortality was 10.8 %, most of them due to sepsis.

Table 4: Other characteristics

DISCUSSION

The occurrence of seizure may be the first indication of neurological disorder and the time of onset of seizure has relationship with the etiology of seizures and prognosis. Seizures are a potentially life-threatening problem with a variety of causes. They require an immediate assessment to determine the underlying cause and necessary interventions, treat the underlying etiology, thereby reducing potential morbidity and mortality. Seizures are more common in the neonatal period than in any other stage of life affecting approximately 1% of all neonates.⁷ Factors that contribute to this high incidence include the neonate’s brain being more prone to seizures due to maturational factors, late gestational and birth-related injuries.⁸ Seizures in neonatal period can be subtle, focal clonic, multi focal clonic, tonic spasm and myoclonic. Spasm, focal clonic or tonic and generalized myoclonic seizures are associated with electrographic discharges, whereas the subtle, generalized tonic and other myoclonic seizures are not associated with EEG discharges.¹ In study by Venkatesh G et al.,⁹ incidence of seizures in late preterm and term neonates was 0.76%. Hypoxic ischemic encephalopathy (HIE) was the commonest etiology (50.4%) followed by sepsis(24.8%). Majority of HIE neonates presented within 12 hrs of life (89%). Hypoglycemia (21.2%) was the commonest primary metabolic abnormality followed by hypocalcemia (9.7%). Clonic type was the commonest type (82.3%) of seizure followed by subtle (73.5%) seizure. Similar findings were noted in present study. Singh SD et al.,¹⁰ noted that 12.26% developed clinical seizures. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (59%), followed by infection (17.09%), and metabolic disturbances (13.7%). The outcomes were mortality (13.7%), post neonatal seizure (15.4%), developmental delay (26.5%), vision impairment (16.2%) and hearing impairment (22.2%). Low Apgar scores at one minute and five minutes, early onset seizure and more than one drug used for seizure control were early prognostic factors for adverse outcome. In the study by Sahay BP¹¹, out of 120 neonates 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 (34.17%); followed by subtle seizures (31.67%), myoclonic (20%), focal tonic (4.17%), multifocal (n=8, 6.67%), and generalized tonic clonic type (3.37%). Among the studied population, perinatal asphyxia was identified as the most common cause of neonatal seizure (35%), followed by septicemia (24.17%), hypocalcemia (10.83%), hypoglycemia (8.33%), hyperbilirubinemia (6.67%), intracranial hemorrhage (3.33%) brain malformations (5%). Reddy KV et al.,¹² noted that, most neonates had focal clonic type (33.3%) followed by the subtle seizures (31.0%), myoclonic (17.9%), focal tonic (8.3%) and multifocal (6%). Also among the studied population, perinatal asphyxia was identified as the most common cause of neonatal seizure (33.3%), followed by septicemia (25 %), hypocalcemia (11.9%), hypoglycemia (9.5%), hyperbilirubinemia (6%), intracranial hemorrhage (4.7%) brain malformations (4.7%). Similar findings were noted in present study. Abhishek CK et al., studied 81 neonates, male: female ratio was 1.25:1. Mean gestational age was 38.9±1.3 weeks and mean admission weight was 3.12 ±0.52 Kg. Perinatal asphyxia was the commonest risk factor (46.9%) followed by septicemia meningitis (32.1%) and metabolic disturbances (32.1%). Subtle seizure was the commonest seizure type (37.2%) followed by clonic seizures (36.1%). 66% of the events were reported before 72 hours of age. In neonates with seizure, mortality was 28.4% and mean duration of hospital stay was 8.4± 2.7 days. There was a significant increase in duration of hospital stay and delay in commencement of oral feeds without increase in mortality, need of ventilator support or inotrope support in such neonates as compared to term neonates without seizures. Neonatal seizures are associated with unfavorable short- and long-term outcomes. More than half the survivors have considerable disability across a range of developmental domains, most frequently cerebral palsy, postneonatal epilepsy, and/or intellectual disability requiring lifelong therapies and social and financial support.⁸ Early recognition and treatment of biochemical disturbances are essential for optimal management and satisfactory long-term outcome. Limitations of present study were small sample size, single center study, follow-up for 1 year only and EEG recording of seizures was not done.

CONCLUSION

In present study birth asphyxia, meningitis, hypoglycemia and hypocalcemia were major causes of neonatal seizures in term neonates. All are preventable by careful labour monitoring, proper asepsis and breastfeeding practices.

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