Neonatal seizures and outcome in NICU

Background: Neonatal seizure is a relatively common pediatric emergency and it is critical to determine the etiology and other factors that determine the outcome. Our study aimed to delineate the Clinco-etiologic profile of neonatal seizures and the neurodevelopmental Outcome in a sample of Egyptian newborns. Methods: This prospective cohort study was conducted in Neonatal Intensive Care Units (NICUs) at Banha University Hospital and Benha Children Hospital between January 2018 and December 2020. The study protocol was approved by the Ethical Scientific Committee of Faculty of Medicine, Banha University conferring to the World Medical Association Declaration of Helsinki, and informed consent was obtained from parents/guardians before enrollment in the study. Eligibility criteria were a birth gestational age 37 weeks or less and clinically evident neonatal seizures (i.e., within the first 28 days of life). The diagnosis of clinical neonatal seizures was made by a pediatric neurologist and neonatologist. Our study population consisted of 65 term and preterm infants, of whom 50 neonates (76.9%) met the inclusion criteria. All neonates were subjected to detailed history included sex, mode of delivery, gestational age, maternal risk factors, Apgar score at 1 and 5 minutes, seizure onset age, seizure type. Etiology, antiepileptic drugs, cranial ultrasonography findings and outcome of seizures were identified. Seizure types were categorized according to Volpe classification schema,1 based on the paroxysmal clinical phenomena. It included subtle, clonic, tonic and myoclonic presentations. Results: Hypoxic ischemic encephalopathy was the most common etiology noted and was identified in 14(28.0%) infants. Second most common was intracranial hemorrhage 11(22.0%) infants, followed by infection 9(18.0%). This study showed that, subtle seizures were the most common clinical type of seizures noted in 29 (58.0%) infants followed by clonic type in 11(22.0%) and tonic type in 9(18.0%) infants. This study showed that, regarding outcome of the studied neonates: of 50 infants, 25(50.0%) infants had a normal outcome and 9(18.0%) infants survived with a neurodevelopmental impairment, while 16(32.0%) infants died. In the present work, there was highly significant Correlation between clinical type of seizures and Apgar score at 5 minutes. And There was significant association between treatment of cases during admission and clinical type of seizures Conclusion: Hypoxic ischemic encephalopathy is the most common etiology of neonatal seizures. Subtle seizure was the most common pattern in their observation. High risks for unfavorable neurological outcomes. The mortality rate was high.