Clinco-etiological Profile and Predictors of Outcome of Neonatal Seizures: A Prospective Observational Study from Egypt

Background: Neonatal seizures are the most prevalent neurological disorders. In Egypt, the characteristics and neurodevelopmental outcomes of neonatal seizures have not been sufficiently explored. Methods: The present study was conducted on 120 full-term and preterm newborns from October 2016 and October 2020. The adverse outcomes of cerebral palsy, mortality, developmental delay, and/or epilepsy have been considered. The associations between adverse outcomes and 13 variables were analyzed. Results: Hypoxic-ischemic encephalopathy (HIE) (34.2%) was the most common etiology for neonatal seizures, followed by intracranial hemorrhage (25.8%). The predominant seizure type was subtle (57.5%), preceded by clonic seizure (16.7%). Moreover, 72 neonates had a normal outcome, 14 (60%) cases had minor functional disabilities, and 27 (22.5%) newborns survived with one or more neurodevelopmental abnormalities (6 cases had cerebral palsy, and 21 newborns had global developmental delay), with a 17.5 % mortality rate. Based on the univariate analysis, 10 variables were associated with an unfavorable outcome; nonetheless, only three variables, namely metabolic acidosis, abnormal cranial ultrasonography findings, and the presence of congenital heart disease, were independent predictors as illustrated by multivariate logistics. Conclusion: As evidenced by the obtained results, HIE and intracranial hemorrhage were the most common causes of neonatal seizures. Perinatal insult, prematurity, seizure onset <24 hours, low Apgar score at 1 min, myoclonic or mixed seizure, the efficacy of the anticonvulsant therapy, abnormal cranial U/S, metabolic acidosis, abnormal electroencephalography (EEG) pattern, and the presence of congenital heart disease were the most reliable predictors of adverse outcome.