Clinical Study on Etiology, Onset and Clinical Manifestations of Neonatal Seizures

Background: Neonatal seizures are clinically significant because very few are idiopathic. Further investigation leading to prompt diagnosis of the underlying condition is important because many of the etiologies have specific treatment. Time of onset of seizures has correlation with etiology. Objectives: The objective of the present study is to know the etiology of neonatal seizures, to know the time of onset of neonatal seizures and its relation to etiology and to know the various types of seizures in neonates. Methodology: The present study included 127 neonates presenting with Neonatal seizures admitted to NICU (Neonatal Intensive care Unit) of tertiary care hospital from August 2014 to December 2016. Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat’s staging. Then relevant investigations were done and etiology of neonatal seizures was diagnosed. Results: In the present prospective study, out of 127 neonates studied, 118 were full-term, among these 88 (69.3%) were AGA (Average for gestational age) and 30 (23.6%) were SGA (Small for gestational age). 7 babies (5.5%) were preterm. Male: Female ratio in our study was 1.6:1. In our study onset of seizures within first 3 days of life was seen in 101 neonates (79.5%). After 3 days of life, 26 neonates developed seizures (20.5%). Onset of seizures within first 3 days of life of had statistically significant correlation with birth asphyxia as the etiology with p<0.001. Subtle seizures were the commonest type of seizures in our study (49 cases – 38.6%), followed by GTS (Generalized tonic seizures - 42 cases – 33.1%), multifocal clonic (19 cases – 15%) and focal clonic seizures (8 cases - 6.3%). Birth asphyxia was the commonest cause of neonatal seizures in our study (84 cases – 66.1%) followed by hypoglycemia (22 cases – 17.3%) and meningitis (11 cases 8.7%). Out of 84 cases of birth asphyxia 66 (78.6%) mothers had prolonged second stage of labour and 28 (33.3%) had MSAF (Meconium Stained Amniotic Fluid). Hypoglycemic seizures were more common in LBW (Low Birth Weight) babies with statistically significant p<0.001. Conclusion: The recognition of etiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is HIE (Hypoxic ischemic encephalopathy) and is frequently associated with perinatal risk factors. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Hypoglycemic seizures are more common in LBW babies. Subtle seizures are commonest type of clinical seizures, which is difficult to identify, therefore careful observation of at risk newborns is necessary.