Iranian Journal of Neonatology

Iranian Journal of Neonatology

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

Document Type : Original Article

Authors
Eman Rateb Abd Almonaem 1
Ahmed Shaheen Dabour 1
Mona Ahmed Elawady 2
Omima Mohamed Abdel Haie 1
1 Pediatric Department, Benha Faculty of Medicine, Benha University, Egypt
2 Community Medicine Department, Benha faculty of medicine, Benha University, Egypt
10.22038/ijn.2022.60558.2152
Abstract
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.
 
 
Keywords
Infants
Neonate
Preterm
Outcome
Seizure
  1. Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, et al. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics. 2006;117(4):1270–80.
  2. Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures:
    a population-based study. Neurology. 2007; 69(19):1816–22.
  3. Kumar A, Gupta A, Talukdar B. Clinico-etiological and EEG profile of neonatal seizures. Indian J Pediatr. 2007;74(1):33–7.
  4. Talebian A, Jahangiri M, Rabiee M, Masoudi Alavi N, Akbari H, Sadat Z. The Etiology and Clinical Evaluations of Neonatal Seizures in Kashan, IRAN. Iran J child Neurol. 2015;9(2):29–35.
  5. Sabzehei MK, Basiri B, Bazmamoun H. The Etiology, Clinical Type, and Short Outcome of Seizures in Newborns Hospitalized in Besat Hospital/ Hamadan/ Iran. Iran J child Neurol. 2014;8(2):24–8.
  6. Puri KS, Suresh KR, Gogtay NJ, Thatte UM. Declaration of Helsinki, 2008: implications
    for stakeholders in research. J Postgrad Med. 2009;55(2):131–4.
  7. Volpe JJ. Neurology of the newborn. Philadelphia: Saunders/Elsevier; 2008. Available at: http://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-B9781416039952X1000X
  8. Levine MS. Cerebral palsy diagnosis in children over age 1 year: standard criteria. Arch Phys Med Rehabil. 1980;61(9):385–9.
  9. Lai Y-H, Ho C-S, Chiu N-C, Tseng C-F, Huang Y-L. Prognostic factors of developmental outcome in neonatal seizures in term infants. Pediatr Neonatol. 2013;54(3):166–72.
  10. Heljic S, Uzicanin S, Catibusic F, Zubcevic S. Predictors of Mortality in Neonates with Seizures; a Prospective Cohort Study. Med Arch. 2016;
    70(3):182–5.
  11. Bagla J, Garg H, Gulati RK, Gupta PP. Clinicoetiology Profile of Neonatal Seizures in Tertiary Care Level Ii Neonatal Intensive Care Unit. Indian J Child Health. 2017;04(03):383–6.
  12. Nunes ML, Martins MP, Barea BM, Wainberg RC, Costa JC da. Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital. Arq Neuropsiquiatr. 2008;66(2A):168–74.
  13. Baudou E, Cances C, Dimeglio C, Hachon Lecamus C. Etiology of neonatal seizures and maintenance therapy use: a 10-year retrospective study at Toulouse Children’s hospital. BMC Pediatr. 2019;19(1):136.
  14. Padiyar S, Nusairat L, Kadri A, Abu-Shaweesh J, Aly H. Neonatal seizures in the U.S. National Inpatient Population: Prevalence and Pediatr Neonatol. 2020;61(3):300–5.
  15. Scher MS, Aso K, Beggarly ME, Hamid MY, Steppe DA, Painter MJ. Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae. Pediatrics. 1993 ;91(1):128–34.
  16. Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population-based J Pediatr. 1999;134(1):71–5.
  17. Pisani F, Barilli AL, Sisti L, Bevilacqua G, Seri S. Preterm infants with video-EEG confirmed seizures: outcome at 30 months of age. Brain Dev. 2008;30(1):20–30.
  18. Holden KR, Mellits ED, Freeman JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982;70(2):165–76.
  19. Mellits ED, Holden KR, Freeman JM. Neonatal seizures. II. A multivariate analysis of factors associated with outcome. Pediatrics. 1982;
    70(2):177–85.
  20. Scher MS. Neonatal seizures and brain damage. Pediatr Neurol. 2003 ;29(5):381–90.
  21. Hall RT, Hall FK, Daily DK. High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr. 1998;132(2):345–8.
  22. Pisani F, Sisti L, Seri S. A scoring system for early prognostic assessment after neonatal seizures. Pediatrics. 2009;124(4):e580-7.
  23. Pisani F, Leali L, Parmigiani S, Squarcia A, Tanzi S, Volante E, et al. Neonatal seizures in preterm infants: clinical outcome and relationship with subsequent epilepsy. J Matern neonatal Med Off J  Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2004;16 Suppl 2:51–3.
  24. Garfinkle J, Shevell MI. Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol EJPN  Off J Eur  Paediatr Neurol Soc. 2011;15(3):222–9.
  25. Ellison PH, Largent JA, Bahr JP. A scoring system to predict outcome following neonatal seizures. J Pediatr. 1981;99(3):455–9.
  26. Sayin U, Sutula TP, Stafstrom CE. Seizures in the developing brain cause adverse long-term effects
    on spatial learning and anxiety. Epilepsia. 2004;45(12):1539–48.
  27. Cornejo BJ, Mesches MH, Coultrap S, Browning MD, Benke TA. A single episode of neonatal seizures permanently alters glutamatergic synapses. Ann Neurol. 2007;61(5):411–26.
  28. Garfinkle J, Shevell MI. Predictors of outcome in term infants with neonatal seizures subsequent to intrapartum asphyxia. J Child Neurol. 2011;
    26(4):453–9.
  29. Gebremariam A, Gutema Y, Leuel A, Fekadu H. Early-onset neonatal seizures: types, risk factors and short-term outcome. Ann Trop Paediatr. 2006;26(2):127–31.
  30. Amare HT, Amare AT. Etiology, Clinical Features, And Short-Term Outcome Of Seizures In Newborns Admitted To The University Of Gondar Hospital, Ethiopia. Pediatr Heal Med Ther. 2019;10:107–13.
  31. van der Heide MJ, Roze E, van der Veere CN, Ter Horst HJ, Brouwer OF, Bos AF. Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period. Early Hum Dev. 2012;88(1):33–8.
  32. Silverstein FS, Jensen FE. Neonatal seizures. Ann Neurol. 2007;62(2):112–20.
  33. McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neuro-developmental outcome. Neurology. 2000;55(4):
    506–13.
  34. Leijser LM, de Bruïne FT, Steggerda SJ, van der Grond J, Walther FJ, van Wezel-Meijler G. Brain imaging findings in very preterm infants throughout the neonatal period: part Incidences and evolution of lesions, comparison between ultrasound and MRI. Early Hum Dev. 2009;
    85(2):101–9.
  35. Leijser LM, Steggerda SJ, de Bruïne FT, van der Grond J, Walther FJ, van Wezel-Meijler G. Brain imaging findings in very preterm infants throughout the neonatal period: part Relation with perinatal clinical data. Early Hum Dev. 2009;85(2):111–5.
  36. Leijser LM, de Vries LS, Cowan FM. Using cerebral ultrasound effectively in the newborn infant. Early Hum Dev. 2006 Dec;82(12):827–35.
  37. Ment LR, Bada HS, Barnes P, Grant PE, Hirtz D, Papile LA, et al. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;58(12):
    1726–38.
  38. Clancy RR, Sharif U, Ichord R, Spray TL, Nicolson S, Tabbutt S, et al. Electrographic neonatal seizures after infant heart surgery. Epilepsia. 2005;
    46(1):84–90.
Iranian Journal of Neonatology
Volume 13, Issue 2
Spring 2022
Pages 22-31