The epidemiology of clinical neonatal seizures in Ramadi city.

A seizure is defined clinically as paroxysmal alternations in neurological function, namely, motor, behavioral, or autonomic function. Neonatal seizures tend to be brief, because immature neurons cannot sustain repetitive activity for a long time and tend to be focal or multifocal. Neonatal seizures are common: estimates of the incidence of clinical seizures in term infants range from 0.7-2.7 per 1,000 live birth and from 57.5-132 per 1,000 live birth in premature infants. Additionally, seizures occur in 1-2% of newborns in the neonatal intensive care unit.1 Most neonatal seizures occur over only a few days and fewer than half of affected infants develop seizures later in life. Such neonatal seizures could be considered acute reactive (acute symptomatic) thus, the term (neonatal epilepsy) is not used to describe neonatal seizures. It is important to recognize the presence of seizure in the neonatal period, since they are often related to a significant underlying illness; in addition, seizures may be sustained for a considerable time, interfering with essential supportive care. Yet, the recognition of neonatal seizures is difficult as seizure activity may be subtle and because there may be marked difference of opinion on what clinical phenomena are considered to be epileptic seizures.2 There are 5 major types of seizures in neonates: Focal, multifocal clonic, tonic, myoclonic, and subtle seizures. Common causes of neonatal seizure are asphyxic encephalopathy, intracranial hemorrhage, metabolic disturbance, and intracranial infection. The cause is unknown in 12%. The natural history of neonatal seizure has not been fully elucidated, although it has been observed that they are most severe during the first weeks of life and usually abate over time despite interventions.1 The prognosis following neonatal seizures is vague. It is difficult to determine whether the neuronal injury that might follow neonatal seizures is a cause or effect. A mortality rate of 21-58% has been reported following neonatal seizure. Furthermore, neonatal seizures might have an adverse effect on neurodevelopmental progression and may predispose to cognitive, behavioral, or epileptic complications later in life.3 The present study was performed to evaluate the incidence, clinical type, and etiologic distribution of neonatal seizures in the neonatal care unit (NCU) of the Maternity and Children Hospital in Ramadi City, and to compare this with results of a previous study in Ramadi, and to see how it differs from the results of other studies. This study was conducted in the Maternity and Children Hospital of Ramadi, the central city of Al-Anbar governorate, approximately 100 km west of Baghdad, Iraq. The NCU in this hospital is a 20-bed unit serving inpatient and outpatient delivered neonates. All neonates, including term and preterm babies, who where admitted to the NCU with seizures or who developed seizures while in the unit were included in this study. The study covers a 6-month period from the 1st of April to 1st of October 2005. Data were collected on gender, age of presentation, mode of delivery, site of delivery (inborn or outborn), preterm (<37 weeks) or term (38-42 weeks), and type of feeding. Weight and head circumference were recorded, and patients were examined for signs of sepsis and meningitis and full neurological examination was carried out. Clinical classifications of seizures were determined by the investigator. All cases were investigated for random blood sugar, serum calcium, and white blood cell count. Other neurometabolic disorders that can manifest with neonatal seizure were not investigated because tests were not available. Furthermore, neuroimaging such as CT scan and MRI were also not available. Blood culture and lumber puncture were carried out when indicated clinically. The diagnosis of neonatal seizures was reached on a clinical basis, and EEG was not carried out as it was unavailable. During the study period, there were 913 neonates attending the NCU. Thirty-one presented with seizures (18 boys, 13 girls). Thus, the incidence of neonatal seizures in the NCU was 34 per 1,000 admissions. Out of the 31 neonates, there were 12 (38.7%) preterm and 19 (61.3%) full term. Additionally, 15 (48.4%) delivered at home (3 preterm and 12 full term) and 16 neonates (51.6%) delivered at the hospital (9 preterm and 7 full term). The mean birth weight and head circumference for full term was 3.2 kg and 34.3 cm, and for preterm was 2.6 kg, and 32.8 cm. The mean gestational age of preterm was 32 weeks, ranging from 28-37 weeks. The total live births in our hospital during the corresponding period was 2,273 (2,134 full term and 139 preterm). Thus, the incidence of neonatal seizures was 3.3 per 1,000 live full term and 64.7 per 1,000 live preterm. Most patients presented after the first 2 days of life (61.3%). Hypocalcemia was the most common abnormal investigation (48.4%) followed by hypoglycemia (25.8%). Twenty-five neonates were investigated for blood culture and CSF examination. Positive blood culture was obtained in 6 (24%) and positive CSF results was 4 (16%). We found the subtle seizure to be the most common, occurring in 19 (61.2%) neonates followed by multifocal clonic in 4 (12.9%) neonates. Tonic occurred in 9.6%,