Etiological Study of Seizures in Neonates

Objective: To determine the incidence and etiology of seizures among neonates admitted to Nursery unit of Hayatabad Medical Complex, Peshawar. Methodology: This descriptive study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan from January to December 2011. During the study period, all admitted neonatal cases were examined and data on neonatal seizures was ascertained. Among admitted neonates, having seizures either at presentation or during their stay in the hospital were investigated for its cause. Cases with clinical diagnosis of neonatal tetanus were excluded from the study. In order to determine the etiology of seizures, metabolic profile including blood glucose, serum calcium and sodium levels and other necessary tests were done in all cases. A proforma was designed comprising detailed history, general physical examination, systemic examination and relevant investigations. Data was recorded for analysis. Results: Seizures were observed in 159/1583 (9.95%) of neonatal admissions and 55.88% neonates had seizures during the first 72 hours of life. Commonest types of seizures observed in this study were subtle (39.6%) followed by tonic (31.4%), clonic (25.10%) and myoclonic (3.70%) seizures. Hypoxic ischemic encephalopathy was found to be the commonest cause (44%) of neonatal seizures, followed by hypoglycemia (18.8%) and hypocalcemia (12.5%). Cases of hypoxic ischemic encephalopathy were associated with higher mortality (42.85%) as compared to cases with metabolic seizures. Conclusion: Neonatal seizures were found in about 10% of neonatal admissions and presented most commonly as subtle type. Birth asphyxia was the commonest etiology of neonatal seizures, followed by the metabolic causes.