Evaluation of the predictors of epilepsy in hypoxic ischemic encephalopathy term neonates

Love Kumar; Nazeer A. Jeergal; A. N. Thobbi

doi:10.18203/2349-3291.ijcp20250411

Authors

Love Kumar Department of Paediatrics, Al- Ameen Medical College and Hospital, Vijayapura, Karnataka, India
Nazeer A. Jeergal Department of Paediatrics, Al- Ameen Medical College and Hospital, Vijayapura, Karnataka, India
A. N. Thobbi Department of Paediatrics, Al- Ameen Medical College and Hospital, Vijayapura, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20250411

Keywords:

HIE, Epilepsy, Apgar scores, Lactate level, Abnormal EEG, Cortical injury

Abstract

Background: Hypoxic ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality, particularly in term infants. Neonates with severe HIE are at high risk for long-term neurological consequences, including epilepsy. This study aims to identify clinical, biochemical, and neuroimaging predictors of epilepsy in HIE neonates.

Methods: A prospective cohort study was conducted on 100 term neonates diagnosed with HIE at a tertiary neonatal intensive care unit (NICU) in India. Data including gestational age, birth weight, Apgar scores, clinical features, neuroimaging results (MRI/CT), serum lactate levels, and EEG findings were collected. Epilepsy was diagnosed based on clinical symptoms and EEG findings.

Results: Of 100 neonates with HIE, 28 (28%) developed epilepsy by 6 months. Significant predictors included low Apgar score at 1 minute (≤3) (p<0.01), early onset seizures (within 24 hours) (p<0.01), and severe HIE (p=0.02). Basal ganglia and cortical injury on neuroimaging were more common in the epilepsy group (p=0.01, p=0.03). Elevated lactate levels (>5 mmol/l) were associated with epilepsy (p=0.02). Abnormal EEG findings were observed in 78.57% of epileptic neonates (p<0.001). Logistic regression identified several independent predictors: Apgar score ≤3, early seizures, severe HIE, brain injury, elevated lactate levels, and abnormal EEG.

Conclusions: Early clinical, biochemical, and neuroimaging factors are strong predictors of epilepsy in term neonates with HIE. These findings highlight the importance of early identification and intervention to improve long-term outcomes.

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