Neonatal seizures and outcome in a NICU of a tertiary care hospital of Andhra Pradesh-an two year study


  • Punith Patak Nagaram Department of Paediatrics, Narayana Medical College, Andhra Pradesh, India
  • Pratima Piduru Department of Paediatrics, Narayana Medical College, Andhra Pradesh, India
  • Venkata Krishna Munagala Department of Paediatrics, Narayana Medical College, Andhra Pradesh, India



Ballard’s scoring system, Hypoxic ischemia, Myoclonic seizures, Neonatal seizures



Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The present study was undertaken to delineate the various aspects of neonatal seizures, with special reference to etiology, clinical spectrum, and outcome in the Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital.

Methods: A prospective cross sectional study was conducted in an NICU of a tertiary care hospital with 65 neonates in the study group for a period of 2 years. Gestational age assessment is done by modified Ballard’s scoring system and detailed neurological assessment was done. Antenatal history of mother, demographic data, and clinical history of neonate was noted and evaluated. Laboratory investigations were done and results noted and outcome was recorded.

Results: Subtle seizure was the commonest (40%) clinical seizures in our study followed by tonic (21.5%). Tonic seizures were common in preterm and in full term subtle seizures. Babies with myoclonic seizures had 100% mortality. Hypoxic ischemic encephalopathy was the commonest cause (41.5%) of mortality in our study. The worst outcome was with CNS malformation (50%). A total of 10 deaths were recorded (15.4%) with maximum association in cases with history of onset 7 days (100%).

Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Seizures may interfere with cardio-respiratory function and nutrition and may have detrimental effects on cerebral development. Global cerebral hypoxia-ischemia is the most common etiology of neonatal seizures, followed by intracranial bleed, hypoglycemia, septicemia, hypocalcemia, BE, CNS malformations. 


Gopakumar H, Putheenveettil V. Neonatal seizures. In: Gupte S (ed): RAP Special New Delhi: Jaypee. 2010;21:290-312.

Holmes GL, Khazipov R, Ben-Ari Y. New concepts in neonatal seizures. Neuro Report. 2002;13:3-8.

Holmes GL. Effects of seizures on brain development: Lessons from the laboratory. Pediatr Neurol. 2005;33:1-11.

Rennie JM, Boylan GB. Neonatal seizures and their treatment. Curr Opin Neurol. 2003;16:177-81.

Bassan H, Bental Y, Shany E, Berger I, Froom P, Levi L, et al Neonatal seizures: dilemmas in workup and management. Pediatr Neurol. 2008;38:415-21.

Zupanc ML. Neonatal seizures. Pediatr Clin N Am. 2004;51:961-78.

Volpe JJ. Neonatal seizures: Current concepts and revised classification. Pediatrics. 1989;84:422-8.

Scher MS, Aso K, Berggarly ME. Electrographic seizures in preterm and full-term neonates: Clinical correlates, associated brain lesions, and risk for neurologic sequelae. Pediatrics. 1993;91:128-34.

Upadhyay A, Aggarwal R, Deorari AK, Paul VK. Seizures in the newborn. Indian J Pediatr. 2001;68:967-71.

Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology. 1987;37:1837-44.

Gupta A, Talukdar B, Kumar A. Clinicoetiological and EEG profile of Neonatal Seizures. Indian J Pediatr. 2007;74(1):33-7.

Mizrahi EM. Neonatal seizures: Problems in diagnosis and classification. Epilepsia. 1987;28:46.

Evan D, Lenene M, Danner R. Neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 1998;78:70-5.

Rose AL, Lombroso CT. Neonatal seizure states. A study of clinical, pathological, and electroencephalographic features in 137 full-term babies with a long-term follow-up. Pediatr. 1970;45:404-25.

Cornblath M, Schwartz R. Disorders of carbohydrate metabolism in infancy. Philadelphia, WB Saunders; 1966.

Scher MS. Seizures in the newborn infant diagnosis, treatment and outcome. Clin Perinatol. 1997;24:735-71.

Legido A, Clancy RR, Berman PH. Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics. 1991;88:583-96.

Ortibus EL, Sum JM, Hahn JS: Predictive value of EEG for outcome and epilepsy following neonatal seizures. Electroencephalogr Clin Neurophysiol 1996;98:175-85.

Yldz. Evaluation of etiologic and prognostic factors in neonatal convulsions. Pediatr Neurol. 2012;47(3):186-92.

Bergman I, Painter MJ, Hirsch RP. Outcome in neonates with convulsions treated in an intensive care unit. Ann Neurol. 1983;14:642-7.

Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. 1991;145:1325-31.

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.






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