NEONATAL SEIZURES: ETIOLOGY, TREATMENT AND PROGNOSIS
Introduction: Seizures are one of the most common pathologies in newborns. Their incidence is 1.5–3.5/1000 for term infants and 10–130/1000 for preterms. The most common causes of seizures in term infants are hypoxic-ischemic encephalopathy (HIE), cerebrovascular insult (CVI), cerebral malformations (CM), and metabolic disorders. For preterm infants: intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and infections. Clinical characteristics are diverse and subtle, and subclinical forms are common. The drug of the first choice is phenobarbitone. Newborns with seizures are more prone to developing neurological disturbances such as epilepsy and cerebral palsy.
Methods: This is a clinical, observational research, one-year, retrospective, cross-sectional study conducted in the Department of neonatal intensive care and neonatology of the Clinic of Pediatrics KCUS. The study included 43 newborns who met the inclusion criteria.
Results: We found that 7.19% of hospitalized newborns had seizures. A number of seizures were recorded in the group of term infants with an earlier time of seizures. The most common etiological causes were: HIE, IVH, infections, and CM. There was a frequent occurrence of metabolic disorders such as acidosis, blood sugar, and mineral (Ca, K, Na, and Mg) disorders. The median of the first day of onset of seizures in full-term infants is on the fourth day, while in premature infants it is on the sixth day of life. Phenobarbitone was mainly used to stop seizures, with great success. Overall mortality in children with seizures was 37.21%.
Conclusions: Seizures are common in newborns, which, depending on the etiological cause, increase mortality, especially in preterm infants. Seizures in term infants occur earlier than in premature infants. The most common etiology of seizures in term infants are infections, hypoxemic-ischemic encephalopathy, intracranial hemorrhage, cerebral malformations, and cerebrovascular insult. In premature infants these are hypoxemic-ischemic encephalopathy, intracranial bleeding, and infections. In the initial treatment of neonatal convulsions, phenobarbitone is most often used, which has proven to be successful in the majority of cases.
Pisani F, Spagnoli C, Falsaperla R, Nagarajan L, Ramantani G. Seizures in the neonate: A review of etiologies and outcomes. Seizure. 2021;85:48-56. doi: 10.1016/j.seizure.2020.12.023.
Heljić S. Neonatologija. Univerzitet u Sarajevu – Medicinski fakultet, Sarajevo, 2008.
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. DOI: 10.1212/01.wnl.0000279335.85797.2c.
Hasanbegović E. Pedijatrija. Univerzitet u Sarajevu – Medicinski fakultet, Sarajevo, 2020.
Padiyar S, Nusairat L, Kadri A, Abu-Shaweesh J, Aly H. Neonatal seizures in the U.S. National Inpatient Population: Prevalence and outcomes. Pediatr Neonatol. 2020;61(3):300-5. DOI: 10.1016/j.pedneo.2019.12.006.
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. DOI: 10.1186/s12887-019-1508-5.
Glass HC, Shellhaas RA. Acute Symptomatic Seizures in Neonates, Seminars in Pediatric Neurology. 2019 ;32:100768. DOI: 10.1016/j.spen.2019.08.004.
Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58(4): 512-21. DOI: 10.1111/epi.13709.
Zuberi SM, Wirrell E, Yozawitz E, Wilmshurst JM, Specchio N, Riney K, et al. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022; 63(6). 1349-97. DOI: 10.1111/epi.17239.
Nguyen T, Wusthoff CJ. Clinical manifestations of neonatal seizures. Pediatr Int. 2021; 63(6): 631-5. DOI: 10.1111/ped.14654.
Sankar J, Agarwal R, Aggarwal R, Deorari A, Paul VK. Seizures in the Newborn. Ind J Pediatr. 2008; 75(2): 149-55. DOI: 10.1007/s12098-008-0023-8.
van Rooij LG, Hellström-Westas L, de Vries LS. Treatment of neonatal seizures. Semin Fetal Neonatal Med. 2013;18(4):209-15. doi: 10.1016/j.siny.2013.01.001.
Abend NS, Jensen FE, Inder TE, Volpe JJ. Neonatal seizures. In: Volpe's Neurology of the Newborn. 6th ed.Elsevier, 2018: 275-321. Doi: 10.1016/C2010-0-68825-0
Tadic BV, Kravljanac R, Sretenovic V, Vukomanovic V. Long-term outcome in children with neonatal seizures: A tertiary center experience in a cohort of 168 patients. Epilepsy Behav. 2018;84:107-13. DOI: 10.1016/j.yebeh.2018.05.002.
Glass HC, Grinspan ZM, Shellhaas RA. Outcomes after acute symptomatic seizures in neonates. Semin Fetal Neonatal Med. 2018; 23(3):218-22. doi: 10.1016/j.siny.2018.02.001.
Spagnoli C, Falsaperla R, Deolmi M, Corsello G, Pisani F. Symptomatic seizures in preterm newborns: a review on clinical features and prognosis. Ital J Pediatr. 2018; 44(1):115. doi: 10.1186/s13052-018-0573-y.
Glass HC, Shellhaas RA, Tsuchida TN, Chang T, Wusthoff CJ, Chu CJ, et al. Seizures in preterm neonates: a multicenter observational cohort study. Pediat Neurol. 2017; 72:19-24. DOI: 10.1016/j.pediatrneurol.2017.04.016.
Al-Momen H, Muhammed MK, Alshaheen AA. Neonatal seizures in Iraq: Cause and outcome. Tohoku J Exp Med. 2018; 246(4): 245-9. doi: 10.1620/tjem.246.245.
Suganthi V, Vinkeswari K, Thivya G. Prevalence of hypomagnesemia in neonatal seizures in a tertiary care hospital in South India. J Pediatr Res. 2017; 4(1): 64-8. DOI: 10.17511/ijpr.2017.i01.13.
Williams KP, Singh A. The correlation of seizures in newborn infants with significant acidosis at birth with umbilical artery cord gas values. Obstet Gynecol. 2002; 100(3): 557-60. doi: 10.1016/s0029-7844(02)02090-2.
Campi F, Longo D, Bersani I, Savarese I, Lucignani G, Haass C, et al. Neonatal cerebral venous thrombosis following maternal SARS-CoV-2 infection in pregnancy. Neonatology. 2022; 119(2):268-72. doi:10.1159/000520537.
Jain P, Thakur A, Kler N, Garg P. Manifestations in neonates born to COVID-19 positive mothers. Indian J Pediatr. 2020; 87(8): 644. doi: 10.1007/s12098-020-03369-x.
Nayak MK, Panda SK, Panda SS, Rath S , Ghosh A, Mohakud NK. Neonatal outcomes of pregnant women with COVID-19 in a developing country setup. Pediatr Neonatol. 2021; 62(5): 499-505. doi: 10.1016/j.pedneo.2021.05.004.
Kumar A, Gupta A, Talukdar B. Clinico-etiological and EEG profile of neonatal seizures. Indian J Pediatr. 2007; 74(1):33-7. doi: 10.1007/s12098-007-0023-0.
Sharpe C, Reiner GE, Davis SL, Nespeca M, Gold JJ, Rasmussen M et all. Levetiracetam versus phenobarbital for neonatal seizures: a randomized controlled trial. Pediatrics. 2020; 145(6): e20193182. doi: 10.1542/peds.2019-3182.
Sharma D, Hussain AM, Sharma SS. Efficacy of Levetiracetam in neonatal seizures: a systematic review. J Matern Fetal Neonatal Med. 2020; 35(20):3923-30.
Russell NK, Hariharan G. EBNEO Commentary: Safety of early discontinuation of anti‐seizure medication in neonates. Acta Paediatrica. 2022; 111(2):449-50. doi: 10.1111/apa.16200.
Garfinkle J, Shevell, MI. Cerebral palsy, developmental delay, and epilepsy after neonatal seizures. Pediatr Neurol. 2011; 44(2): 88-96. doi: 10.1016/j.pediatrneurol.2010.09.001.
Uzicanin S, Heljic S, Zubcevic S, Catibusic F, Krdzalic B. PP10. 9–2483: Neurodevelopmental outcome of infants with neonatal seizures. European Journal of Paediatric Neurology. 2015;: 19( suppl 1):S72. doi: 10.1016/S1090-3798(15)30237-3.
Lemmon ME, Bonifacio SL, Shellhaas RA, Wusthoff CJ, Greenberg RG, Soul JS et all. Characterization of death in infants with neonatal seizures. Pediatr Neurol. 2020; 113: 21-5. DOI: 10.1016/j.pediatrneurol.2020.08.002.
Heljic S, Uzicanin S, Catibusic F, Zubcevic S. Predictors of mortality in neonates with seizures; a prospective cohort study. Medical archives. 2016; 70(3):182. DOI: 10.5455/medarh.2016.70.182-5.
- There are currently no refbacks.
Copyright (c) 2022 Verica Misanovic, Edna Hodzic, Sabina Terzic, Emina Vukas-Salihbegovic, Amila Kljucic
This work is licensed under a Creative Commons Attribution 4.0 International License.