Determination of the risk factors and underlying biochemical abnormalities of neonatal seizures in a tertiary care centre of South India

Background: Neonatal seizures represent most common symptom rather than a cause for underlying functional brain abnormality. Commonly seen in first 48 hours of birth resulting in significant long-term morbidity and mortality causing impaired motor and cognitive functions in the childhood. Hence it become critically important for early diagnosis and treatment of neonatal seizures. Methods: This prospective observational study took place in NICU of Al Ameen Medical college Vijayapura for period of 6 months including all neonates within 28 days of life presenting with seizures not on any anticonvulsants. Results: Males were in majority with 58% with maximum onset within 24 hours of birth. Vaginal deliveries (66%), preterms (56%), SGA (62%) and LBW (54%) infants are high risk. Birth asphyxia and sepsis were identified to be most common underlying precipitating factors. Hypoglycaemia (38%) and hypocalcemia (28%) were the most common biochemical abnormalities found. Hypoglycaemia was more commonly found in preterm, LBW and SGA, whereas Hypocalcemia in term, LBW and AGA neonates. Hypoglycaemia was found to be significantly high with onset within 24 hours of birth. Sodium imbalance was the main cause identified in subtle seizures, hypoglycaemia in tonic seizures and Hypocalcemia in clonic type of seizures. Conclusions: Quick assessment and timely diagnosis according to the etiology are necessary to prevent long term neurological outcome as it not only determines course of treatment but also associated morbidity and mortality. Biochemical abnormalities, if not treated properly, can result in poor prognosis therefore work up should be done in all neonates with seizures and should be included as routine investigation in all cases as they are easily treatable and can prevent long term morbidities.