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

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.