Biochemical Profile in Neonatal Seizures at a Tertiary Care Center at Rajasthan

Introduction: Neonatal seizures, a prominent concern in neonatal neurology, represent an urgent clinical condition frequently stemming from various biochemical, structural, or infectious etiologies. The study, conducted at Government Medical College and Bangar Hospital, Pali, Rajasthan, investigates the biochemical profile of neonates presenting with seizures to aid in the early detection and management of underlying metabolic disturbances. Methods: The study involved 1487 newborns admitted between June 2023 and May 2024, among whom 128 (8.6%) presented with or developed seizures. Data was systematically recorded, capturing each neonate’s clinical history, maternal obstetric background, and onset details. Biochemical profiles, including glucose, calcium, sodium, magnesium, potassium, and phosphorus levels, were measured, with abnormal values indicative of potential seizure-related metabolic disturbances. The study distinguished primary metabolic seizures from those secondary to other etiologies, such as hypoxic-ischemic encephalopathy (HIE), intracranial hemorrhage (ICH), sepsis, and meningitis. Results: Among the 128 neonates with seizures, HIE emerged as the leading etiology, accounting for 44.53% of cases, followed by primary metabolic disturbances (17.96%) and ICH (14.84%). Metabolic profiles revealed that 54% of neonates with seizures exhibited biochemical abnormalities, with hypocalcemia as the predominant disturbance in 56.52% of primary metabolic cases. Hypoglycemia was the next most frequent abnormality, constituting 17.39% of primary metabolic seizures. Notably, the incidence of seizures was higher in outborn neonates (70.31%) than in inborn neonates (29.68%), which may reflect limited perinatal care access in rural areas and higher rates of home deliveries. Subtle seizures were the most common type, observed in 46.09% of cases, followed by focal clonic (16.41%) and generalized tonic seizures (13.28%). Hypocalcemia and hypoglycemia were also significant in non-metabolic seizures associated with HIE, ICH, and other non-metabolic etiologies. Male neonates showed a higher incidence of seizures (59.38%), aligning with previous research highlighting increased neurological vulnerability in male infants. Conclusions: The findings underscore the importance of prompt biochemical screening in neonates with seizures, as metabolic abnormalities like hypocalcemia and hypoglycemia are common and potentially modifiable contributors. The study’s insights support the necessity for heightened neonatal monitoring, especially in outborn neonates from underserved regions. Furthermore, the predominance of HIE and metabolic abnormalities as seizure etiologies suggests that improving perinatal care quality and early intervention for metabolic disturbances could reduce neonatal seizure incidence and associated morbidities.