Neurodevelopmental Sequelae of Neonatal Seizures in Newborn

Shiva Shankaran, S (2012) Neurodevelopmental Sequelae of Neonatal Seizures in Newborn. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Clinical seizures are defined as paroxysmal alteration in neurological function i.e. behavioural, motor and/or autonomic function. Newborn period is the time when the incidence of seizures is the highest, yet their clinical recognition is difficult, therefore true incidence of neonatal seizures is difficult to determine. Its incidence varies from 1-5 per 1000 live births. 2-6 Neonatal seizures are very common in the first weeks of life. Clinical features of neonatal seizures are different from those in adults. Neonatal seizures are distinctive clinical manifestation of neurological dysfunction in the newborn.8 Newborn infants with seizures are at risk for neonatal death and survivors are at risk for neurological impairment, developmental delay, and later epilepsy. 8-12 Despite increasingly sophisticated neonatal intensive care, neonatal seizures remains a challenge. 8-13 Neonatal seizures can be due to various causes like hypoxicischemic encephalopathy, intracranial hemorrhage, meningitis, hypoglycemia, hypocalcemia, congenital malformation, etc. The most important factor that predicts their outcome is the underlying etiology.14 Patients with hypoxic encephalopathy (HIE), intraventricular hemorrhage (IVH) and neuronal migration disorders (NMD) are reported to have the worst prognosis. Etiologic profile of neonatal seizures is also changing over the years due to advanced development in obstetric and neonatal management that have changed the spectrum of insults to which the immature brain is exposed. The mortality of infants developing seizures during the neonatal period has shown a decreasing trend over time. In earlier studies, the mortality was as high as 40%, but decreased in subsequent reports to 20%. As opposed to this increase in survival, the prevalence of long-term neurodevelopmental sequelae in survivors has remained unchanged at 30%. However, neonatal seizures remain an important predictor of future neurological complications. In addition it may be associated with other permanent neurological disorders such as mental retardation and cerebral palsy. The occurrence of epilepsy after neonatal seizures varies in frequency as shown in previous studies from 3.5 to 56% according to sample selection. STUDY OBJECTIVES: 1. To assess the neurodevelopemental sequelae of neonatal seizure of newborns admitted in NICU at Govt. Stanley Medical College Hospital. 2. To identify the risk factors for poor neurodevelopemental outcome in neonatal seizures. DISCUSSION: The current study was undertaken between March 2010 and August 2011. In this study conducted at institute of social paediatrics, and Govt. RSRM NICU we studied the neurodevelopmental outcome of the babies who had neonatal seizure and analyzed the risk factors for the poor developmental outcome. A total of 1856 babies got admitted in NICU, among them 108 term newborns had neonatal seizure. 4 newborns with neonatal seizure expired during the hospital stay.Out of 108 newborns 91 completed the study, among the 91 infants 22 had developmental delay, 10 had microcephaly, 3 had microcephaly with developmental delay and 2 had macrocephaly with developmental delay. On analyzing data out of 22 infants with developmental delay 50% were male infants and 50% were female infants, among 10 microcephaly 60% were male and 40% were female infants. There was no predilection for sexes as observed in other studies.53% were delivered by normal vaginal delivery 41 % were delivered by caeserian section, 4% were born by forceps delivery. There was no difference in outcome between the two groups. Similar finding was observed in study conducted by Pisani et al SUMMARY: 1. A prospective study was conducted at NICU of Institute of Social Paediatrics and NICU of Govt. RSRM Hospital to assess the neurodevelopmental sequelae in infants who had neonatal seizure. 2. Out of 1856 newborn admission 108 newborn had neonatal seizure, of which 100 participated in the study, 91 infants completed the study, 4 newborns expired during the hospital stay and 5 were lost in follow-up. 3. 55% were delivered by spontaneous vaginal delivery, 41 % were born by LSCS, 4% were delivered by forceps and 2% by vacuum extraction. 4. 33% of neonatal seizure were due to birth asphyxia, 27 % due to septicemia, 20 % due to hypoglycemia. In 8% of cases cause was unknown. 5. Subtle seizure was the most common seizure(42%), followed by focal seizure(26%), tonic seizure(19%) Mixed type of seizure was observed in 8 % of cases. 6. 46% of seizure manifested within 24 hours of life, 34% of cases between 24 to 72 hours of life, 5% of cases occurred after 14 days. 7. 20% of hypoglycemic seizure had developmental delay and level of blood glucose did not have significant association with the outcome. CONCLUSION: From our study it may be concluded that 59% of infants with neonatal seizure had normal development, while 41% had adverse neurological outcome at the end of 1 year follow-up. The risk factors for developmental delay from our study was early onset of seizure, low 5 minute Apgar score and abnormal background EEG.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neurodevelopmental Sequelae ; Neonatal Seizures ; Newborn.
Subjects: MEDICAL > Paediatrics
Depositing User: Ravindran C
Date Deposited: 16 Apr 2018 10:57
Last Modified: 16 Apr 2018 11:24

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