scholarly journals Clinical profile, etiology, type and outcome of neonatal seizures: a hospital-based study

2021 ◽  
Vol 9 (1) ◽  
pp. 104
Author(s):  
Mohmad Saleem Chesti ◽  
Naveed Shahzad ◽  
Shilakha Chaman ◽  
Sheenam Gazala
Keyword(s):  
Birth Asphyxia ◽  
Clinical Profile ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Medical Sciences ◽  
Long Term Outcomes ◽  
Acute Symptomatic Seizure ◽  
Ethical Clearance ◽  
Common Infections

Background: Our study was undertaken to study the etiological factor, clinical profile, types and outcome of newborn with neonatal seizures (NNS).Methods: Our study was hospital based prospective study was done in Sheri Kashmir institute of medical sciences (SKIMS) Bemina from April 2013 to April 2015 in NICU, after obtaining ethical clearance from institutional ethical committee. All neonates fulfilling inclusion criteria were included in our study.Results: In our study, 80 neonates with seizures were included in our study, among them 48 were males and 32 were females. Majority of neonates (57.5%) developed seizures during first 72 hours of life due to birth asphyxia. Commonest types of neonatal seizures observed in our study were subtle observed in 46 cases, followed by tonic (21.2 %), clonic (14.9 %) and mixed (6.2%) seizures. Birth asphyxia was commonest cause (57.5%) of NNS, sepsis with meningitis (18.7%) followed by hypoglycemia (13.7%) and hypocalcemia (5%). Cases of birth asphyxia were associated with higher mortality (58.3%) as compared to cases with metabolic seizures.Conclusions: From our study we conclude that commonest cause of neonatal seizure was birth asphyxia occurring within 72 hours of birth. Sepsis and meningitis were also common infections resulting in neonatal seizure, while as hypoglycaemia and hypocalcemia were common biochemical abnormalities leading to NNS. Early identification and treatment are likely important for long-term outcomes in acute symptomatic seizure.

scholarly journals ETIOLOGICAL PROFILE OF NEONATAL SEIZURES WITH SPECIAL REFERENCE TO BIOCHEMICAL ABNORMALITIES

2019 ◽  
Vol 8 (6) ◽  
Author(s):  
Gurdeep Singh Dhanjal ◽  
Vikramjot Singh ◽  
Gurnoor Singh
Keyword(s):  
Seizure Activity ◽  
Early Recognition ◽  
Birth Asphyxia ◽  
Neurological Dysfunction ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Biochemical Abnormalities

Introduction: Neonatal seizure are the most frequent manifestation of neurological dysfunction in a neonate.  Detection of seizure and its etiology is important for guiding therapy. In the presence of biochemical abnormalities, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical abnormalities are essential for optimal management and satisfactory long term outcome. The aim was to determine the etiology of neonatal seizures and to study the biochemical abnormalities. Material and Methods: The present study included 70 inborn neonates presenting with seizures admitted to the neonatal unit in MMIMSR, Mullana, Ambala, Haryana, India over a period of one and a half years. A detailed history was taken and clinical examination of the neonate was done. Etiological causes and various biochemical parameters were evaluated. Results:  Neonatal seizures occurred more commonly in males. The most common cause of neonatal seizures was birth asphyxia seen in 26 (37.1%) neonates followed by sepsis in 24 (34.3%) neonates. The Primary Biochemical abnormalities were seen in 12 (17.1%) neonates with seizures. Among these neonates, hypoglycemia was most commonly seen in 4 (33.3%) neonates followed by hypocalcemia seen in 3 (25%) neonates. Conclusion: Biochemical abnormalities are common in neonatal seizures and often go unrecognized. These abnormalities may significantly contribute to seizure activity and hence a biochemical workup is necessary for all cases of neonatal seizures.

Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

2019 ◽  
Author(s):  
Vi T. Le ◽  
Hibo H. Abdi ◽  
Pablo J. Sánchez ◽  
Lina Yossef ◽  
Patricia B. Reagan ◽  
...  
Keyword(s):  
Neonatal Period ◽  
Health Information System ◽  
Neonatal Seizure ◽  
Long Term Outcomes ◽  
Adjusted Risk ◽  
Antiepileptic Medication ◽  
Anticonvulsant Medication ◽  
Risk Ratios ◽  
Ischemic Encephalopathy

Abstract Objective This article aims to describe the frequency and characteristics of anticonvulsant medication treatments initiated in the neonatal period. Study Design We analyzed a cohort of neonates with a seizure diagnosis who were discharged from institutions in the Pediatric Health Information System between 2007 and 2016. Adjusted risk ratios and 95% confidence intervals for characteristics associated with neonatal (≤ 28 days postnatal) anticonvulsant initiation were calculated via modified Poisson regression. Results A total of 6,245 infants from 47 institutions were included. There was a decrease in both phenobarbital initiation within the neonatal period (96.9 to 91.3%, p = 0.015) and continuation at discharge (90.6 to 68.6%, p <0.001). Levetiracetam (7.9 to 39.6%, p < 0.001) initiation within the neonatal period and continuation at discharge (9.4 to 49.8%, p < 0.001) increased. Neonates born at ≥ 37 weeks' gestation and those diagnosed with intraventricular hemorrhage, ischemic/thrombotic stroke, other hemorrhagic stroke, and hypoxic ischemic encephalopathy (HIE) had a higher probability of anticonvulsant administration. The most prevalent diagnosis was HIE (n = 2,223, 44.4%). Conclusion Phenobarbital remains the most widely used neonatal seizure treatment. Levetiracetam is increasingly used as a second line therapy. Increasing levetiracetam use indicates a need for additional study to determine its effectiveness in reducing seizure burden and improving long-term outcomes.

scholarly journals NEONATAL SEIZURES;

2018 ◽  
Vol 21 (05) ◽  
pp. 1048-1053
Author(s):  
Arshad Mahmood ◽  
Syed Qamar Zaman ◽  
Shahid Mahmud
Keyword(s):  
Cerebral Palsy ◽  
Neurodevelopmental Outcome ◽  
Birth Asphyxia ◽  
Unknown Etiology ◽  
Neonatal Seizures ◽  
Inborn Errors ◽  
Cross Sectional ◽  
Normal Delivery ◽  
Female Ratio

Objective: To study the types, etiology and long term neurodevelopmentaloutcome in neonates with seizures. Study Design: A descriptive cross-sectional study. Placeand Duration of Study: PNS Shifa Naval hospital Karachi from Jan 2011 to Feb 2014. StudyPopulation: Ninety six neonates of either gender presented with seizures at NICU PNS ShifaNaval hospital Karachi were studied. Method: All neonates with seizures were evaluated.The seizures were classified according to the simiology. They were investigated according toNICU protocol to confirm the underlying diagnosis and timely management. The patients afterdischarge were regularly followed up for one year to assess the long term neurodevelopmentaloutcome. Results: A total of 96 neonates with seizures were studied and it was observedthat 60 (62.5%) were male babies and 56 (58.33%) were term with a male to female ratio of1.6:1. Majority of the neonatal seizures were seen in 1stweek of life (85%). The most commontype of seizures was clonic 40 (41.67%) followed by subtle 20 (20.84%), mixed 16 (16.67%),tonic 10 (10.41%), myoclonic 5 (5.20%) and unclassified 5 (5.20%). Antiepileptics were usedin 82 (85.41%) patients. Phenobarbitone 49 (59.76%) was most commonly prescribed drug.The most common cause of seizures was birth asphyxia 48 (50%) followed by metabolic 16(16.68%), sepsis 10 (10.41%), intracranial hemorrhage 6 (6.25%), bilirubin encephalopathy 4(4.16%), inborn errors of metabolism 2 (2.08%), birth trauma 2 (2.08%) and unknown etiology 5(5.20%). 25 (26.04%) patients develop adverse neurodevelopmental outcome i.e. cerebral palsywith epilepsy 10 (40%) and cerebral palsy without epilepsy 05 (20%), developmental delay 10(40%). Mortality in the study was 12 (12.5%). Conclusions: Clonic seizures are commonestin neonates apart from infants and children who have GTCS. The most common etiology ofseizures in neonates is birth asphyxia. Phenobarbitone is still the most commonly prescribedantiepileptic. Quick assessment, timely diagnosis and aggressive management according tothe etiology are necessary to prevent the morbidity and mortality associated with neonatalseizures. Long term neurodevelopmental outcome is worse in patients with birth asphyxiaespecially with low Apgar score at 5 minutes. Normal delivery and birth asphyxia were the majorrisk factors for cerebral palsy

scholarly journals Clinical profile of Candidiasis in neonates

2017 ◽  
Vol 4 (5) ◽  
pp. 1875
Author(s):  
Latha G. S. ◽  
Veeresh Babu D. V. ◽  
Thejraj H. K.
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Asphyxia ◽  
Central Venous Catheters ◽  
Clinical Profile ◽  
Central Venous ◽  
Factors Associated

Background: Opportunistic infections are increasing in Neonatal Intensive Care Unit (NICU). Neonates often have compromised skin integrity, gastrointestinal tract disease, chronic malnutrition, central venous catheters, long term endotracheal intubation and other factors that lead to increased risk of acquiring such infections. Infections with fungi (candida) and with coagulase-negative staphylococci (CoNS) are especially prevalent. The need of study is to know the clinical profile of candidiasis in neonates in our setup and to determine associated risk factors of candidiasis.Methods: The present study was undertaken by Dept of paediatrics, SSIMS and RC Davangere among 296 neonates of which 96 babies admitted in NICU and 200 were in PNC ward to study clinical profile of candidiasis in neonates and risk factors associated with them. Parents of 296 babies were interviewed using preformed study proforma. Clinical examination was done and investigations included KOH examination of oral swab, Gram stain of the swab and blood culture of suspected sepsis babies. There are several factors associated with development of neonatal candidiosis. Of them, prematurity, LBW, perinatal birth asphyxia, long term antibiotics, central venous catheters, mechanical ventilation, septicemia, played a major role in development of candidosis.Results: In the present study, incidence of candidiasis in neonates revealed 13.8% of babies admitted in NICU. Male babies out numbered the female babies in incidence of candidiasis in neonates. Males formed 69% and females 31% of positive cases. Most of neonates admitted in NICU (96) were of low birth weight between 1.5kg to 2.5 kg. Out of which most of cases positive for candidiasis/candidemia were belonged to 1.0-1.5 kg. In present study, 13 babies were positive for candidiasis, of which 5 babies (38.3%) were of birth weight between 1-1.5kg. Birth asphyxia alone or with mechanical ventilation played an important risk factor in development of candidiasis in neonates. In present study, birth asphyxia and mechanical ventilation per se had played a significant role in development of candidiasis in neonates admitted in NICU.Conclusions: The present study revealed the clinical profile of candidiasis in neonates associated with various risk factors. Study shows that low birth weight, birth asphyxia and mechanical ventilation were significant risk factors for candidiasis in neonates. Blood cultures were positive in babies without mucosal lesions suggesting the importance of diagnosing fungal sepsis. 

scholarly journals Targeting ischemia-induced KCC2 hypofunction rescues refractory neonatal seizures and mitigates epileptogenesis in a mouse model

2020 ◽  
Author(s):  
Brennan J. Sullivan ◽  
Pavel A. Kipnis ◽  
Brandon M. Carter ◽  
Shilpa D. Kadam
Keyword(s):  
Mouse Model ◽  
Neonatal Seizure ◽  
Seizure Susceptibility ◽  
Neonatal Seizures ◽  
First Line ◽  
Chloride Homeostasis ◽  
Epilepsy Models ◽  
And Function ◽  
Ischemic Encephalopathy

AbstractNeonatal seizures pose a clinical challenge for their early detection, acute management, and mitigation of long-term comorbidities. A major cause of neonatal seizures is hypoxic-ischemic encephalopathy that results in seizures that are frequently refractory to the first-line anti-seizure medication phenobarbital (PB). One proposed mechanism for PB-inefficacy during neonatal seizures is the reduced expression and function of the neuron-specific K+/Cl− cotransporter 2 (KCC2), the main neuronal Cl− extruder that maintains chloride homeostasis and influences the efficacy of GABAergic inhibition. To determine if PB-refractoriness after ischemic neonatal seizures is dependent upon KCC2 hypofunction and can be rescued by KCC2 functional enhancement, we investigated the recently developed KCC2 functional enhancer CLP290 in a CD-1 mouse model of refractory ischemic neonatal seizures quantified with vEEG. We report that acute CLP290 intervention can rescue PB-resistance, KCC2 expression, and the development of epileptogenesis after ischemic neonatal seizures. KCC2 phosphorylation sites have a strong influence over KCC2 activity and seizure susceptibility in adult experimental epilepsy models. Therefore, we investigated seizure susceptibility in two different knock-in mice in which either phosphorylation of S940 or T906/T1007 was prevented. We report that KCC2 phosphorylation regulates both neonatal seizure susceptibility and CLP290-mediated KCC2 functional enhancement. Our results validate KCC2 as a clinically relevant target for refractory neonatal seizures and provide insights for future KCC2 drug development.

scholarly journals Efficacy of antiepileptic drugs in neonatal seizures: a systematic review protocol

2020 ◽  
Vol 4 (1) ◽  
pp. e000683
Author(s):  
Yang He ◽  
Jun Tang ◽  
Meng Zhang ◽  
Tao Xiong ◽  
Shalini Ojha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiepileptic Drugs ◽  
Neurodevelopmental Outcome ◽  
Case Series ◽  
Primary Data ◽  
Cochrane Library ◽  
Neonatal Seizures ◽  
Case Control Studies ◽  
Long Term Outcomes

IntroductionSeizures are one of the most common neurological disorders of neonates, which is also an emergency in the neonatal intensive care unit. For neonates, the recommended first-line antiepileptic drugs (AEDs) include phenobarbitone, which may be effective in only 50% of seizures. Some new AEDs, such as levetiracetam, have been shown to be effective in adults and older children. However, their efficacy for neonatal seizures remains uncertain. The aim of this investigation is to conduct a systematic review to evaluate the efficacy of all AEDs in neonates. Additionally, the long-term outcomes following neonatal seizures, in relation to the development of cerebral palsy and epilepsy, will be studied.MethodWe will perform a systematic review including randomised controlled studies (RCTs), cohort studies, case-controlled studies and case series studies which evaluated the efficacy of AEDs and short-term and long-term outcomes in neonatal seizures. PubMed, Embase, Web of Science, Cochrane Library and Clinical trial.gov will be searched. There will be no language restriction. Risk bias in RCTs will be evaluated by the Cochrane risk-of-bias tool, while cohort and case-control studies will be evaluated by the Newcastle-Ottawa Scale. A network meta-analysis will be performed by the Bayesian model using WinBUGS V.1.4.3 and R software if there is a high degree of homogeneity among studies. Otherwise, we will perform a narrative review without pooling. Subgroup analyses will be performed in different AEDs and dosage groups.OutcomeThe primary outcomes will be seizure cessation confirmed by electroencephalogram and long-term neurodevelopmental outcome. Secondary outcomes will be neonatal mortality during hospitalisation and suspected drug toxicity.Ethics and disseminationFormal ethical approval is not required as no primary data are collected. This systematic review will be disseminated through a peer-reviewed publication.

Efficacy of Fosphenytoin as First-Line Antiseizure Medication for Neonatal Seizures Compared to Phenobarbital

2020 ◽  
Vol 36 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Veronica Alix ◽  
Mansi James ◽  
Anthony H. Jackson ◽  
Paul F. Visintainer ◽  
Rachana Singh
Keyword(s):  
Negative Impact ◽  
Study Groups ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
First Line ◽  
Neurodevelopmental Outcomes ◽  
Treatment Protocols ◽  
Neurodevelopmental Delay ◽  
Observational Cohort

Currently used treatment protocols for neonatal seizures vary among centers with limited evidence to support the choice of a given antiseizure medication. Because of concerns about the potential negative impact of phenobarbital on long-term neurodevelopment outcomes, our unit transitioned to fosphenytoin as the first-line antiseizure medication. A retrospective observational cohort study was conducted to compare the acute and long-term outcomes of fosphenytoin and phenobarbital as first-line antiseizure medication for neonatal seizure treatment. The 2 study groups had similar baseline characteristics for neonatal variables as well as maternal antenatal complications. We did not find any differences in the acute outcomes between the 2 groups. However, significantly fewer infants in the fosphenytoin group had moderate-to-severe neurodevelopmental delay at the 18- and 24-month assessments. In conclusion, although both medications were equally efficacious for acute neonatal seizure control, fosphenytoin had the potential for significantly better neurodevelopmental outcomes at 18-24 months of age.

scholarly journals Clinico- Biochemical Profile of Neonatal Seizure

1970 ◽  
Vol 28 (1) ◽  
pp. 7-9 ◽  
Author(s):  
GS Shah ◽  
MK Singh ◽  
S Budhathoki ◽  
BK Kalakheti ◽  
DD Baral
Keyword(s):  
Neonatal Intensive Care ◽  
Birth Asphyxia ◽  
Etiological Factor ◽  
Neonatal Seizure ◽  
Test Results ◽  
Neonatal Seizures ◽  
Chi Square ◽  
Common Cause ◽  
Multiparous Women ◽  
Biochemical Abnormalities

Objectives: The present study was undertaken to study the incidence, etiological factor, and days of onset, clinical types and biochemical abnormalities in babies having neonatal seizures. Materials and Methods: This is a retrospective, observational hospital based study. Ninety neonates, who developed seizures before 28 days of life and admitted to neonatal intensive care unit and nursery with neonatal seizure, were evaluated for incidence, etiological factor, clinical types and biochemical abnormalities found in neonatal seizure. The variables were analysed using Chi- Square and student t- test. Results: The incidence of neonatal seizure was 10.3/ 1000 live births. The seizures were common in male babies. 65 (72.2%) neonates were born to multiparous women while 35 (38%) were born to primigravidas. In birth asphyxia (n= 40), the most common type of seizure observed was subtle seizure 20 (50%), followed by focal clonic 10 (25%) and multifocal clonic 5 (12.5%). Tonic type of seizure was observed in 3 (7.5%) and myoclonic in 2 (5%). Meningitis and septicaemia was the second most common cause of neonatal seizure observed in our study. Among metabolic abnormalities hypoglycaemia was found in 20 (22%) and hypocalcaemia in 10 (11%). Conclusion: The commonest cause of seizure was birth asphyxia presenting within 72 hours of life. Among infection septicaemia and meningitis was the most common cause leading to neonatal seizure. Among biochemical abnormalities the most common cause of seizure observed in our study was hypoglycaemia and hypocalcaemia. Subtle seizures were the commonest type of seizure observed in this study. Key words: Neonatal seizure, biochemical disturbances in seizure.    DOI = 10.3126/jnps.v28i1.1398   J. Nepal Paediatr. Soc. Vol.28(1) p.7-9

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