Pediatrics
72
Indian Journal of Clinical Practice, Vol. 24, No. 1, June 2013
11.30%
12 10 8
Term Preterm
6 4 2
0.70%
0
1.10%
Intramural
0.70% Extramural
Figure 1. Distribution of incidence of seizures.
H
IE al ce H m yp ia Py og og ly ce en m ic ia m en in Bi gi lir tis ub in en IC ce El H ph ec a tro lo pa ly te th y im ba l an M ix ce ed ca us es
90 80 70 60 50 40 30 20 10 0
yp oc
Once the neonate was hemodynamically stable and off intravenous fluids, he/she was sent for the EEG recording at the earliest. EEG was obtained on RMS EEG machine having 25 leads. EEG was done at a Neurophysian’s clinic and was read by a Pediatric neurophysician. The techniques used were as per guidelines of the American EEG Society for recording EEG in neonates. Neonatal montages were used and 16 leads were used as against the standard of 25 leads in the adult. Triclofos was used in the dose of 50 mg/kg/dose to induce sleep when required. Babies were also subjected to photic stimulation to provoke any abnormalities in brain activity. Each EEG recording was made for 30-40 minutes in order to bring out the sleep wake cycles in each neonate and read by a pediatric neurologist.
During the study period a total of 4,412 babies were admitted in the intramural NICU, and 1,900 were admitted in the extramural NICU. One hundred seventy-two newborns satisfying the inclusion criteria were enrolled in the study. The incidence of seizures was found to be 0.77% with 0.7% among term newborns and 1.1% among preterm newborns (Fig. 1). One hundred twenty-one males and 51 females were enrolled in the study and the male:female ratio was found to be 2.37:1. The incidence of seizures was found to be 2.8% among low birth weight and 0.88% among very low birth weight infants. Twenty-two percent of the newborns with neonatal seizures were found to be small for date (SFD). Eighty-one percent of the neonatal seizures were found to be early-onset (<48 hours of life)
H
Investigations done included: Serum C-reactive protein, random blood sugar, packed cell volume, serum calcium, serum magnesium, serum sodium, blood urea, serum creatinine, serum bilirubin, blood culture and sensitivity, cerebrospinal fluid (CSF) examination, USG head, CT scan, MRI (wherever feasible and indicated) and EEG. All babies were treated using standard treatment protocol.
RESULTS
Percentage (%)
Details of each baby with a complete antenatal and perinatal history including Apgar scores for intramural deliveries and history suggestive of birth asphyxia or examination revealing signs of hypoxic ischemic encephalopathy (HIE), were noted. A history of seizures associated with poor feeding, prolonged lethargy, recurrent vomiting, with family history of consanguinity and/or neonatal seizure with early fetal and neonatal death was taken to rule out inborn errors of metabolism. A complete description of the seizure, day of onset, duration and frequency was noted and classified according to Volpe. Vital signs, congenital malformation and cutaneous markers, were examined for and systemic examination was done. Neurological examination was done at the time of onset of seizures. Sarnat and Sarnat score was considered for HIE grading.
Statistical analysis: Data was recorded in a pretested detailed Proforma and entered in Microsoft Excel worksheet. Median and mean were used to analyze data that was distributed in the Gaussian manner.
Percentage (%)
the study, ethical approval was taken from the local IECHR (Institutional Ethics Committee for Human Research), Medical College Baroda. The cohort consisted of neonates admitted in the NICUs (intramural and extramural) from September 2008 to November 2009. It was an observational study. A total of 172 neonates who either had seizures during the NICU stay or had seizures which were noticed by other doctors and referred from outside, were included in the study after written and informed consent of the parents.
Figure 2. Distribution of various etiologies of neonatal seizures.