European Journal of Cardiovascular Medicine

The most recurrent neurological emergency in neonates is a seizure, which can cause serious death and neurodevelopmental impairment. Because of their subtle clinical presentation, inconsistent electroclinical connection, and poor responsiveness to antiseizure medications, neonatal seizures provide a significant challenge to doctors. It is commonly known that fever and illness can cause seizures in young children, and that children with epilepsy are more susceptible to this danger. Vaccination can be a non-specific cause of seizures in children since it can result in a fever. However, there is no indication that children having epilepsy are more prone to experience seizures after receiving an immunisation¹. Whether immunisation in mothers or infants is linked to an increased chance of seizures among the neonate is unknown. However, it is becoming crucial to develop widely accepted standard definitions for adverse events that may be connected to these interventions as maternal immunisation with proven vaccines spreads throughout various regions and new maternal vaccine candidates reach the late stages of development. A case definition for seizures in children has already been published by the Brighton Collaboration ², but not for seizures in newborns.

Worldwide, the reported rate of newborn seizures ranges from 5/1000 live births in countries which have upper-middleincome (Iran)¹³ to 1.0–4.4/1000 live births among high-income nations (USA)^3,4. The seizures incidence among preterm infants was reported to range between 3.9 and 57.5 seizures / 1000 live births according to only clinical observation⁵. However, studies employing amplitude-integrated electroencephalography (aEEG) show a seizure burden of up to 48% ^6,7. AEEG can, however, be mistakenly positive, especially in premature newborns, as is well known. According to studies employing cEEG in preterms, the incidence ranges from 4 to 9% in high-income nations, with 75% of seizures being electrographic-only ^8,9.

In the literature there are very few studies on this topic in this part of Uttar Pradesh, hence the present study is being caried out to analyse associated risk factors for development of neonatal seizures in admitted patients in NICU

This cross-sectional study was done on patients admitted in NICU with complaints of abnormal body movement Department of Pediatrics at Rohilkhand Medical College and Hospital, Bareilly (U.P.).The study was done for total duration of 12 months. (August 2023 to July 2024).

Inclusion Criteria:

• All patients admitted in NICU at Rohilkhand medical college and hospital and had complaints of abnormal body movement.
• Clinically diagnosed and investigation proven neonatal seizures.

Exclusion Criteria:

• Patient’s having abnormal body movements other than neonatal seizures (Eg: Jitteriness, benign myoclonus of infancy, etc.)
• Patient’s attendant who did not give informed consent.

Sample Size:

P             =             anticipated proportion of neonatal seizures because of meningitis⁵

Q            =             100-p

L             =             absolute error (5%)

N            =             4pq/l²

=             (4 x 3.2 x 96.8)/25

               =             49.56

                              ~ 50

Thus, the sample size planned for this study was 50.

METHODOLOGY:

After taking clearance from Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, the study wasconducted.

Written informed consent was taken from parents/guardians of all the patients participating in the study in a language they could understand. Anonymity was proposed as optional and confidentiality was guaranteed.

A detailed clinical history and examination was done of the patient with seizures.Appropriate investigations according to history and clinical presentation was done. Heart rate, respiration, capillary refill time, blood pressure, and temperature were recorded in all cases.Gestation, birth weight, weight for age were recorded. Detailed neurological examination was done including the assessment of consciousness, tone, and fundus examination. Systemic examination was done to rule out hepatosplenomegaly, abnormal urine odor, neuro- cutaneous markers,hypopigmentedmacules on skin etc. All essential investigations were conducted as multiple etiologies can coexist. Patient with seizures onset had undergone lumbar puncture under all aseptic precautions to confirm the diagnosis like meningitis. All the patients were also planned to undergo contrast enhanced MRI brain under proper protocol but most of them were hemodynamically unstable hence MRI brain was planned for follow up. USG cranium was also done in participants of study in order to rule out intracranial hemorrhages and malformations. EEG was also planned for all participants.

From all the patients who gave consent to participate in study, detailed maternal medical and obstetric history was obtained and recorded in predesigned proforma.

Statistical Analysis:

The data wasimported into SPSS (statistical package for Social Sciences); licenced version 23.0.Data was analysed by applying frequency, percentage, mean, standard deviation. Appropriate statistical tests were applied depending upon the type and distribution of data. P value <0.05 is considered significant.

RESULTS:

In our study, majority of the study subjects had term gestation. 58 % study subjects had term gestational age whereas 42 % study subjects had preterm gestational age.

In our study, majority of the study subjects of both genders had subtle seizures followed by multifocal-clonic seizures. Out of 50 study subjects, 37 were males and 13 were females. There is no statistical association of types of neonatal seizures with gender as p-value is more than 0.05.

Figure 1: Distribution of cases according to gender:

In our study, majority of the study subjects were outborn. 84 % study subjects had outborn delivery whereas 16 % study subjects had inborn delivery.

Table 1: Distribution of cases according to mode of delivery

In our study, majority of the study subjects were delivered vaginaly. 78 % study subjects had vaginal delivery whereas 22 % study subjects had c-section delivery.

In our study, majority of the study subjects had onset of seizures on day one.  In our study, majority of the study subjects had subtle seizure (36 %) followed by multifocal clonic seizure (28%) > focal clonic seizure (20%) > tonic seizure (14%) > myoclonic seizure (2%).

Figure 2: Distribution of cases according to type of neonatal seizures

In our study, etiology of majority of the study subjects was HIE (42%) followed by meningitis (38%) >IVH (10%) >hypoglycemia (4%) >hypocalcemia (4%) > hyponatremia (2%).

Figure 3: Distribution of cases according to etiology of neonatal seizures

In our study, majority of the study subjects were those who needed resuscitation at time of birth with neonatal seizures. 58 % study subjects needed resuscitation whereas 42 % study subjects didn’t needed resuscitation. There is strong statistical association of etiology of seizures with resuscitation needed at time of birth to babies with neonatal seizures as p-value is 0.001 by applying chi square formula.

In our study, majority of the study subjects (12%) were hospitalised in first 7 days.

Table 2: Distribution of study subjects according to outcome

In our study, majority of the study subjects (50%) got discharged; 34% got LAMA/DOPR and mortality occurred in 16% of the study subjects.

In our study, maximum study subjects i.e. 36% had APGAR score at 5 minutes = 5. There is strong statistical association of etiology of seizures with APGAR score at 5 minutes of patients with neonatal seizuresas p-value is 0.001 by applying chi square formula.

Figure 4: Distribution of study subjects according to APGAR score at 5 minutes

In our study, maximum study subjects i.e. 46% had APGAR score at 10 minutes = 6. There is strong statistical association of etiology of seizures with APGAR score at 10 minutes of patients with neonatal seizures as p-value is 0.001 by applying chi square formula.

Figure 5: Distribution of study subjects according to APGAR score at 10 minutes

There is no statistical association of etiology with type of neonatal seizures as p-value is 0.210 by applying chi square test.

Figure 6: Association of etiology with type of neonatal seizures

There is no statistical association of etiology with day of onset of seizures as p-value is 0.122 by applying chi square test.

Figure 7: Association of etiology with day of onset of seizures

There is no statistical association of type of neonatal seizures with day of onset of seizures as p-value is 0.416 by applying chi square test.

Figure 8: Association of type of neonatal seizures with day of onset of seizures

Table 3: Association of type of neonatal seizures with gestational age

There is no statistical association of types of neonatal seizures with gestational age as p-value is 0.409by applying chi square test.

This cross-sectional study was done on patients admitted in NICU with complaints of abnormal body movement Department of Pediatrics at Rohilkhand Medical College and Hospital, Bareilly (U.P.).The study was done for total duration of 12 months. (August 2023 to July 2024).

Inclusion Criteria:

• All patients admitted in NICU at Rohilkhand medical college and hospital and had complaints of abnormal body movement.
• Clinically diagnosed and investigation proven neonatal seizures.

Exclusion Criteria:

• Patient’s having abnormal body movements other than neonatal seizures (Eg: Jitteriness, benign myoclonus of infancy, etc.)
• Patient’s attendant who did not give informed consent.

Sample Size:

P             =             anticipated proportion of neonatal seizures because of meningitis⁵

Q            =             100-p

L             =             absolute error (5%)

N            =             4pq/l²

=             (4 x 3.2 x 96.8)/25

               =             49.56

                              ~ 50

Thus, the sample size planned for this study was 50.

METHODOLOGY:

After taking clearance from Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, the study wasconducted.

Written informed consent was taken from parents/guardians of all the patients participating in the study in a language they could understand. Anonymity was proposed as optional and confidentiality was guaranteed.

A detailed clinical history and examination was done of the patient with seizures.Appropriate investigations according to history and clinical presentation was done. Heart rate, respiration, capillary refill time, blood pressure, and temperature were recorded in all cases.Gestation, birth weight, weight for age were recorded. Detailed neurological examination was done including the assessment of consciousness, tone, and fundus examination. Systemic examination was done to rule out hepatosplenomegaly, abnormal urine odor, neuro- cutaneous markers,hypopigmentedmacules on skin etc. All essential investigations were conducted as multiple etiologies can coexist. Patient with seizures onset had undergone lumbar puncture under all aseptic precautions to confirm the diagnosis like meningitis. All the patients were also planned to undergo contrast enhanced MRI brain under proper protocol but most of them were hemodynamically unstable hence MRI brain was planned for follow up. USG cranium was also done in participants of study in order to rule out intracranial hemorrhages and malformations. EEG was also planned for all participants.

From all the patients who gave consent to participate in study, detailed maternal medical and obstetric history was obtained and recorded in predesigned proforma.

Statistical Analysis:

The data wasimported into SPSS (statistical package for Social Sciences); licenced version 23.0.Data was analysed by applying frequency, percentage, mean, standard deviation. Appropriate statistical tests were applied depending upon the type and distribution of data. P value <0.05 is considered significant.

There was no statistical association of etiology with type of seizures (p-value = 0.210). There was no statistical association of etiology with day of onset of seizures (p-value = 0.122). There was no statistical association oftypes of neonatal seizures with gestational age (p-value = 0.409). There was no statistical association of types of neonatal seizures with day of onset of seizures (p-value = 0.416).

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