STUDY OF THE CLINICO-ETIOLOGICAL PROFILE AND IMMEDIATE OUTCOME OF NEONATAL SEIZURES

Background: Neonatal seizures are a common neurological emergency and are often associated with significant morbidity and mortality. The present study aimed to determine the distribution of clinical seizure types, the spectrum of causative etiologies, and the relationship between etiology and the timing of seizure onset in term neonates.

Methods: This prospective observational study was conducted in the NICU of a tertiary care hospital over 24 months (June 2023–June 2025). A total of 238 term neonates presenting with seizures within the first 28 days of life were enrolled after informed consent. Detailed clinical evaluation was done and immediate outcomes were assessed in terms of survival, treatment response, and duration of hospital stay.

Results: Most seizures occurred within 24–72 hours of life (50%), followed by >72 hours (25.63%) and <24 hours (24.36%). Subtle seizures were the most common type (56.72%). Metabolic disturbances were the leading etiology (40.75%), followed by sepsis/meningitis (33.19%) and hypoxic-ischemic encephalopathy (24.36%). Hypoglycemia (31.9%) and hypocalcemia (29.9%) were the most frequent biochemical abnormalities. HIE predominated in early-onset seizures (<24 hours), while metabolic and infectious causes were more common after 24 hours. Abnormal neurosonogram findings were observed in 21.85% of neonates, most commonly diffuse parenchymal echoes. Escherichia coli was the most frequently isolated organism in culture-positive cases (36.7%). Phenobarbitone monotherapy was effective in 71% of neonates. Overall survival was 90.75%, with a mortality rate of 9.24%.

Conclusion: Metabolic abnormalities and infections were the predominant causes of neonatal seizures. Early recognition, timely correction of biochemical derangements, and etiology-specific management are crucial to improving outcomes and reducing mortality