Clinco-etiological Profile and Predictors of Outcome of Neonatal Seizures: A Prospective Observational Study from Egypt

Neonatal seizures are the most prevalent neurological disorders. In Egypt,  the characteristics and neurodevelopmental outcomes of neonatal seizures have not been sufficiently explored.
The present study was conducted on 120 full-term and preterm newborns from  October 2016 and October 2020.  The adverse outcomes of cerebral palsy, mortality, developmental delay, and/or epilepsy have been considered. The associations between adverse outcomes and 13 variables were analyzed.
Hypoxic-ischemic encephalopathy (HIE) (34.2%) was the most common etiology for neonatal seizures, followed by intracranial hemorrhage (25.8%). The predominant seizure type was subtle (57.5%), preceded by clonic seizure (16.7%). Moreover,  72 neonates had a normal outcome, 14 (60%) cases had minor functional disabilities, and 27 (22.5%) newborns survived with one or more neurodevelopmental abnormalities (6 cases had cerebral palsy, and 21 newborns had global developmental delay), with a 17.5 % mortality rate. Based on the univariate analysis, 10 variables were associated with an unfavorable outcome; nonetheless, only three variables, namely metabolic acidosis, abnormal cranial ultrasonography findings, and the presence of congenital heart disease, were independent predictors as illustrated by multivariate logistics.
As evidenced by the obtained results, HIE and intracranial hemorrhage were the most common causes of neonatal seizures. Perinatal insult, prematurity, seizure onset <24 hours, low Apgar score at 1 min, myoclonic or mixed seizure, the efficacy of the anticonvulsant therapy, abnormal cranial U/S, metabolic acidosis, abnormal electroencephalography (EEG)  pattern, and the presence of congenital heart disease were the most reliable predictors of adverse outcome.