Neonatal Seizure Pattern, Outcome, and its Predictors Among Neonates Admitted to NICU of Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia

Abstract

Background

Seizure is the most frequently observed symptom of neurological disorders and an important determinant of outcome during neonatal period. In clinical practice, it is prevalent and observed in neonates admitted to hospital in low-resources countries, but due to the paucity of studies in these regions, little is known about its pattern, clinical outcomes of hospitalization, and its predictors. Therefore, aims to evaluate seizure patterns, clinical outcomes, and its predictors among neonates admitted to the NICU of ACSH, Mekelle, and Tigray.

Methods

A hospital-based cross-sectional study design was conducted among neonates with neonatal seizures admitted to NICU of Ayder Comprehensive Specialized Hospital. Data collection was done from record reviews. SPSS Version 25 was used. Descriptive statistics and bivariate logistic regressions where a p-value of <0.05 is considered statistically significant.

Results

Out of 1622 NICU admissions, 155 (9.6%) were cases of neonatal seizure. The most frequently observed types of seizure in this study were subtle 70 (45.1%) and tonic 49 (31.6%) respectively. At the end of hospitalization 70.3% of neonates were discharged improved, 21.3% of neonates died and 8.4% of neonates had severe neurologic deficits. Poorly controlled seizures (AOR 4.8, 95% CI 2.6–9.2), prolonged duration of labor (AOR 4.3, 95% CI 2.2–8.8) and seizure onset <72 hours (AOR 3.7, 95% CI 1.6–8.5), respectively, were found to be independent predictors of poor neonatal outcome.

Conclusion

Of all neonatal admissions, neonatal seizure was observed in close to 9.6%. The most frequently observed type of seizure was subtle. Of those admitted neonates, 30% had poor outcomes following the end of their hospitalization or when they leave against medical advice for lack of improvement). Poorly controlled seizures, prolonged duration of labor, and seizure onset <72 hours were independent predictors of poor neonatal outcomes.

Keywords:

• neonatal seizure
• pattern
• outcome
• predictors

Abbreviations

ACSH, Ayder Comprehensive Specialized Hospital; NICU, Neonatal Intensive Care Unit; EEG, Electro Encephalo Gram; APGAR, Appearance, Pulse Grimace Activity Respiratory rate; CBC, Complete Blood Count; CSF, Cerebro Spinal Fluid; US, Ultra Sound; MRI, Magnetic Resonance Imaging; CT, Computed Tomography; KMC, kangaroo mother care; ICH, Intra Cranial Hemorrhage; SGA, small for gestational age; LGA, large for gestational age; AGA, appropriate for gestational age; HC, Head Circumference.

Data Sharing Statement

The data set can be made available based on the request to the corresponding author and Confidentiality of the data maintained safely.

Ethical Considerations

Ethical clearance was obtained from the Health Research Ethics Review Committee (HRERC) and Ethical Review Board of the College of Health Sciences of Mekelle University with MU-IRB reference number of 1640/2020. Permission from the dataset owner (Ayder Comprehensive Specialized Hospital clinical director’s offices) and a support letter from the chief clinical director were obtained before the commencement of the study. This study was conducted in line with “the Decleration of Helsinki”. Data were taken from patient records. Therefore, confidentiality of the data was kept safely and the data were only used for our current study. Patient consent was not needed for this retrospective chart review study as Mekelle University, College of Health Sciences: Ayder Comprehensive Specialized Hospital retains (right to own) the medical chart of the patients.

Acknowledgments

The authors are grateful to the authors, editors, and publishers of the articles that are cited and included in the references for this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.