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

Figures & data

Table 1 Socio-Demographic Characteristics of Neonates with Seizure and Their Parents in ACSH, 2018/2019

Variable	Frequency	Percentage
Age of Neonate at admission
<24 hours	70	45.2
25–72 hours	49	31.6
72 hours and above	36	23.2
Gestational age at delivery
Term	125	80.6
Pre-term	28	18.1
Post-term	2	1.3
Birth weight
Normal birth weight	105	67.7
Low birth weight	20	12.9
Macrosomia	4	2.6
Unknown birth	26	16.8
Maternal educational status
Primary	59	38.1
Secondary	29	18.7
Higher Education	19	12.3
Illiterate/None	48	31
Family’s residence
Mekelle City	45	29
Tigrian towns out of Mekelle	58	37.4
Rural areas of Tigray	41	26.5
Out of Tigray	11	7.1
Weight for gestational age
AGA	139	89.7
SGA	10	6.4
LGA	6	3.9
Sex of neonate
Male	84	54.2
Female	71	45.8

Table 2 Perinatal Characteristics of Neonates with Seizure and Their Mothers in ACSH, 2018/2019

Perinatal Characteristics	Findings/Measurements in this Study
APGAR Score:	Low = 54(34.9%)	Normal 66(42.6%)	UK 35(22.6%)
Delayed cry after delivery:	Yes = 66(42.6%)	No = 89(57.4%.)	–
Presence of prolonged labor:	Yes = 55(35.5%)	No = 100(63.5%)
Yellowish discolorations of the body in the neonate:	Yes = 36(23.2%)	No = 119(76.8%)	–
Birth trauma involving the Scalp/Brain:	Yes = 18(11.6%)	No = 137(88.4%)	–
Instrumental delivery:	Yes = 20(12.9%)	No = 135(87.1%)	–
Maternal fever during pregnancy	Yes = 19(12.2%)	No = 136(87.8)
Maternal hypertension during pregnancy:	Yes = 21(13.5%)	No = 134(86.5%)	–
Maternal offensive vaginal discharge:	Yes = 16(10.3%)	No = 139(89.7%)	–

Table 3 Clinical and Laboratory Characteristics Findings of Neonates with Seizure

Laboratory and Clinical Findings/Measurements in Neonates with Seizure
Variables			Results/Findings
Brain imaging (US/MRI/CT scan)	Normal = 97(62.6%)	ICH = 19(12.3%)	Hydrocephalus/ Effusions = 15(9.7%)	Congenital malformations = 3(1.9%)	Not done =21 (13.5%)
Random blood sugar	Normal = 132 (85.2%	Hypoglycemia = 13 (8.4%)	Hyperglycemia = 3 (1.9%)	Not done = 7 (4.5%)	–
CBC	Normal = 92 (59.4%)	Shows sepsis = 53 (34.2%)	Shows anemia = 10 (6.5%)	Not done = 0	–
Serum electrolytes	Normal = 118 (76.1%)	Abnormally low = 6 (3.9%)	Abnormally high = 7 (4.5%)	Not done =24 (15.5%)	–
Total bilirubin	Normal = 24 (15.5%)	Abnormally high =21 (13.5%)	Not done = 110 (71%)	–	–
CSF analysis	Normal = 102 (65.8%)	Shows meningitis = 22 (14.2%)	Was traumatic = 10 (6.5%)	Not done = 21 (13.5%)
APGAR Score	Normal (>7) = 66 (42.6%)	Moderate Asphyxia (3–6) =37 (23.9%	Severe Asphyxia (<3) = 17 (11%)	Unknown = 35 (22.6%)	–
General Appearance	Well looking = 15 (9.7%)	Acutely sick looking = 140 (90.3%)	–	–	–
Weight for Gestational age	AGA = 139 (89.7%)	SGA = 10 (6.5%)	LGA = 6 (3.9%)	–	–
HC for Age	Normal = 126 (81.3%)	Macrocephaly = 27 (17.4)	Microcephaly = 2 (1.3%)	–	–
Respiratory condition	Normal = 24 (15.5%)	In distress = 100 (64.5%)	Apnea = 31 (20%)	–	–
Skin condition	Normal = 100(64.5%	Jaundice = 33 (21.3%)	Pallor = 18 (11.6%)	Rashes = 4 (2.6%)	–
Mental status	Alert = 9 (5.8%)	Lethargic = 110 (71%)	Comatose = 36 (23.2%)	–	–
Moro reflex	Complete= 6 (3.9%)	Incomplete = 113 (72.9%)	Absent = 36 (23.2%)	–	–
Suckling reflex	Sustained =19 (12.3%	Unsustained = 101 (65.2%)	Absent = 35 (22.5%)	–	–
Grasp reflex	Strong = 8 (5.2%)	Weak = 113 (72.9%)	Absent = 34 (21.9%)	–	–
Tone	Normal = 42 (27.1%)	Hypotonic = 87 (56.1%)	Hypertonic = 26 (16.8%)	–	–

Table 4 Shows Patterns, Episodes of Attacks, Time Onset, Treatment and Outcome Related Findings of Neonatal Seizure in ACSH, 2018/2019

What were the Characteristics/Descriptions of the Seizure?	Frequency	Percent
Subtle	70	45.1
Tonic	49	31.6
Clonic	26	16.8
Myoclonic	10	6.5
Episodes of seizure attacks
A single episode of attacks	39	25.2
Multiple episodes of attacks	116	74.8
Time onset of a seizure
<72 hours	108	69.7
>72 hours	47	30.3
Was anticonvulsant therapy started?
Yes	155	100
No	0	0
What was the medication used
Phenobarbitone	106	68.4
Phenytoin	38	24.5
Diazepam	9	5.8
Pyridoxine	2	1.3
How many drugs were used to treat the seizure?
One	86	55.5
Two	54	34.8
Three	13	8.4
Above three	2	1.3
How was the seizure control after treatment initiations?
Well-controlled	113	73
Poorly controlled	42	27
What was the total duration of the hospital stay?
<7 days	25	16.2
7 to 14 days	78	50.3
14 to 21 days	33	21.3
>21 days	19	12.2
Treatment for nosocomial infections during hospital stay?
Yes	92	59.3
No	63	40.7

Figure 1 Clinical outcome of neonates with a seizure at the end of hospitalization in ACSH, 2018/2019.

Table 5 Shows Predictors of Poor Neonatal Outcome Among Neonates with Seizure n = 155

Predictors	COR (95% CI)	P value	AOR (95% CI)	P value
Age at the onset of a seizure
<72 hours	2.8 (1.4, 5.8)	0.01	3.7 (1.6, 8.5)	0.007
>72 hours	1		1
Gender
Male	1.4 (0.7, 2.8)	0.190	1.1 (0.5, 2.4)	0.530
Female	1		1
Low APGAR Score
Yes	2 (1.0, 4.5)	0.210	2.2 (0.85, 5.7)	0.236
No	1		1
Instrumental delivery
Yes	1.7 (0.8, 3.7)	0.206	1.8 (0.7, 4.4)	0.197
No	1		1
Maternal offensive vaginal discharge
Yes	2.4 (1.1, 4.88)	0.016	1.4(0.78, 3.2)	0.350
No	1		1
Presence of prolonged labor
Yes	3.8 (2.0, 7.6)	0.004	4.3(2.2, 8.8)	0.003
No	1		1
Presence of maternal Hypertension
Yes	1.6 (0.8, 3.0)	0.188	1.3 (0.6, 2.7)	0.483
No	1		1
Birth trauma to SCALP/BRAIN
Yes	1.9 (0.9, 4.3)	0.194	2.1 (0.72, 5.9)	0.252
No	1		1
Delayed cry after delivery
Yes	2.3 (1.4, 6.2)	0.017	2.4 (0.74, 3.6)	0.322
No	1		1
Status of seizure control
Poorly controlled	4.1 (2.1, 7.6)	0.001	4.8 (2.6, 9.2)	0.001
Well-controlled	1		1
Place of delivery
Health institution	1.5 (0.73, 3.24)	0.186	1.2 (0.6, 2.6)	0.560
Home	1		1
Maternal medication intake
Yes	2.1 (1.3, 6.0)	0.019	2.6 (0.82, 3.90)	0.386
No	1		1
Maternal education status
Literate	1.8 (0.8, 4.2)	0.190	1.9 (0.7, 5.3)	0.212
Illiterate	1		1
Number of seizure attacks
Single episode	2.2 (1.4, 6.3)	0.082	2.7 (0.73, 3.34)	0.412
Multiple episodes of attacks	1		1
Type of drug used for treatment
Phenobarbitone	1.3 (0.69, 3.11)	0.198	1.1 (0.58, 2.56)	0.658
Phenytoin

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.