Aims The incidence of seizures is higher in the neonatal period than any other time of life. Despite this, clinical detection is poor with limited evidence for anticonvulsant use. Furthermore, neonatal seizures may have an adverse effect on neurodevelopmental progression. We aimed to review the investigation and management of babies aged less than 28 days of life presenting with seizures. We also aimed to evaluate neurodevelopmental outcomes.
Methods The study period was January 2013 to June 2015 (30 months). Babies of any gestation, aged less than 28 days of life and presenting with seizures were included. Electronic databases, records and paper case notes were reviewed independently by 2 authors. Demographic data, seizure details, investigations and management were noted. Survival and neurodevelopmental outcomes were also recorded. Key features of neurodevelopment that were assessed were: diagnosis of cerebral palsy (CP), indication of abnormalities of tone or movement without a diagnosis of CP, developmental delay, epilepsy, neurosensory impairment and not orally feeding.
Results Fifty-three babies with neonatal seizures between January 2013–June 2015 were included, with a median gestational age of 39 weeks. 30% were born preterm. There were many different diagnoses, with 53% having a diagnosis of hypoxic ischaemic encephalopathy (HIE) and 9% with an intracranial bleed. The most common anticonvulsant used was phenobarbitone (85%). Investigations varied considerably and reversible causes were often not excluded. 75% of babies with seizures survived. Neuro-developmental outcome in survivors was considered abnormal in 54%. 23% had cerebral palsy and 37% had developmental delay. In a subgroup analysis of those who had a diagnosis other than HIE/prematurity survival was greater (93%). Neurodevelopmental outcomes however were similar, with abnormal development in 40%. There was less cerebral palsy, more non-specific abnormalities of tone or posture, and similar rates of developmental delay.
Conclusions This work highlights the need for clear guidelines on the management of neonatal seizures. Babies with early onset seizures are an important group who have varied, but often poor neurodevelopmental outcomes. The non-HIE babies are a vulnerable group who may not be included in conventional follow up programmes, but whom may need close follow up and early intervention.
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