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Assessment of epidemiological profile of neonatal seizure cases admitted to a tertiary health center of Odisha, India: a cross-sectional study

Neonatal seizure is the frequent and distinctive manifestations of neurologic dysfunction in newborn period. Incidence of seizure in neonatal period is higher than any other period in life. According to NNPD 20022003 data from 18 tertiary care centre across India, incidence of neonatal seizure was 10.3 per 1000 live birth. The incidence of neonatal seizure in developed countries is 2.8 per 1000 in infants with birth weight of more than 2500 gm. It is higher in preterm low birth weight neonates – as high as 57.5 per 1000 in very low birth weight infants. Incidence increases with decreasing gestational age and birth weight.


INTRODUCTION
Neonatal seizure is the frequent and distinctive manifestations of neurologic dysfunction in newborn period. Incidence of seizure in neonatal period is higher than any other period in life. 1 According to NNPD 2002-2003 data from 18 tertiary care centre across India, incidence of neonatal seizure was 10.3 per 1000 live birth. 2 The incidence of neonatal seizure in developed countries is 2.8 per 1000 in infants with birth weight of more than 2500 gm. It is higher in preterm low birth weight neonatesas high as 57.5 per 1000 in very low birth weight infants. Incidence increases with decreasing gestational age and birth weight. 1 Reasons why neonatal seizure should be recognized and managed early are many folds. Seizures contribute to significant cause mortality and morbidity. They are detrimental to the developing brain. Presence or absence of seizure modify the treatment plan in a particular baby.
The objective of the present study was to assess the epidemiological profile of neonatal seizure

METHODS
A cross-sectional study was conducted from January2017 to June 2018 in the special newborn care unit of MKCG Medical College and Hospital, Berhampur. A total of 300 neonates admitted to special newborn care unit (SNCU) with clinically apparent seizure were the study population. They were selected by using convenient sampling method.
Methodology: Babies admitted for subtle seizure, tonic seizures, clonic seizures, myoclonic seizures who were clinically diagnosed, were taken as study group. Data was collected by using scientifically designed pretested proforma, from medical record as well as interview of parents. Written informed consent was taken from parents in a pre-structured proforma. Approval by institutional ethical committee was taken prior to the beginning of the study.

Inclusion criteria
• Sampling units was-term neonates admitted to SNCU with clinically apparent seizure.

Exclusion criteria
• Babies older than 28 days ,seizure due to hypoglycaemia or hypo-calcemia.

RESULTS
Neonatal seizure is one of the common causes of admission to SNCU. However, the etiology of neonatal seizure is quite different in term and preterm babies. Out of the total 300 study population, 198 (66%) were male babies . Maximum number of babies were between 0-7 days of life in which male and female were 61.34%&32% respectively. Among age group of 8 to14 days also prevalence of male gender was more. Only 2.34% children were in age group of 15 to 28 days . Overall prevalence of seizure decreases with age among the neonates (Table 1). Also, maximum number of babies belonged to primi gravida (77%).
Mothers below 30yrs of age(90.7%) predominated in this study followed by 30-40 years (8%). In all age group prime mothers were maximum. The cause may be more difficult delivery process and inexperienced mother which were the contributary factor of neonatal seizure (Table 2). More outborn prevalence might be due to mismanagement at periphery or home during conduction of delivery (Table 3).

DISCUSSION
Out of the total 300 babies, male constituted two third of the study population. As per national data, sex ratio in India is 940 females for every 1000 males. 3 More number of male babies in the study population might be due to prevalent sex ratio. early gestational age are the most common risk factor for seizure. Seizures are detrimental to immature and developing brain which may lead to significant cognitive impairment. Risk of future epilepsy is also higher in these babies. Control of maternal and neonatal factors associated with seizures and timely use of an effective drug with minimum side effects are the two important cost-effective measures to prevent immediate complication and future intellectual disability, motor delay & cognitive impairment.