Etiology and Outcome of Neonatal Seizures in a tertiary care nursery
Etiology and Outcome of Neonatal Seizures in a tertiary care nursery
Showing posts with label Etiology and Outcome of Neonatal Seizures in a tertiary care nursery. Show all posts
Showing posts with label Etiology and Outcome of Neonatal Seizures in a tertiary care nursery. Show all posts
Thursday, June 17, 2010
Introduction:
Seizure is described as a paroxysmal behavior caused by hyper synchronous discharge of a group of neurons1. Neonatal seizures refer to the paroxysmal activity occurring in first 28 days of life or up to 44 weeks conception age in an infant2. They are often the first sign of neurological dysfunction in neonates3.
Neonatal seizures occur in 80-120 cases per 100,000 neonates per year and the highest incidence is in first 10 days of life1. The underlying pathology is diverse and determines the immediate and long term outcome in terms of developmental impairment. It includes hypoxic ischemic encephalopathy, intracranial hemorrhage, infections and metabolic abnormalities. Determining the underlying etiology is critical and delay in treating the inciting pathology may adversely affect the final outcome. Western literature shows higher incidence of seizures related to hypoxic ischemic encephalopathy (65%) and intracranial hemorrhage (10%)3,4. Repeated neonatal seizures lead to further brain injury. The probable mechanisms include hypoventilation causing further hypoxic injury, hypercarbia increasing cerebral blood flow with risk of intracranial hemorrhage, increased glycolysis causing hypoglycemia and excitatory amino acids causing excitotoxic brain injury. The etiology of neonatal seizures varies with socioeconomic environment and health facilities available. Pakistani studies point towards CNS infections (40 - 45.2%) and birth asphyxia (40 – 56%) being more common5, 6. The duration of treatment and outcome also depends on the underlying cause7. Only limited studies are available regarding the outcome of the neonatal seizures according to the underlying pathology in developing countries like
In this study, I aim to determine the frequency of various etiological factors responsible for neonatal seizures at a tertiary care hospital in
Objective
1. To determine the frequency of various etiological factors causing neonatal seizures
2. To determine the outcome of neonatal seizures due to various etiological factors at 2 months and at 4 months.
Operational definitions:
Seizures
Any child less than 28 days presenting with a physical convulsion due to uncontrolled electrical activity in the brain.
Outcome;
Outcome in terms of no residual deficit, morbidity (residual focal neurological deficit including motor, hearing or visual impairment, developmental delay and uncontrolled seizures) and death.
Developmental milestones
These are tasks most children learn, or physical developments, that commonly appear in certain age ranges or major and minor social, emotional, physical, and cognitive skills acquired by children as they grow up
Material and methods:
Setting:
The study will be conducted at Neonatology unit of the Children’s Hospital and the
Duration of study
This study will be carried out over a period of 06 months after approval of synopsis
Sample size
The calculated sample size is 120 cases with 5% margin of error, 95% confidence level taking expected percentage of neonatal seizures 80 per 100,000. This sample size is calculated using web site www.openepi.com.
Sample technique
It will be purposive, non-probability sampling.
Sample Selection
Inclusion criteria
1) Age group up to 28 days.
2) Both male and female patients.
3) all preterm, term and post term patients
4) All patients with seizures for the first time.
Exclusion criteria
1. All patients with congenital anomalies
2. All patients who died before any etiology could be established either by history, examination or investigations
3. Patients who left against medical advice or lost to follow up
Study design:
It will be cross sectional descriptive observational study
All patients with seizures presenting to Neonatology unit of the Children’s Hospital and the Institute of Child Health, Lahore up to 28 days of life will be included in the study. Informed consent will be taken from parents of children and will be explained that the data will be used and published but confidentiality will be maintained.
Demographical data including age, gender, term will be recorded on a proforma. Detailed history regarding birth asphyxia, fever, fits and feeding will be taken and relevant examination will be carried out in all patients. Relevant investigations like cranial ultrasonography, cerebrospinal fluid examination, serum electrolytes including sodium, calcium, magnesium, random blood sugar, complete and differential blood counts, C-reactive proteins, blood culture, renal function tests will be carried out. CT scan or MRI brain will be conducted in patients with equivocal cranial ultrasound study. Electroencephalography will be recorded if no metabolic or structural lesion could be detected. All the results will be recorded on the proforma. All the patients will be followed up at 2 months and 4 months regarding their developmental assessment and outcome. Developmental assessment shall be made using ___________.
DATA ANALYSIS
The data will be entered on SPSS v. 12.0 and analyze through its statistical package. The variables to be analyzed will include age, gender, etiological factors and outcome. Quantitative variables like age will be presented by calculating mean and standard deviation. Qualitative variables like gender, etiological factors, and outcome will be presented by calculating frequencies and percentages. Comparison will be made between the etiological factors and outcome using Chi square test for test of significance. P value >
References:
1. Volpe JJ. Hypoxic-Ischemic Encephalopathy: Biochemical and Physiological Aspects. In: Neurology of the Newborn 5th ed. Mumbai: Elsevier Health Sciences; 2008. p211-59.
2. John PTC, Elia M, Engel J, Guerrini R, Mizrahi EL, Mosh´e SL et al. Proposal of an algorithm for diagnosis and treatment of neonatal seizures in developing countries. Epilepsia 2007; 48:1158–64.
3. Rone GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures. Neurology 2007;69:1816-22
4. Blume HK, Loch CM, Li CI. Neonatal encephalopathy and socioeconomic status - Population-based case-control study. Arch Pediatr Adolesc Med. 2007; 161:663-8
5. Parkash J, Das N. Pattern of admissions to neonatal unit. J Coll Physicians Surg Pak 2005;15:341-4.
6. Butt TK, Maqbool S, Ali L, Hamid H. Neonatal seizures - etiology, treatment and outcome. Pak Paed J 2005; 29:151-6.
7. Ronen GM, Buckley D, Penney S, Trenier DL. Long-term prognosis in children with neonatal seizures; a population-based study. Neurology 2007; 69:1816.
PROFORMA
NAME:___________________ FATHER’S NAME:___________________
AGE: PRETERM
>
>7M 11-20 DAYS
21-28 DAYS
GENDER:- MALE FEMALE
ADDRESS:_______________________________________________________
PHONE NUMBER: _________________________________
DATE OF ADMISSION: _____________________________
DATE OF DISCHARGE: _____________________________
PRESENTING COMPLAINTS:____________________________________________
Etiology :
EARLY ONSET SEIZURES (O-3RD DAY OF LIFE)
LATE ONSET SEIZURES (4TH-28TH DAY OF LIFE)
Perinatal Asphyxia Intracranial Hemorrhage
Metabolic Abnormalities
Hypoglycemia Hyponatremia Hypernatremia
Hypocalcemia Hypomagnesemia
Infections
Meningitis Sepsis TORCH
Kernicterus Tetnus neonatorum Familial neonatal seizures
Investigations
CBC: Hb WBC Platelets CRP
S/E: Na Ca+ Mg+ BSR
RFT’s: BUN S/Cr
Blood Culture: Lumbar Puncture:
Crainal Ultrasound:
CT Scan Brain:
EEG:
Outcome
Death Mental retardation Hearing
Vision Recurrence of seizures
Follow Up
At 2 Months
Hold head erect and lift head Turns from side to back Drop toys
Regards faces and follow objects Become alert in response to voice
Activites Related To Parents
Recognize parents Give response to mother’s voice
Engages in vocalization Social smile
At 4 months
Grasp cubes Reaches for and bring object to mouth
Make sounds Sits with support
Activites Related To Parents
Laughs Anticipate food on sight Turns from back to side
Medicine List
Acebutolol, Atenolol, Atenolol/chlorthalidone, Betapace, Betaxolol, Bisoprolol, Bisoprolol/fumarate, Bisoprolol/hydrochlorothiazide, Blocadren, Brevibloc, Bystolic,
Carteolol, Cartrol, Carvedilol, Coreg, Corgard, Esmolol, Inderal, Inderal LA, Inderide,
Inderide LA, InnoPran XL, Kerlone, Labetalol, Levatol, Lopressor, Lopressor HCT, Lopressor/hydrochlorothiazide, Metoprolol, Metoprolol/hydrochlorothiazide, Metoprolol Tartrate/hydrochlorothiazide, Nadolol, Nadolol/bendroflumethiazide,
Nebivolol, Nebivolol HCL, Nebivolol Hydrochloride, Normodyne, Penbutolol, Pindolol, Propranolol, Propranolol HCL, Propranolol Hydrochloride, Propranolol/hydrochlorothiazide, Sectral, Sorine, Sotalol, Sotalol HCL, Tenoretic, Tenormin, Tenormin I.V., Timolide, Timolol, Timolol Maleate/hydrochlorothiazide,
Timolol/hydrochlorothiazide, Toprol, Toprol-XL, Trandate, Trandate HCL, Visken, Zebeta, Ziac
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