Tayyaba Khawar Butt, Shazia Maqbool, Liaqat Ali, Haroon Hamid.
Neonatal seizures - etiology, treatment and ouctome.
Pak Paed J Jan ;29(3):151-6.

Objective: To determine the underlying etiology, response to treatment and immediate outcome of neonatal seizures. Design: Observational study with prospective collection of data. Place and duration: The study was carried out in the Neonatology Unit at The Children`s Hospital and the Institute of Child Health, Lahore. Subjects and Methods: All babies presenting with the complaint of fits from 01/10/03 to 31/03/04 were entered on a database prospectively and the results analyzed. Babies with kernicterus and tetanus were excluded from the study. Results: A total of 125 cases were analyzed for underlying cause, response to treatment and outcome. Birth asphyxia was identified as the underlying cause in 71 (56.8%) cases. This was the largest underlying causal factor. Out of these 12 babies (9.6%) had stage 3 hypoxic ischaemic encephalopathy. Meningitis was the diagnosis in 29 (23.2%) cases while in 10(8%) case no cause could be clearly determined. Four cases (3.2%) showed evidence of intracranial bleed. Five babies (4%) had an underlying metabolic cause. Three (2.4%) babies were diagnosed as having benign sleep myoclonus, while there was 1 (0.8%) case each of hydrocephalus, holoprosencephaly and cerebral edema. One hundred (80%) cases requiring long term anticonvulsants responded to phenobarbitone as monotherapy. Eight (6.4%) cases required a combination of two anticonvulsants while 2 (1.6%) babies required more than two anticonvulsants. Fifteen cases (12%) needed no long term anticonvulsants. One hundred and three cases (82.4%) survived and were discharged. Seventeen (13.6%) died while in five cases (4%) the parents chose to leave against medical advice. Conclusion: Hypoxic insult at birth is the commonest cause of babies presenting with seizures. Majority respond clinically to phenobarbitone monotherapy. The overall mortality in this group was 13.6%

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