Clinico-aetiological profile and outcome patterns of neonatal seizures at a tertiary care centre

Background: Neonatal seizures are a major risk factor for neonatal mortality and subsequent neurological disability. The incidence of seizure varies from 1.5-3.7/1000 live birth; while in NICU it can be up to 5/1000 live birth.Methods: This Descriptive type of observational study aimed to study clinical profile, aetiology in neonatal seizures and short term outcome was done in all Neonatal units attached to paediatric Department of SMS Medical College, Jaipur.Results: In the 100 cases Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Most common type of neonatal seizure was subtle(75%), other types were tonic seizure (17.3%), clonic seizure (5.1%) and least common type was myoclonic (2.5%). Most common cause of neonates seizure noted was birth asphyxia (73%) second common cause is pyomeningitis and third common cause is hypoglycaemia. Most common cause of neonatal seizure both in full term (71.17%) and preterm (25%) is birth asphyxia. Second most common cause of neonatal seizure in full term is pyomeningitis (8.70%) and in preterm is pyomeningitis and hypoglycaemia (25%). Most common cause of neonatal seizure both in onset of seizure <3 days (<72 hours) 53% and in onset of seizure >3 days (>72 hours).Conclusions: Out of total 100 cases, neonates with normal birth weight 92% and low birth weight 8%. Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Majority of neonates with seizure delivered by vaginal route (86%) and remaining 14% neonates were delivered by LSCS.

Standard curves for mid arm circumference and mid-arm/head circumference ratio in newborns.

One Thousand singleton neonates, between 28 and 44 weeks of estimated gestational age (EGA) were measured within 48 hours of their birth for upper mid-arm circumference (MAC), head circumference (HC) and birth weight (BW). Regression analysis was used to draw standard curves for MAC versus EGA and mid-arm circumference/head circumference ratio (MAC/HC) versus EGA. Correlation coefficients were 0.961 for MAC versus EGA and 0.889 for MAC/HC versus EGA (p less than 0.001). MAC, MAC/HC and HC were also highly correlated with birth weight (p less than 0.001). These standard curves make available a discriminating method for evaluation of intra-uterine growth and a non-invasive technique for following somatic protein status in growing preterm infants.

Ratio of mid arm circumference to head circumference as a predictor of small for gestational age babies.

Birth weight (BW), mid-arm circumference (MAC), head circumference (HC) and MAC/HC ratio were evaluated in 845 term babies within 48 h of birth. MAC/HC ratio of less than 0.28 had a statistically significant sensitivity, specificity and predictive value (p less than 0.001) for identifying term small for gestational age babies. This ratio provides a simple, accurate and cheap way of screening SGA babies. This method may be employed for identification of SGA babies even by paramedical workers at community level. As with any other field index appropriate supervision and standardisation are essential for its usefulness.

Thigh circumference at birth as the best predictor of low birth weight babies.

The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight babies (LBW). A total of 1000 newborn babies were subjected to anthropometry within 48 hours of life. Birth weight was significantly correlated (p less than 0.001) with thigh circumference (TC), mid-arm circumference (MAC), chest circumference (CC), length (L) and head circumference (HC). However, the correlation was maximum for TC (r = 0.9201). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p less than 0.001) for identifying less than or equal to 2500 g birth weight babies. However, thigh circumference of less than or equal to 14.5 cm and less than or equal to 13.5 cm had the best sensitivity, specificity and predictive value for identifying babies with birth weight of less than or equal to 2500 g and less than or equal to 2000 g, respectively. TC at birth is a cheap, simple, quick and reliable indicator for predicting LBW babies. It may be used whenever weighing at birth is not feasible.

Serum phenytoin levels with different brands.

Four brands of phenytoin were studied in 60 newly diagnosed epileptic patients randomly and equally placed in 4 groups. Serum phenytoin levels were estimated by EMIT and spectrophotometric methods both of which gave close values with good correlation (r = 0.985). Average serum levels and the incidence of remission achieved with the 4 brands varied within statistical scatter; thus these 4 brands manifested equivalent therapeutic efficacy. In 22 patients serum level was less than 5 micrograms/ml, in 9 of whom attacks remained uncontrolled. In 38 patients serum level exceeded 5 micrograms/ml in 2 of whom attacks were uncontrolled. In 44 out of 60 patients the 2 weeks serum levels were significantly higher (P less than 0.001 by paired t-test) than those after 3 months. In the remaining 16 patients the serum levels at 3 months were significantly higher than at 2 weeks levels (P less than 0.01).