Risk factors for mortality in neonatal seizure in a Nigerian newborn unit

Objective . To determine the risk factors for mortality in neonatal seizures. Methods and design. A prospective study of consecutive newborn babies with seizures admitted to a Nigerian hospital between January and December 2006. Multiple regression analysis was used to determine the risk factors for mortality among consecutive neonates admitted with seizures. Results . Seventy-eight babies were studied. Thirty-six of these (46.1%) had seizures within the first 24 hours of life. The mean age at onset of seizure was 85.4 ± 106.1 hours. The leading aetiologies included hypocalcaemia (65.4%), hypoxic-ischaemic encephalopathy (HIE) (60.3%) and hypoglycaemia (50.0%). Severe anaemia occurred in 56.4% of babies. Most (85.9%) had multiple aetiologies while no aetiology was identified in 5.1%.The mortality rate was 43.6%. Significant risk factors for mortality included duration of seizure longer than 24 hours (p = 0.019), hypoglycaemia (p = 0.001) and severe anaemia (p = 0.004). The co-existence of HIE with hypoglycaemia and hypocalcaemia was also more significantly associated with mortality (p = 0.03) than each of hypoglycaemia and hypocalcaemia co-existing with HIE separately. Conclusion . The prevention of fatal neonatal seizures should start with good intrapartum care, prompt detection and correction of hypoglycaemia and anaemia and early control of seizures.