Neonatal seizures in Nigerian infants

Abstract

Nigerian newborns presenting with convulsion in University of Calabar Teaching Hospital, Calabar during the period January 1989 to December 1990 were prospectively studied to determine the aetiology and pattern of their seizures. There were 60 patients representing 4% of admissions into the Newborn Unit during the period. Birth asphyxia, infections and hypoglycaemia were the important identifiable aetiological factors which operated either singly (48% of cases) or in concert (in another 48%) of the infants. Detectable infections included meningitis and septicaemia caused predominantly by coliforms and Staphylococcus aureus. Hypocalcaemia and electrolyte imbalance did not feature. There was an unusually high prevalence (63% of cases) of the generalised type of seizures probably due to the high frequency of mixed aetiology. The mortality rate of 50% encountered appears to be related to the underlying aetiology and prematurity. Detectable caused of neonatal seizures in our environment appear to be potentially preventable by improved obstetric and neonatal care. There is dire need also to provide modern facilities for investigating newborn seizures in order to improve upon the diagnostic yield.

PIP: During 1989-1990 in Nigeria, 60 newborns were admitted to the Special Care Baby Unit of the University of Calabar Teaching Hospital for seizures, representing 4.1% of admissions. 11.7% of the newborns with seizures were preterm. 48.3% had more than 1 detectable cause of the seizures. The leading cause of seizures was asphyxia (36 newborns) followed by infections (16), especially meningitis (8). Coliforms and Staphylococcus aureus were the primary etiologic agents for the infections. Among the 36 newborns with asphyxia, 13 also suffered from hypoglycemia, 13 also suffered from infection, and 5 also suffered from infection and hypoglycemia. 63% of the newborns had generalized seizures, which may be associated with the mixed etiology in 48% of the cases. 50% of the 60 newborns presenting with seizures died. Newborns whose seizures were associated with infection had the highest fatality rate (50%). The mortality rate was lowest in infants whose seizures occurred during the first day of life (36.7% vs. 86% 4-7 days after birth). The causes of neonatal seizures in these newborns can be prevented by improving obstetric and neonatal care. Pediatricians need access to modern diagnostic and therapeutic facilities to improve the accuracy of diagnoses in cases of newborn seizures. Health workers need to increase health education activities geared to prenatal patients.