Neonatal seizures: A cohort evaluation at a pediatric referral center

Neonatal seizures have an incidence of 1-5/1000 newborns. Their clinical, etiology, and therapeutic characterization is a clinical challenge. The objective of this study was to characterize neonatal seizures recorded over 6 years, considering the clinical presentation, management, and follow-up. A retrospective analysis of clinical, neurophysiological (video-electroencephalogram), and imaging data of all newborns who had suspected neonatal seizures with electroencephalographic findings (paroxysmal activity, electrographic-only seizures, and/or electroclinical seizures) was performed. The study considered all cases that occurred between January 2010 and December 2015, with the respective follow-up equal to or longer than 7 years. Seizures were diagnosed in 85 newborns, 87.1% within the first 48 h of life. In 72.9% of suspected cases, only paroxysmal activity in the v-EEG was recorded, in another 16.5% electrical-only seizures were found, and in 10.6% there were electroclinical seizures. Epilepsy was diagnosed in 23.5% of cases, with 14% currently maintaining therapy. Motor sequelae occurred in 44.3% of children and 41.4% had normal neurological examination. There were also 11.4% of deaths in the neonatal period. Neonatal seizures occur mostly in the first 48 h of life and mainly due to hypoxic-ischemic injuries. During follow-up, we recorded epilepsy in ¼ of patients.