Management of neonatal seizures developed after the first 24 hours of life: a clinical audit from a tertiary children’s hospital, Sri Lanka

Neonatal seizures represent the most frequent emergency encountered during the neonatal period. Improved diagnosis of both clinical and subclinical seizures, evaluation of specific aetiologies and optimized treatment help reduce mortality and morbidity associated with neonatal seizures.
Methods:  A longitudinal, descriptive study was performed at the Lady Ridgeway Hospital for Children over a 12-month period. Neonates admitted or transferred due to neonatal seizures that occurred after the first 24 hours of life were included. Details pertaining to clinical presentation, evaluation of aetiology and the management of seizures were extracted from a parental interview and review of medical records.
Results: There were 31 neonates admitted with seizures during the study period. The majority were born at term. The number of seizures experienced was few (<5) in 48%. A definite aetiology was identified only in one third (n=9). The majority were considered as being related to a central nervous system infection, though none were microbiologically confirmed.

Electroencephalographic confirmation of seizures was not performed. Advanced neuroimaging was not offered to the majority. Detailed evaluation for metabolic diseases or for genetic epilepsies was not feasible.
The recommended first-line medication was prescribed to 93% of neonates. However, irregularities pertaining to the appropriate dose and route were noted in 22%. Thera-peutic drug monitoring was unavailable in this hospital.
Conclusion: This study depicts the current practice regarding diagnosis, evaluation of aetiology and treatment of neonatal seizures in a low resource setting. The knowledge on the deficiencies is envisaged to divert focus onto areas needing improvement of care.