Characterization of neonatal seizures in a large well-defined multicenter cohort of a tertiary neonatology center in Germany

Introduction: Prevalence of seizures is 1–5/1000 neonates. The most common causes of neonatal seizures are hypoxic-ischemic encephalopathy (HIE), vascular events (haemorrhages, stroke) and infections. We assessed prevalence and etiology of seizures defined according to the recent Brighton and International League of Epilepsy (ILAE) criteria in a neonatology monocenter cohort. Methods: In a retrospective cross-sectional cohort study of all 12154 neonates born in our three maternities from 01/01/ 2022 to 31/12/2023 seizures were categorized by frequency, etiology, risk profile, semiology and EEG. 19 neonates (male: n=11 [57.9%]; full-term: n=11 [57.9%], preterm VLBW (very low birth weight): n=6 [31.6%] [10.5%], preterm >1500g birth weight: n=2) were identified. Results: In 19/12154 neonates seizures were confirmed by application of the ILAE criteria. 174 were preterm VLBW with birth weight <1500g. Seizure incidence was 1.6/1000 in all neonates and 3.4% in VLBW infants. Hypoxic Ischemic Encephalopathy (HIE) was the most frequent etiology in term infants (30.8%), followed by vascular events in preterm >1500g and term infants (30.8%). Vascular events were the most common cause in preterm VLBW infants (83.3%). Whole Exome Sequencing (WES) was performed in 4 cases (21.1% of neonates with seizures). Discussion: Incidence of neonatal seizures in our center is in the lower range and leading seizure etiologies are comparable to literature. Early recognition of neonatal seizures including the detection of electrographic only seizures and early WES to identify rare genetic defects possibly offering tailored treatment options have the potential to further rise the standard of neonatal care and improve neurodevelopmental outcome.

Publication History

Received: 31 January 2025

Accepted after revision: 16 September 2025

Accepted Manuscript online:
26 September 2025