J Pediatr Intensive Care
DOI: 10.1055/s-0042-1757479
Original Article

Metabolic Abnormalities in Association with Clinical Neonatal Seizures in an Indian Tertiary Care Centre

1   Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Sandeep PD
1   Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
› Author Affiliations

Abstract

Metabolic disturbances frequently occur in neonatal seizures either as an underlying cause or as an associated abnormality. A prompt recognition of metabolic abnormalities and early therapy are necessary to avoid poor neurological outcome. Neonates with clinical seizures were enrolled in the study. Diagnostic evaluation included complete blood count, sepsis screen, and estimation of blood glucose, serum sodium, calcium and magnesium before instituting any specific treatment. Metabolic abnormalities were considered as isolated when hypoxic ischemic encephalopathy (HIE), sepsis, intracranial hemorrhage, and polycythemia were ruled out. Among 80 newborns with clinical seizures, one metabolic abnormality was detected in 46 (57.5%) newborns. The commonest metabolic abnormality observed was hypoglycemia, noted in 22/80 (27.5%) newborns. Hypocalcemia was the second common abnormality, noted in 10/80 (12.5%) newborns. Isolated metabolic abnormalities were observed in 23.8% (19/80) of newborns with seizures. Associated morbidities with seizures included HIE in 21 (26.3%) and sepsis in 28 (35%). Hypoglycemia was the commonest isolated metabolic abnormality (12.5%). Metabolic abnormalities co-existed with HIE in nine out of 21 neonates and with sepsis in eight out of 28 neonates. Hypoglycemia was the common abnormality associated with both the conditions. Inborn errors of metabolism constituted 8.8% of the cohort studied (7 of 80 patients). A metabolic abnormality was detected in more than 50% neonates with clinical seizures enrolled in our study. Metabolic abnormality also co-exists in neonates with HIE as well as sepsis-related seizures.



Publication History

Received: 10 February 2022

Accepted: 26 July 2022

Article published online:
11 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Joseph JVolpe. Neonatal Seizures. Joseph J. Volpe, Terrie E. Inder, Basil T. Darras, Linda S. de Vries, Adré J. du Plessis, Jeffrey J. Neil, Jeffrey M. Perlman, eds. Volpe's Neurology of the Newborn. 6th ed. Elsevier; 2018: 275-321.e14
  • 2 Natarajan N, Gospe SM, Seizures N. eds. Christine A. Gleason, Sandra E. Juul, Avery's Diseases of the Newborn. 20th ed. Elsevier; 2018: 961-970.e4
  • 3 Tekgul H, Gauvreau K, Soul J. et al. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics 2006; 117 (04) 1270-1280
  • 4 Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med 2013; 18 (04) 185-191
  • 5 Mizrahi EM, Kellaway P. Diagnosis and Management of Neonatal Seizures. Philadelphia: Lippincott-Raven; 1998. :1–155
  • 6 Kumar A, Gupta A, Talukdar B. Clinico-etiological and EEG profile of neonatal seizures. Indian J Pediatr 2007; 74 (01) 33-37
  • 7 Bergin AM. Neonatal seizures. In: Cloherty JP, Eichenwald EC, Hansen AR, Stark AR. eds. Manual of Neonatal Care. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2012: 729-742
  • 8 Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population-based study. J Pediatr 1999; 134 (01) 71-75
  • 9 Levene M. The clinical conundrum of neonatal seizures. Arch Dis Child Fetal Neonatal Ed 2002; 86 (02) F75-F77
  • 10 Deshpande S, Ward Platt M. The investigation and management of neonatal hypoglycaemia. Semin Fetal Neonatal Med 2005; 10 (04) 351-361
  • 11 Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. BMJ 1988; 297 (6659): 1304-1308
  • 12 Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed 2000; 83 (02) F117-F119
  • 13 Sperling MA, Menon RK. Differential diagnosis and management of neonatal hypoglycemia. Pediatr Clin North Am 2004; 51 (03) 703-723 , x
  • 14 Evans D, Levene M. Neonatal seizures. Arch Dis Child Fetal Neonatal Ed 1998; 78 (01) F70-F75
  • 15 Shah GS, Singh MK, Budhathoki S. et al. Clinico-biochemical profile of neonatal seizures. J Nepal Paediatr Soc 2008; 28 (01) 7-9
  • 16 Basu P, Som S, Choudhuri N, Das H. Contribution of the blood glucose level in perinatal asphyxia. Eur J Pediatr 2009; 168 (07) 833-838
  • 17 Sood A, Grover N, Sharma R. Biochemical abnormalities in neonatal seizures. Indian J Pediatr 2003; 70 (03) 221-224
  • 18 Duvanel CB, Fawer CL, Cotting J, Hohlfeld P, Matthieu JM. Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants. J Pediatr 1999; 134 (04) 492-498
  • 19 Lynch BJ, Rust RS. Natural history and outcome of neonatal hypocalcemic and hypomagnesemic seizures. Pediatr Neurol 1994; 11 (01) 23-27
  • 20 Mwaniki M, Mathenge A, Gwer S. et al. Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization. BMC Med 2010; 8: 16
  • 21 Gebremariam A, Gutema Y, Leuel A, Fekadu H. Early-onset neonatal seizures: types, risk factors and short-term outcome. Ann Trop Paediatr 2006; 26 (02) 127-131
  • 22 Kumar A, Gupta V, Kachhawaha JS, Singla PN. Biochemical abnormalities in neonatal seizures. Indian Pediatr 1995; 32 (04) 424-428
  • 23 Masuduzzaman SM, Islam MN, Mollah MAH, Hoque MA, Hossain MA, Islam MS. Clinico-Biochemical abnormalities in hospitalized neonates with or without seizure. Med Today 2020; 32 (01) 37-41