Term early-onset neonatal seizures: Obstetric characteristics, etiologic classifications, and perinatal care

doi:10.1016/0029-7844(94)00375-N

Obstetrics & Gynecology

Volume 85, Issue 2, February 1995, Pages 163-169

https://doi.org/10.1016/0029-7844(94)00375-N Get rights and content

Objective

To describe obstetric characteristics and etiologic classifications and assess perinatal care in term neonates with early-onset seizures.

Methods

We performed a retrospective review of neonatal and obstetric records of neonates delivered at term with a diagnosis of early-onset seizures between January 1981 and December 1992 at Long Beach Memorial Medical Center. Data regarding obstetric characteristics and etiologic classifications of the seizures were abstracted from the medical records. Lack of antepartum testing in high-risk patients, delayed intervention with nonreassuring antepartum or intrapartum fetal heart rate patterns, birth trauma, and failure to use prophylactic antibiotics or treat infection were the criteria used for identifying seizures that were potentially preventable.

Results

Forty term neonates had early-onset seizures out of 60,712 live births (0.07%). These seizures were attributed to hypoxic events in 15 neonates (37.5%), cerebral malformations in seven (17.5%), cerebral infarcts in seven (17.5%), intracranial hemorrhage in five (12.5%), infection in three, and an unknown etiology in three. Twenty-three neonates had 5-minute Apgar scores of 7 or greater (cerebral malformations excluded). Seven of these neonates (30%) had cerebral infarcts. A review of all records identified nine cases (22.5%) of the early-onset seizures as potentially preventable.

Conculsion

The majority of the term early-onset neonatal seizures identified did not appear to be preventable. Many of the neonates with 5-minute Apgar scores of 7 or greater had cerebral infarcts.

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Nearly 10–26% of deliveries are complicated by the passage of meconium of which 4–10% develop meconium aspiration syndrome (MAS)1,2; of which nearly half require mechanical ventilation; 15–30% develop pulmonary air leaks and 5–12% die.3,4 In addition, early onset neonatal seizures, hypotonia and cerebral palsy have been reported in neonates born through MSAF.5–8 Several modalities have evolved in the antepartum, intrapartum and immediate postpartum period for prevention of MAS.
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Term early-onset neonatal seizures: Obstetric characteristics, etiologic classifications, and perinatal care

Objective

Methods

Results

Conculsion

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Pediatr Neurol

J Pediatr

Pediatr Neurol

Pediatr Neurol

Pediatr Clin North Am