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Background: Neonatal seizures are the most common manifestation of neurological
disease in New Born Units and have been associated with increased mortality and
morbidity among survivors which underlies the need for early initiation of treatment.
However, it continues to offer both diagnostic and therapeutic challenges to
clinicians. Although it is clear that diagnosis requires prolonged
electroencephalography monitoring accompanied by observation, many newborn units
lack the technology and therefore rely on direct observation for diagnosis. Therapeutic
challenges have been occasioned by lack of standardized protocols which was the
basis of development of the World Health Organisation guidelines that has the
potential of improving outcome. The local approach to diagnosis and the extent to
which clinicians follow the guidelines is unknown.
Objective: To determine the clinical characteristics, adherence to World Health
Organization (WHO) guidelines by clinicians and short-term outcomes in the
management of neonates with clinical neonatal seizures in Moi Teaching and Referral
Hospital newborn unit.
Methods: A prospective descriptive study of newborns admitted to newborn unit
from January 2014 to July 2014. Nurses and doctors working in the unit were trained
on recognition of neonatal seizures by direct observation. They were asked to record
the observed behavior or motor movement in the patient’s file and inform the
researcher or research assistant of the same. The researcher or research assistant used
a data collection tool to collect the required data from the newborns who met the
inclusion criteria. The neonates were then followed up every 48 hours until death or
discharge from the unit. Data was analyzed using STATA version 13 at 95%
confidence interval. Categorical variables were summarized as frequencies and the
corresponding percentages while continuous variables were summarized as mean,
median and standard deviation.
Results: A total of 158 neonates were included in the study, and 31.6% had clinical neonatal
seizures. The median age at admission was 4 (IQR: 1-48) hours. The male to female ratio was
1.5:1. Most of the neonates were born at term (82%). In univariate analysis, birth weight and
gestation age were significantly associated with neonatal seizures (P = 0.001). The most
frequent seizure type observed was tonic focal at 36%. Overall, Adherence to WHO
guidelines was found to be inadequate. Compared to the WHO guidelines, only 12% and 16%
of the neonates who had suspected sepsis and meningitis had blood cultures and lumbar
punctures done respectively. None of the neonates had calcium levels checked while 64% had
random blood sugar levels. The first line anticonvulsant was Phenobarbital. The median time
taken to control seizures was 24 hours (IQR 0.17-48). Of the 50 participants, 44% died. A
longer time taken to control seizures was associated with a higher mortality (p=0.006).
Conclusion: About a third of admitted neonates had seizures and almost half of them
died. There was inadequate adherence to the WHO guidelines in the management of
neonatal seizures.
Recommendations: There is need to reduce the prevalence of neonatal seizures
through vigorous study of its aetiology and subsequent prevention. A future study
should look at the reason for none adherence to WHO recommended guidelines in
care of neonatal seizures at MTRH. |
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