Predictors of Early Adverse Outcomes in Neonates with Seizures: A Prospective Observational Study from a Tertiary NICU

Introduction:

Neonatal seizures are among the most serious neurological emergencies encountered in the neonatal intensive care unit (NICU) and are associated with a high risk of mortality and long-term neurological impairment. Identifying infants at greater risk of adverse outcomes early in their clinical course can help guide timely management and improve prognosis. This study aimed to identify clinical and investigative factors associated with early adverse outcomes in neonates presenting with seizures.

Methods:

This prospective observational study included 30 consecutive neonates admitted to a tertiary NICU with clinically suspected or electroencephalographically confirmed seizures. Demographic details, perinatal history, seizure characteristics, laboratory parameters, neuroimaging, electroencephalography (EEG) findings, and treatment details were collected prospectively. Early adverse outcomes were defined as death, persistent seizures despite treatment, prolonged mechanical ventilation (>72 hours), or abnormal neurological examination at discharge. Multivariable logistic regression was performed to identify independent predictors.

Results:

Eleven (36.7%) neonates experienced an early adverse outcome. Severe hypoxic–ischaemic encephalopathy, seizure onset within the first 24 hours of life, abnormal EEG findings, and significant metabolic disturbances were significantly associated with poorer outcomes (p<0.05). After adjustment for confounding factors, abnormal EEG findings and severe hypoxic–ischaemic encephalopathy remained independent predictors of adverse outcomes. In contrast, neonates achieving seizure control within the first 24 hours were more likely to have favourable short-term outcomes.

Conclusions:

Abnormal EEG findings and severe hypoxic–ischaemic encephalopathy are important early predictors of adverse outcomes in neonates with seizures. Early recognition of these high-risk infants may enable prompt intervention, better risk stratification, and improved short-term neonatal outcomes.