Prenatal and perinatal risk factors for neonatal seizures occurring in 100 newborns in the first week were determined in a case-control study at Grottaferrata, the University of Rome, and other centers, Italy. The majority (71%) had more than one type of seizure, the most common being generalized tonic (29% of infants). Less frequently, multifocal clonic (13%), focal clonic (9%), and myoclonic seizures (5%); all were associated with subtle seizures. Interictal EEG was normal in 20%, and showed asymmetries of background activity in 47%, burst suppression in 5%, and episodic voltage attenuation in 28%. Etiologies presumed to be responsible for seizures included hypoxic-ischemic encephalopathy in 30%, intracranial hemorrhage (10%), hypocalcemia (9%), meningitis (8%), hypoglycemia (2%), and unknown (10%). A history of epilepsy in first degree relatives was found in 4 cases and for none of the controls. Parents of cases had a lower socioeconomic status than those of controls. Neonatal seizures were associated with maternal disease in the 2 years preceding the pregnancy, excessive weight gain, placental pathology, preeclampsia, low geastational age, low birth weight, and neonatal jaundice. Cardiopulmonary resuscitation was needed in 37% of cases and none of the controls. [1]

COMMENT. Neonatal seizures in the first week are strongly associated with low gestational age and low birthweight, risk factors that might be preventable. Other familial, maternal, and neonatal factors are associated, including placental pathology, preeclampsia, and a family history of epilepsy and febrile seizures.