The risk factors, causes, and prognosis of convulsions in 156 neonates are reviewed at the Mater Misericordiae Mothers Hospital, South Brisbane, Queensland, Australia. The incidence of early neonatal convulsions was 3/1000 live births. Compared to infants who did not convulse, the leading risk factors for convulsions were prematurity, intra-uterine growth retardation, low 5 min Apgar score, pre-eclampsia, antepartum hemorrhage, twin pregnancy, and breech presentation. The cause was hypoxic-ischemic encephalopathy (HIE) in 40%, intracranial hemorrhage (30%), metabolic (12%), infection (8%), malformation (3%), misc (7%). Mortality (31%) was related to etiology: 57% for intracranial hemorrhage, 33% infection, 27% HIE. Of the 107 infants who survived, long-term disability occurred in 43%; severe in 25 infants, moderate in 8 and mild in 10. The highest mortality and morbidity are associated with prolonged convulsions, tonic and multifocal clonic convulsions, convulsions due to asphyxia and intracranial hemorrhage, and an abnormal neurologic examination at discharge. [1]

COMMENT. The outcome of neonatal convulsions in this study is similar to that reported in a Dublin Collaborative Study of neonatal asphyxiai seizures in which 43% had a poor outcome [2]. In the Dublin study, asphyxiai seizures occurring within 48 hours of birth in 0.87/1000 live births were correlated with antenatal complications, primiparity, and prolonged pregnancy. The incidence of seizures ranged from 0.55-1.2/1000 in the 3 participating maternity hospitals, reflecting differences in management policies in regard to frequency of cesarean section, induced labor, and forceps delivery. The mortality rate was 18% and of those who survived, 28% were handicapped at 1 year. Outcome was correlated with the infants' feeding habits at 1-2 weeks, those requiring tube feeding for more than 14 days being handicapped at follow up.