The association between maternal characteristics and birth admission seizures in a cohort of 2.3 million California children born at >36 weeks’ gestation between 1998 and 2002 was evaluated using database statistics at the University of California San Francisco and Davis, CA. The incidence of birth admission seizures was 0.95/1000 live births. The risk of seizures was higher in male infants. Women age 40 years and older who were nulliparous, had diabetes mellitus, intrapartum fever, or infection (chorioamnionitis) or delivered at >42 weeks had an increased risk of delivering an infant with seizures. Maternal/race ethnicity was significantly associated with seizures, with a lower risk in infants of Hispanic and Asian compared with Caucasian and African–American mothers. Identifying antenatal and intrapartum risk factors for neonatal seizures might lower infant neurological morbidity and mortality. Late delivery is one risk factor that might be avoided. 
COMMENT. Previous reports found a higher incidence of neonatal seizures, from 1 to 3.5 per 1000 in term infants, but other studies included seizures up to 28 days of life. The increased risk of seizures at birth with maternal intrapartum fever and infection remains elevated even when meningitis or neonatal infection is excluded. The risk is higher in febrile multiparous compared to nulliparous women. A higher risk of seizures in infants born by cesarean section during night hours is unexplained.
Unexplained seizures in an infant. A girl born by cesarean section at 38 weeks after placental detachment developed generalized tonic-clonic seizures and tremors at 2 months. Blood tests, EEG and MRI were normal. The mother was receiving amitriptyline for postnatal depression and tension headache. The infant was treated with phenobarbital but seizures recurred, even during hospitalization. Metabolic studies were considered. At one hospital stay, the seizure was complicated by ventricular tachycardia and fibrillation. After transfer to intensive-care for resuscitation, she was comatose and hypotonic, her pupils were dilated but reactive, and she was ventilated mechanically. She rapidly recovered consciousness, breathed independently, and moved all limbs. Mother was unimpressed and denied improvement in her child’s condition. Toxicological studies obtained because of mother’s incongruous response disclosed serum concentrations of amitryptyline 350 mcg/L. Mother admitted that she had administered amitryptyline drops to the infant for the past month. When removed to live with maternal grandmother, the child remained well and without seizures. The child was a victim of the factitious disorder, Munchausen’s syndrome by proxy.