Objectives: To identify the etiological risk factors associated with neonatal seizures from the history, physical examination, lab findings, imaging studies and EEG in NICU setting, to identify the type of anti-epileptic medications used for treatment in NICU setting, to find out the duration of anti-epileptic medications during hospital stay and to ascertain any association between the etiological factors, type of antiepileptic medications and the duration of treatment

Materials/Methods: Charts were retrospectively reviewed for those infants with an ICD -9 code of (ICD-9 CODE -779.0) from January 1, 2005 to December 31, 2010 at Women and Children hospital’s NICU division.

Results: Eighty-one neonates, less than 1 year of age, were diagnosed with neonatal seizures during the 5 year period. Three patients were excluded due to duplication. Our study focused on 78 infants, both term and preterm, with a history of clinical seizures. The seizure types that were identified from the charts reviewed included generalized (51.61%), clonic (25.81%), focal (9.68%), tonic (9.68%), myoclonic (3.23%) among documented types and undocumented (60.26%). Factors taken into consideration in prenatal history included instances of maternal tobacco use (19.74%), maternal drug use (21.05%) and maternal alcohol use (0.0%). Imaging studies performed included abnormal EEG results (61.76%), abnormal CT head (50.88%), abnormal MRI head (73.33%) and abnormal cranial ultrasound (43.59%). Among the patients who were treated with Phenobarbital, 6.41% of them were given only one dose and 7.69% of them were treated for duration of less than one week. Also, 50% of the patients were discharged on Phenobarbital and the mean duration of treatment while in hospital was found to be 3.15 weeks with standard deviation of 2.995. Out of the total number of patients, 92.31% of patients were discharged from the hospital, 6.41% died and 1.28% got transferred to higher centers of care.

Conclusion: The common etiological risk factors that we identified in our NICU division based on the chart review include prenatal history, type of seizures, lab findings, EEG, imaging studies. Based on the chart reviews, the most commonly associated risk factors that were identified from pre-natal history are maternal drug abuse and maternal smoking. In addition, EEG and imaging studies play a crucial role in the diagnosis of neonatal seizures. Phenobarbital is the most frequently used drug in the NICU setting with a mean duration of 3.15 weeks during hospital stay. Finally, infants with abnormal imaging results were more likely to have started Phenobarbital while in the hospital and also be discharged on Phenobarbital.