Etiology, Clinical Profile, and Short-Term Outcomes of Neonatal Seizures at a Tertiary NICU in Ethiopia: A Prospective Cohort Study

Etiology, Clinical Profile, and Short-Term Outcomes of Neonatal Seizures at a Tertiary NICU in Ethiopia: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Etiology, Clinical Profile, and Short-Term Outcomes of Neonatal Seizures at a Tertiary NICU in Ethiopia: A Prospective Cohort Study Eyob Seleshi Debebe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7180673/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Neonatal seizures represent an early and critical sign of underlying neurological or systemic dysfunction, demanding urgent evaluation and management. Timely identification of risk factors is essential to mitigate long-term complications. Objectives This study assessed the clinical patterns, underlying causes, and short-term outcomes of neonatal seizures, as well as their predictive determinants, in a tertiary NICU setting in Ethiopia. Methods A prospective cohort study was conducted on neonates admitted with seizures at St. Paul’s Hospital Millennium Medical College from June 2024 to January 2025. Data were collected via structured questionnaires capturing maternal, perinatal, clinical, and laboratory characteristics. Outcomes were analyzed using SPSS version 27, employing descriptive statistics and logistic regression. Results Of 1686 NICU admissions, 64 neonates (3.79%) experienced seizures. Subtle seizures were most common (31.3%), followed by tonic (21.9%) and clonic (18.8%). Seizures predominantly occurred within the first 24 hours of life (57.8%). Hypoxic-ischemic encephalopathy (32.8%) was the leading etiology, with sepsis (9.4%) and congenital anomalies (4.7%) also noted. Combined etiologies were found in 40.6%, most frequently HIE with sepsis (12.5%). Phenobarbital was the primary antiepileptic used (40.6%). Short-term outcomes included improvement in 68.8%, with 12.5% mortality. Conclusion Hypoxic-ischemic encephalopathy remains the primary cause of neonatal seizures. Subtle seizures were the predominant presentation. Key predictors of adverse short-term outcomes were abnormal temperature and status epilepticus. Strengthening perinatal care and early intervention can significantly improve neonatal outcomes. Neonatal seizure hypoxic-ischemic encephalopathy predictors NICU Ethiopia Figures Figure 1 Introduction Seizures are paroxysmal alterations of neurologic function, including behavioral, motor and/or autonomic changes [13]. They are defined as reported or observed repeated involuntary muscle contractions, abnormal tonic extensions or jerky movements of any part of the limb, face or mouth that was not stimulus sensitive or repetitive abnormal chewing, ocular or pedaling movements [15]. Neonatal seizures are defined as seizures occurring within 4 weeks after birth in full-term infants or within 44 weeks of postmenstrual age in preterm infants [7]. Neonates are particularly vulnerable due to immature brain structures and a high risk of perinatal insults. Because of immature myelination and developing neuronal circuits, generalized tonic-clonic convulsions are rare in neonates. Instead, seizure types include subtle, clonic, tonic, myoclonic, and focal seizures. Subtle seizures, which can include ocular movements, bicycling, and autonomic changes, are more common in term neonates with diffuse brain injuries, with incidence ranging from 10% to 35% [8]. Clonic seizures comprise about 50% of all neonatal seizures and are more common in term infants. Tonic seizures make up around 20% and are more prevalent in preterm neonates, while myoclonic seizures account for roughly 5% [8]. Electroclinical dissociation, where EEG-confirmed seizures occur without observable clinical signs, is especially common in neonates [9]. Literature Review The etiology of neonatal seizures varies by region, with HIE, sepsis, and metabolic disturbances being among the most common causes globally [3, 5]. Studies from Ethiopia and other sub-Saharan countries have consistently identified HIE as the leading contributor to neonatal seizures [4, 5]. Antiepileptic drug use, primarily phenobarbital, remains a mainstay of treatment in low-resource settings [12]. Several studies suggest that early seizure onset (within 24 hours of life) is often associated with HIE, while delayed onset may indicate infectious or metabolic causes [2, 6]. Methods and Materials Study Design and Setting A prospective hospital-based cohort study was conducted at the NICU of St. Paul’s Hospital Millennium Medical College, a tertiary referral hospital in Addis Ababa, Ethiopia, between June 2024 and January 2025. Population and Sampling All neonates (≤28 days of life) admitted with clinically diagnosed seizures during the study period were enrolled. Exclusion criteria included major congenital anomalies incompatible with life and parental refusal to participate. Data Collection Structured questionnaires were used to collect demographic, obstetric, neonatal, clinical, and laboratory data. Diagnosis of seizure type and etiology was based on clinical presentation, laboratory findings, and neuroimaging where available. Data Analysis Data were analyzed using SPSS version 27. Descriptive statistics summarized the data. Binary logistic regression was used to assess associations between clinical factors and short-term outcomes. P-value <0.05 was considered statistically significant. Results Among 1686 NICU admissions, 64 neonates (3.79%) had seizures. Subtle seizures (31.3%) were the most common, followed by tonic (21.9%), clonic (18.8%), and mixed types. Seizure onset occurred within 24 hours of life in 57.8% of neonates. HIE was the primary etiology in 32.8%, followed by sepsis (9.4%) and congenital CNS anomalies (4.7%). Multiple etiologies were identified in 40.6% of cases, with HIE and sepsis as the most common combination. Phenobarbital was administered to 40.6% of the patients. Status epilepticus was observed in 17.2%. Short-term outcomes showed 68.8% improvement, 12.5% mortality, and 18.7% referred with complications. Multivariate regression analysis revealed that abnormal temperature (p = 0.015) and status epilepticus (p = 0.009) were significantly associated with poor short-term outcomes. Discussion This study highlights that neonatal seizures accounted for nearly 4% of NICU admissions. Subtle seizures were most common, consistent with international literature [6, 8]. HIE was the leading etiology, echoing findings from previous Ethiopian studies [3, 4]. Early seizure onset correlated with HIE, while mixed causes reflected ongoing perinatal challenges. Phenobarbital remained the most used antiepileptic, aligning with global guidelines [12]. The mortality rate (12.5%) was comparable to previous studies in Ethiopia and Bangladesh [5, 9]. Abnormal temperature and status epilepticus were strong predictors of poor outcomes. These findings underscore the importance of early identification and aggressive management of underlying etiologies. Conclusion and Recommendations Neonatal seizures remain a serious challenge in NICU settings in Ethiopia, with HIE as the leading cause. Subtle seizures are the predominant clinical type, and early-onset seizures are common. Adverse outcomes were strongly associated with status epilepticus and abnormal temperature regulation. Improving perinatal care, early seizure recognition, and timely intervention are critical. Declarations Acknowledgment First and foremost, I express my profound gratitude to my Lord Jesus Christ and the Virgin Mary for the strength and blessings granted to pursue this medical journey. I also wish to extend sincere appreciation to Dr. Mahlet Abayneh for her guidance, insights, and support throughout this research. Special thanks go to the Department of Pediatrics and Child Health at St. Paul’s Hospital Millennium Medical College for facilitating this academic endeavor. Ethics approval and consent to participate: This study was reviewed and approved by the Institutional Research Ethics Review Committee (IRERC) of St. Paul’s Hospital Millennium Medical College (SPHMMC) . Ethical clearance reference number: PM23/326 Approval date: 13 September 2024 The research was conducted in accordance with the principles of the Declaration of Helsinki . Written informed consent was obtained from the parents or legal guardians of all neonates included in the study. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality restrictions, but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research was institutionally supported by St. Paul’s Hospital Millennium Medical College (SPHMMC) and received no external or third-party funding. Clinical trial registration: Clinical trial number: not applicable. Authors' contributions: ESD conceptualized and designed the study, collected and analyzed the data, and wrote the manuscript. The author read and approved the final version of the manuscript. Authors' information: ESD (Eyob Seleshi Debebe) is a Medical Doctor and Pediatrician, a former senior resident at SPHMMC, and currently serves as an Assistant Researcher at the Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia. References Volpe JJ. Pediatrics. 1989;84(3):422–8. Glass HC, et al. Pediatr Neurol. 2012;46(2):111–5. Tekleab AM, et al. Int J Gen Med. 2023;16:3169–78. Tekleab AM, Melkamu YM. Int J Gen Med. 2023;16:3179–87. Zewdu FA, Belachew A, Ethiop. J Health Dev. 2021;35(2):143–9. Scher MS. Epilepsy Res. 2006;70(Suppl 1):S41–57. Rennie JM, Boylan GB. Curr Opin Neurol. 2007;20(2):161–6. Pisani F, Spagnoli C. Neonatology. 2016;109(4):366–72. Rahman S, et al. Bangladesh J Child Health. 2014;38(3):124–9. Ogunlesi TA, et al. J Trop Pediatr. 2007;53(2):114–9. Young GB. J Clin Neurophysiol. 2000;17(5):473–85. Pisani F, et al. Italian J Pediatr. 2015;41(1):74. Shrestha R, et al. J Nepal Paediatr Soc. 2020;40(1):22–7. Milh M, et al. Arch Pediatr. 2010;17(8):1129–34. Tables Tables 1 to 9 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7180673","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":521488950,"identity":"b7fbff93-dce0-494a-a217-dd8828405876","order_by":0,"name":"Eyob Seleshi Debebe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYFAC5gYGxgYJIIOH/UNChQ2Qwdh4AL8WRrgWNoYPZ9LAIsRoYQBrYZzZdhgshleLfHtj48OfOyzkDI73HnvMc+a83dr2w0BbamyicWkxOHOw2Zj3jISxwZlz6cY8FbeTt51JBGo5lpbbgEuLRGKbNGObROKGGzkG0jxnbiebHQBqYWw4jFOL/PyH7T9/tknUg7Xwtp1LNjv/EL8WhhuMbQy8bRIJBjdyzCRnth2wM7tBwBaDM4nNQMMlDGeeOZds8OFMcoLZDaAtCXj8It9++ODHn2118nzHew8+SKiwszc7n/7wwYcaG9wOgwGFAxA6EawygZBysHVQQ+2JUTwKRsEoGAUjCwAArmZs1TerLTIAAAAASUVORK5CYII=","orcid":"","institution":"Armauer Hansen Research Institute","correspondingAuthor":true,"prefix":"","firstName":"Eyob","middleName":"Seleshi","lastName":"Debebe","suffix":""}],"badges":[],"createdAt":"2025-07-21 20:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7180673/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7180673/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92480149,"identity":"d9c00d06-705a-4247-8ac8-851dfae258db","added_by":"auto","created_at":"2025-09-30 07:40:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7143,"visible":true,"origin":"","legend":"\u003cp\u003eShort term Outcome of Neonates with Seizure at SPHMMC, NICU, in Addis Ababa Ethiopia, from June 2024 G.C. to January 2025 G.C. (n=64)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7180673/v1/24f3dda7cc182b42d5ddf2bf.png"},{"id":92480151,"identity":"4615b74b-f63e-487f-abcf-86c6358419f8","added_by":"auto","created_at":"2025-09-30 07:40:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":500952,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7180673/v1/43c7c51b-5d71-4b84-a4eb-d3623a09852b.pdf"},{"id":92480148,"identity":"b851fe45-d941-4ae9-9bce-4ba3aef6dc8f","added_by":"auto","created_at":"2025-09-30 07:40:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45197,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7180673/v1/8344526209004e07b576bf5d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Etiology, Clinical Profile, and Short-Term Outcomes of Neonatal Seizures at a Tertiary NICU in Ethiopia: A Prospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSeizures are paroxysmal alterations of neurologic function, including behavioral, motor and/or autonomic changes [13]. They are defined as reported or observed repeated involuntary muscle contractions, abnormal tonic extensions or jerky movements of any part of the limb, face or mouth that was not stimulus sensitive or repetitive abnormal chewing, ocular or pedaling movements [15]. Neonatal seizures are defined as seizures occurring within 4 weeks after birth in full-term infants or within 44 weeks of postmenstrual age in preterm infants [7]. Neonates are particularly vulnerable due to immature brain structures and a high risk of perinatal insults.\u003c/p\u003e\n\u003cp\u003eBecause of immature myelination and developing neuronal circuits, generalized tonic-clonic convulsions are rare in neonates. Instead, seizure types include subtle, clonic, tonic, myoclonic, and focal seizures. Subtle seizures, which can include ocular movements, bicycling, and autonomic changes, are more common in term neonates with diffuse brain injuries, with incidence ranging from 10% to 35% [8]. Clonic seizures comprise about 50% of all neonatal seizures and are more common in term infants. Tonic seizures make up around 20% and are more prevalent in preterm neonates, while myoclonic seizures account for roughly 5% [8]. Electroclinical dissociation, where EEG-confirmed seizures occur without observable clinical signs, is especially common in neonates [9].\u003c/p\u003e"},{"header":"Literature Review","content":"\u003cp\u003eThe etiology of neonatal seizures varies by region, with HIE, sepsis, and metabolic disturbances being among the most common causes globally [3, 5]. Studies from Ethiopia and other sub-Saharan countries have consistently identified HIE as the leading contributor to neonatal seizures [4, 5]. Antiepileptic drug use, primarily phenobarbital, remains a mainstay of treatment in low-resource settings [12]. Several studies suggest that early seizure onset (within 24 hours of life) is often associated with HIE, while delayed onset may indicate infectious or metabolic causes [2, 6].\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective hospital-based cohort study was conducted at the NICU of St. Paul’s Hospital Millennium Medical College, a tertiary referral hospital in Addis Ababa, Ethiopia, between June 2024 and January 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll neonates (≤28 days of life) admitted with clinically diagnosed seizures during the study period were enrolled. Exclusion criteria included major congenital anomalies incompatible with life and parental refusal to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStructured questionnaires were used to collect demographic, obstetric, neonatal, clinical, and laboratory data. Diagnosis of seizure type and etiology was based on clinical presentation, laboratory findings, and neuroimaging where available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 27. Descriptive statistics summarized the data. Binary logistic regression was used to assess associations between clinical factors and short-term outcomes. P-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 1686 NICU admissions, 64 neonates (3.79%) had seizures. Subtle seizures (31.3%) were the most common, followed by tonic (21.9%), clonic (18.8%), and mixed types. Seizure onset occurred within 24 hours of life in 57.8% of neonates.\u003c/p\u003e\u003cp\u003eHIE was the primary etiology in 32.8%, followed by sepsis (9.4%) and congenital CNS anomalies (4.7%). Multiple etiologies were identified in 40.6% of cases, with HIE and sepsis as the most common combination.\u003c/p\u003e\u003cp\u003ePhenobarbital was administered to 40.6% of the patients. Status epilepticus was observed in 17.2%. Short-term outcomes showed 68.8% improvement, 12.5% mortality, and 18.7% referred with complications.\u003c/p\u003e\u003cp\u003eMultivariate regression analysis revealed that abnormal temperature (p\u0026thinsp;=\u0026thinsp;0.015) and status epilepticus (p\u0026thinsp;=\u0026thinsp;0.009) were significantly associated with poor short-term outcomes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights that neonatal seizures accounted for nearly 4% of NICU admissions. Subtle seizures were most common, consistent with international literature [6, 8]. HIE was the leading etiology, echoing findings from previous Ethiopian studies [3, 4]. Early seizure onset correlated with HIE, while mixed causes reflected ongoing perinatal challenges.\u003c/p\u003e\n\u003cp\u003ePhenobarbital remained the most used antiepileptic, aligning with global guidelines [12]. The mortality rate (12.5%) was comparable to previous studies in Ethiopia and Bangladesh [5, 9].\u003c/p\u003e\n\u003cp\u003eAbnormal temperature and status epilepticus were strong predictors of poor outcomes. These findings underscore the importance of early identification and aggressive management of underlying etiologies.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eNeonatal seizures remain a serious challenge in NICU settings in Ethiopia, with HIE as the leading cause. Subtle seizures are the predominant clinical type, and early-onset seizures are common. Adverse outcomes were strongly associated with status epilepticus and abnormal temperature regulation. Improving perinatal care, early seizure recognition, and timely intervention are critical.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst and foremost, I express my profound gratitude to my Lord Jesus Christ and the Virgin Mary for the strength and blessings granted to pursue this medical journey. I also wish to extend sincere appreciation to Dr. Mahlet Abayneh for her guidance, insights, and support throughout this research. Special thanks go to the Department of Pediatrics and Child Health at St. Paul\u0026rsquo;s Hospital Millennium Medical College for facilitating this academic endeavor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the \u003cstrong\u003eInstitutional Research Ethics Review Committee (IRERC)\u003c/strong\u003e of \u003cstrong\u003eSt. Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical clearance reference number:\u003c/strong\u003e \u003cem\u003ePM23/326\u003c/em\u003e\u003cbr\u003e\u003cstrong\u003eApproval date:\u003c/strong\u003e \u003cem\u003e13 September 2024\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the principles of the\u0026nbsp;\u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e.\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from the parents or legal guardians of all neonates included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality restrictions, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was institutionally supported by St. Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC) and received no external or third-party funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration:\u003c/strong\u003e Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eESD\u003c/strong\u003e conceptualized and designed the study, collected and analyzed the data, and wrote the manuscript. The author read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eESD (Eyob Seleshi Debebe) is a Medical Doctor and Pediatrician, a former senior resident at SPHMMC, and currently serves as an Assistant Researcher at the Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVolpe JJ. Pediatrics. 1989;84(3):422\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlass HC, et al. Pediatr Neurol. 2012;46(2):111\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTekleab AM, et al. Int J Gen Med. 2023;16:3169\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTekleab AM, Melkamu YM. Int J Gen Med. 2023;16:3179\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZewdu FA, Belachew A, Ethiop. J Health Dev. 2021;35(2):143\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScher MS. Epilepsy Res. 2006;70(Suppl 1):S41\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRennie JM, Boylan GB. Curr Opin Neurol. 2007;20(2):161\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePisani F, Spagnoli C. Neonatology. 2016;109(4):366\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahman S, et al. Bangladesh J Child Health. 2014;38(3):124\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOgunlesi TA, et al. J Trop Pediatr. 2007;53(2):114\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoung GB. J Clin Neurophysiol. 2000;17(5):473\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePisani F, et al. Italian J Pediatr. 2015;41(1):74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShrestha R, et al. J Nepal Paediatr Soc. 2020;40(1):22\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMilh M, et al. Arch Pediatr. 2010;17(8):1129\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 9 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neonatal seizure, hypoxic-ischemic encephalopathy, predictors, NICU, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7180673/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7180673/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNeonatal seizures represent an early and critical sign of underlying neurological or systemic dysfunction, demanding urgent evaluation and management. Timely identification of risk factors is essential to mitigate long-term complications.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eThis study assessed the clinical patterns, underlying causes, and short-term outcomes of neonatal seizures, as well as their predictive determinants, in a tertiary NICU setting in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective cohort study was conducted on neonates admitted with seizures at St. Paul\u0026rsquo;s Hospital Millennium Medical College from June 2024 to January 2025. Data were collected via structured questionnaires capturing maternal, perinatal, clinical, and laboratory characteristics. Outcomes were analyzed using SPSS version 27, employing descriptive statistics and logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 1686 NICU admissions, 64 neonates (3.79%) experienced seizures. Subtle seizures were most common (31.3%), followed by tonic (21.9%) and clonic (18.8%). Seizures predominantly occurred within the first 24 hours of life (57.8%). Hypoxic-ischemic encephalopathy (32.8%) was the leading etiology, with sepsis (9.4%) and congenital anomalies (4.7%) also noted. Combined etiologies were found in 40.6%, most frequently HIE with sepsis (12.5%). Phenobarbital was the primary antiepileptic used (40.6%). Short-term outcomes included improvement in 68.8%, with 12.5% mortality.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHypoxic-ischemic encephalopathy remains the primary cause of neonatal seizures. Subtle seizures were the predominant presentation. Key predictors of adverse short-term outcomes were abnormal temperature and status epilepticus. Strengthening perinatal care and early intervention can significantly improve neonatal outcomes.\u003c/p\u003e","manuscriptTitle":"Etiology, Clinical Profile, and Short-Term Outcomes of Neonatal Seizures at a Tertiary NICU in Ethiopia: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:39:57","doi":"10.21203/rs.3.rs-7180673/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"84439595-6137-4815-be42-9821f433da2e","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T07:39:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:39:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7180673","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7180673","identity":"rs-7180673","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}