الفهرس 
Introduction
Neonatal seizuresOnly 14 pages are availabe for public view
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Abstract
Optimal care of the neonate can be achieved by optimal observation of the newborn that starts from time of birth. Educating doctors how to analyze any abnormal behavior of the newborn helps greatly to discover and treat many life threatening conditions. The present study aimed to evaluate the diagnosis of neonatal seizures among neonates attending Neonatal Intensive care Unit of Assiut University Children Hospital during the period from 1st of November 2016 to 30th of April 2017 according to protocol of diagnosis of neonatal seizures which is locally approved and documented by Neonatal Intensive care Unit of Assiut University Children Hospital as a reference standard (Gomella et al., 2013). The study included 64 patients with neonatal seizures. Their age ranged from 1 to 28 days, 30 cases were males and 34 were females. The cases included 48 fullterm neonates and 16 preterm. Data of the study showed that diagnosis of neonatal seizures in Neonatal Intensive care Unit of Assiut University Children Hospital mostly followed the reference standard of the study. Recorded data about history: Data of the age, sex and maturity were recorded in 100% of cases. Data of maternal history, maternal age was recorded in 75% of cases, drug intake was recorded in 81.2% of cases and presence of any maternal diseases during pregnancy in 100% of cases. Data of pregnancy history, prenatal care was recorded in 82.8% of cases. Asking about occurrence of fever during pregnancy was recorded in 76.6% of cases. History of previous abortion and premature rupture of membrane were fully recorded in 100% of cases. Data about delivery: type and duration of delivery and type of anesthesia used were recorded in 100 of cases. Data about family history: consanguinity and early fetal or neonatal deaths were fulfilled. Family history of seizures was recorded in 37.5% of cases. Recorded data about neonatal history symptoms of intracranial hemorrhage, history of trauma and focal seizures were recorded in 100% of cases. Symptoms of bleeding tendency were recorded in 84.8% of cases. As regards symptoms of meningitis; history of fever was recorded in 85.9% of cases and history of irritability was recorded in 90.6% of cases. Data about history of seizures including whether these movements occurred during awake or sleep and whether they could be arrested or provoked with any stimulus was fulfilled. Type of these movements was recorded in 90.6% of cases. Frequency and duration of these movements were recorded in 59.4% of cases. Recorded data about examination Measurement of head circumference was assessed in 62.5% of cases. Assessment of vital signs was fulfilled. Presence of malformations or dysmorphic features was recorded in 100% of cases. Presence of skin lesions or discoloration was recorded in 100% of cases.Presence of signs of intracranial hemorrhage (pallor and bulging anterior fontanelle) was recorded in 89.1% of cases. Data about assessment of neurological manifestations in neonates with seizures: Assessment of conscious level was fulfilled but assessment of muscle tone was recorded in only 37.5% of cases. Primitive reflexes: moro reflex was recorded in 87.5% of cases and grasp reflex in 93.7% of cases but parachute, tonic neck and stepping reflexes were not done in any case.. Cranial nerve examination was not done in any case. Recorded data about laboratory investigationsComplete blood picture was done in 68.8% of cases. Blood glucose level was done in 71.9% of cases (46 cases) at time of admission. 30.4% of these cases presented by hypoglycemia, 60.9% by normal blood glucose level and 8.7% by hyperglycemia (3 cases due to prematurity and 1 case due to septicemia). Serum electrolytes were recorded. Serum sodium level was done in 81.2% of cases (52 cases). 11.5% of these cases presented by hyponatremia, 3.8% by hypernatremia and 84.6% by normal levels. Serum magnesium level was assessed in 12.5% of cases (8 cases) and all of them were normal. Serum calcium level was done in 81.3% of cases (52 cases). 11.5% of these cases presented by hypocalcemia and 88.5% by normal levels. Cerebrospinal fluid examination was indicated in only12.5% of cases (8 cases) who suspected to have intracranial infection and it was done for 100% of indicated cases. Blood culture was indicated in 12.5% of all cases (8 cases) who presented with manifestations of septicemia. It was done for 50% of indicated cases. Blood gases was recorded in 56.2% of cases. Serum ammonia and lactate were indicated in 9.4% of all cases (6 cases) who were suspected to have inborn errors of metabolism and it was assessed in 100% of indicated cases. Serum aminogram was indicated in 9.4% of cases (6 cases) and it was assessed in 66.7% ( 4 cases) of all indicated cases. TORCH was indicated in 15.6% of all cases who presented with malformations and it was not done in any case. Recorded data about electrographic studies. Electroencephalogram was indicated in 25% of cases who suspected to had HIE but it was done for 87.5% of indicated cases. Recorded data about neuroimaging studies: Cranial ultrasound was indicated for all cases with neonatal seizures as a bedside examination but was done only for 59.4% of cases. Computed tomography was indicated in 34.4% of cases and it was done for 90.9% of indicated cases. Magnetic resonance imaging was indicated in 9.4% of cases (6 cases) and it was done for 66.7% of indicated cases. Follow up of neonatal seizures revealed that all cases were diagnosed except 4 cases that died before diagnosis Assessment of head circumference as a routine for all neonates helps in early assessment of hydrocephalus. Good general observation of the neonate to exclude any congenital malformations or syndromes. Assessment of conscious level daily as it helps in daily as it helps in the progression and prognosis of the disease. Cranial nerve examination should be taken in consideration during examination. Primitive reflexes are considered as a mirror for neurological assessment of the neonate and must be done. Routine laboratory investigation as blood picture, serum electrolytes and blood glucose should be done for all neonates with seizures. Cerabrospinal fluid examination and blood culture are mandatory in only specified cases. Serum ammonia and lactate should be taken in consideration if we suspect inborn errors of metabolism TORCH should be done for cases with malformations to help to avoid that in her next pregnancy Cranial ultrasound should be done as a bedside examination for all, neonates. Computed Tomography and Magnetic Resonance Imaging are done for, indicated cases.