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

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.