Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
BMC Med. 2010 Mar 17;8:16. doi: 10.1186/1741-7015-8-16.
Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya.
From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days) admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint) was modelled from the census data.
Seizures were reported in 142/1572 (9.0%) of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI) 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%), neonatal encephalopathy in 30 (21%) and meningitis in 21 (15%), but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR) 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02). Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates >or= 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46), P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge.
There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available to the neonates.
在资源匮乏国家的医院中，急性发作在儿童中很常见。然而，在撒哈拉以南非洲，关于新生儿发作的负担、病因和结果的数据很少。我们确定了在肯尼亚一家农村地区医院入院的新生儿发作的最小发生率、病因和即刻结果。
从 2003 年 1 月 1 日至 2007 年 12 月 31 日，我们评估了所有（年龄 0-28 天）居住在一个确定的、定期计数的研究区域内的基利菲区医院入院的新生儿的发作情况。人口分母，即 2005 年 7 月 1 日（研究中点）社区内的活产数，是根据人口普查数据建模得出的。
在 1572 例新生儿入院中，有 142 例（9.0%）报告了发作。发病率为每 1000 例活产 39.5 [95%置信区间（CI）26.4-56.7]，且发病率随出生体重增加而增加。发作新生儿的主要诊断为败血症 85 例（60%）、新生儿脑病 30 例（21%）和脑膜炎 21 例（15%），但只有新生儿脑病和细菌性脑膜炎与发作独立相关。与无发作的新生儿相比，有发作的新生儿住院时间更长[中位数为 7 天[四分位距（IQR）4-10] - 无发作的新生儿为 5 天[IQR 3-8]，P=0.02]。总体而言，发作和无发作的新生儿住院病死率无差异，但根据出生体重分层时，体重≥2.5kg 的新生儿明显高于低出生体重新生儿[比值比 1.59（95%CI 1.02-2.46），P=0.037]。出院时有发作的存活新生儿中，有 13%左右存在神经发育异常。
在肯尼亚的这一地区，新生儿发作的发生率很高，最重要的病因是新生儿脑病和脑膜炎。新生儿发作的高发生率可能反映了新生儿获得的围产期和产后护理的质量。
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