Very early neonatal seizure rate: a possible epidemiological indicator of the quality of perinatal care.

The most frequently cited objective of perinatal care is the prevention of mortality and morbidity; but there is no general agreement about the indices which should be used to assess the extent to which this broad objective is being achieved. As mortality and morbidity observed during the perinatal period may reflect pathological processes originating earlier in pregnancy, putative indices of perinatal care should ideally be evaluated in clinical experiments comparing different modes of practice. Also, because perinatal practice can affect mortality and morbidity in a reciprocal manner, it is important to define indices of both mortality and morbidity. Morbidity indices should preferably be based on neonatal clinical signs which are both unambiguous and strongly predictive of later morbidity. We propose that the frequency of neonatal seizures beginning within 48 h of birth should be considered as an index which may meet these criteria in respect of full-term babies.