Emergency. 2017; 5 (1): e41

BR I E F RE P O RT

Brain Ultrasonography Findings in Neonatal Seizure; a
Cross-sectional Study
Seyed Saeed Nabavi1∗. Parinaz Partovi1

1. Clinical Research Development Center, Amir-Almomenin Hospital, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.

Received: December 2016; Accepted: December 2016; Published online: 12 January 2017

Abstract: Introduction: Screening of newborns with seizure, who have curable pathologic brain findings, might be able
to improve their final outcome by accelerating treatment intervention. The present study aimed to evaluate
the brain ultrasonography findings of newborns hospitalized with complaint of seizure. Methods: The present
cross-sectional study designed to evaluate brain ultrasonography findings of hospitalized newborns complain-
ing seizure. Neonatal seizure was defined as presence of tonic, clonic, myoclonic, and subtle attacks in 1 - 28
day old newborns. Results: 100 newborns with the mean age of 5.82 ± 6.29 days were evaluated (58% male).
Most newborns were in the < 10 days age range (76%), term (83%) and with normal birth weight (81%). 22 (22%)
of the ultrasonography examinations showed a pathologic finding. A correlation was only found between birth
age and probability of the presence of a pathologic problem in the brain as the frequency of these problems was
significantly higher in pre-term newborns (p = 0.023). Conclusion: Based on the findings of the present study,
frequency of pathologic findings in neonatal brain ultrasonography was 22%. Hemorrhage (12%) and hydro-
cephaly (7%) were the most common findings. The only factor correlating with increased probability of positive
findings was the newborns being pre-term.

Keywords: Seizures; infant, newborn; ultrasonography; diagnosis; brain

© Copyright (2017) Shahid Beheshti University of Medical Sciences

Cite this article as: Nabavi S, Partovi P. Brain Ultrasonography Findings in Neonatal Seizure; a Cross-sectional Study. Emergency. 2017; 5(1):

e41.

1. Introduction

S
eizure is the most common neurologic problem in in-

fants, recurrence of which can cause disturbance in the

central nervous system growth process. Most cases of

seizure are idiopathic; but neonatal seizure is usually a sign of

a pathologic problem in the brain that may be accompanied

by a permanent damage in future stages of life (1, 2). Preva-

lence of newborn seizure is reported to be between 1.8 and

8.6 in each 1000 live births (2). The considerable difference in

the reported statistics can be related to problem in diagnosis,

different definitions of neonatal seizure, and various popula-

tions. Sometimes determining which clinical phenomenon

should be considered to be seizure is a difficult task (3).

The most common causes of neonatal seizure are hypoxia-

ischemia (asphyxia), brain stroke, intra-ventricular or in-

tracranial hemorrhage, meningitis, sepsis, and metabolic

∗Corresponding Author: Seyed Saeed Nabavi; Department of Pediatrics;
Amir-Almomenin Hospital, Shirmohammadi Street, Naziabad, Tehran, Iran.
Email: seyedsaeednabavi@yahoo.com Tel: 00989122405399

disorders (4, 5). Recent studies have shown that the nervous

system of newborns may be resistant to long-lasting seizures

to some extent; however, recurrent short seizures may be as-

sociated with permanent damage to the central nervous sys-

tem, increased risk of epilepsy and durable cognitive disabili-

ties (1, 6). Screening of newborns with seizure, who have cur-

able pathologic brain findings, might be able to improve their

final outcome by accelerating treatment intervention. Elec-

troencephalogram (EEG) has been reported to be abnormal

in 100% of clonic, partial tonic, and spasmic seizures; 60% of

generalized myoclonic ones; 7% of focal and multifocal my-

oclonic, and 10% of generalized tonic seizures. Meanwhile,

silent, apnostic, and autonomic types of seizure do not have

a known correlation with EEG findings (7). Brain magnetic

resonance imaging (MRI), computed tomography (CT) scan,

and EEG, despite having a high accuracy are not available ev-

erywhere and require special conditions such as immobiliza-

tion. Currently, ultrasonography is considered to be used for

various purposes such as measuring intracranial pressure (8,

9), fracture diagnosis (10-12), etc. in emergency setting (13,

14). Although the ability of ultrasonography in detection of

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S. Nabavi et al. 2

newborn intracranial lesions has been introduced during the

1990s, it has not been seriously considered until now, espe-

cially in third world countries (15). It seems that ultrasonog-

raphy as a safe, affordable, available and bedside screening

tool can be of great help for physicians in charge of such pa-

tients (16-19). Therefore, the present study aimed to evaluate

the brain ultrasonography findings of newborns hospitalized

with complaint of seizure.

2. Methods

2.1. Study design and setting

The present study is a retrospective cross-sectional one aim-

ing to evaluate brain ultrasonography findings of newborns

hospitalized in the neonatal unit of Milad Hospital, Tehran,

Iran, during 2011 to 2013 complaining seizure. Researchers

adhered to principles of Helsinki declaration and confiden-

tiality of patient data. This study was approved by the ethics

committee of Islamic Azad University, Tehran Medical Sci-

ences branch.

2.2. Participants

Newborns hospitalized in neonatal unit following seizure

were studied using convenience sampling. Age between 1

and 28 days; presence of tonic, clonic, myoclonic, and auto-

nomic; no missing data in the clinical profile of the newborn;

availability of data on brain ultrasonography of the newborn,

and not having history of trauma were among the inclusion

criteria. Newborns with a history of apnea due to pulmonary,

cardiac, digestive, and infectious problems as well as those

who did not have a definite diagnosis of seizure were ex-

cluded from the study.

2.3. Data gathering

Using the clinical profile of the patients, a checklist consist-

ing of demographic data including age, sex, birth weight,

birth age, family history of neonatal seizure, history of under-

lying illnesses, and type of birth as well as brain ultrasonog-

raphy findings was filled for each of them. Neonatal seizure

was defined as presence of tonic, clonic, myoclonic, and sub-

tle attacks based on Mizrahi and Kellawaycriteria in 1 – 28

day old patients (20). Data gathering was done by a trained

medicine student. Ultrasonography was done using a 3.5 –

5 MHz curve probe. All ultrasonography examinations were

performed from the anterior fontanelle, by a single radiolo-

gist.

2.4. Statistical Analysis

Data analysis was done using SPSS version 13. Quantitative

data were reported as mean and standard deviation (SD) and

qualitative ones as frequency and percentage. For evaluating

the correlation between ultrasonography findings and de-

Table 1: Baseline characteristics of the studied newborns

Variable Number (%)
Age (days)
0 – 9.9 78 (76)
10 – 19.9 13 (13)
20 – 28 9 (9)
Birth weight (gr)
Low (< 2500) 16 (16)
Normal (2500 – 4000) 81 (81)
High (> 4000) 3 (3)
Delivery type
Natural 33 (33)
Cesarean section 67 (67)
Birth age
Term 83 (83)
Pre-term 17 (17)
Family history of seizure
Yes 6 (6)
No 94 (94)
Underlying problem
Yes 27 (27)
No 73 (73)
Variable Number (%)
Normal 78 (78)
Hemorrhage 12 (12)
Hydrocephaly 7 (7)
Other 3 (3)

Table 2: Brain ultrasonography findings of the newborns with

seizure

Variable Number (%)
Normal 78 (78)
Hemorrhage 12 (12)
Hydrocephaly 7 (7)
Other 3 (3)

mographic data of the patients, chi-square and ANOVA tests

were used. P< 0.05 was considered as significance level.

3. Results

100 newborns with the mean age of 5.82 ± 6.29 days were
evaluated (58% male). Table 1 depicts the baseline charac-

teristics of the studies patients. Most newborns were in the

< 10 days age range (78%), term (83%) and with normal birth

weight (81%). 6 (6%) newborns had a history of seizure and

27 (27%) cases had an underlying illness. Table 2 shows the

brain ultrasonography findings of the studied newborns. 22

(22%) of the ultrasonography examinations showed a patho-

logic finding. Table 3 demonstrates the correlation between

ultrasonography findings and demographic data of the pa-

tients. A correlation was only found between birth age and

probability of the presence of a pathologic problem in the

brain as the frequency of these problems was significantly

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3 Emergency. 2017; 5 (1): e41

Table 3: The correlation between ultrasonography findings and baseline characteristics of the newborns with seizure

variable Pathologic findings n (%) P value
Yes No

Sex
Male 14 (24.1) 44 (75.9) 0.544
Female 8 (19) 34 (81)
Birth weight (gr)
Low (< 2500) 5 (31.2) 11 (68.8)
Normal (2500 – 4000) 16 (19.8) 65 (80.2) 0.343
High (> 4000) 1 (23.3) 2 (67.7)
Delivery type
Natural 7 (21.2) 26 (78.8) 0.894
Cesarean section 15 (22.4) 52 (77.6)
Birth age
Term 22 (10.1) 68 (81.9) 0.023
Pre-term 7 (41.2) 10 (58.8)

higher in pre-term newborns (p = 0.023).

4. Discussion

Based on the findings of the present study, 22% of the hospi-

talized newborns in the neonatal unit of the studied hospital

had at least 1 pathologic finding in their brain ultrasonogra-

phy. Hemorrhage and hydrocephaly with 12 and 7 cases were

the most common ultrasonography findings, respectively.

The only factor correlating with increased probability of pos-

itive findings in brain ultrasonography was the newborns be-

ing pre-term. In a study by Zahid et al. carried out in 2010

and 2011 for evaluation of brain ultrasonography findings in

newborns with seizure, 48.5% of the performed ultrasonogra-

phy examinations had pathologic findings such as: intraven-

tricular hemorrhage (27.6%), brain edema (11.7%), subdural

hemorrhage (6.4%), and subarchanoid hemorrhage (5.3%).

They introduced ultrasonography as a proper non-invasive

method for timely diagnosis of cerebral causes of seizure in

newborns (19). In our study, although the number of ultra-

sonography examinations with positive finding was half the

rate reported in the mentioned study, 22% prevalence of ul-

trasonography findings was also important. In Leth et al.

study, based on brain ultrasonography findings, the cause

of 10% of newborn seizures was determined to be brain le-

sions, while this rate rose to 68% after performing MRI. In

the study, 35% of the seizures were reported to be due to hy-

poxic problems, 26% hemorrhagic, 16% metabolic disorders

and unknown in 23% (16). In a study by Mercuri et al. 11 out

of 16 newborns with seizure (69%) had pathologic lesions in

their brain ultrasonography, which were mostly hemorrhagic

in the initial weeks and ischemic after that (17). This rate was

estimated to be 95% in Rutherford et al. study. Small infarcts

that had not been detected in ultrasonography were seen in

MRI (18). Wang et al. in their study in 2004 concluded that

ultrasonographic screening of brain for all newborns can be

helpful in detection of rare but important problems affecting

neurologic outcomes (21). Considering the vastly different

results that exist regarding the rate of pathologic findings de-

tected by brain ultrasonography, it seems that further stud-

ies with larger sample sizes and more accurate methodolo-

gies are required before making a final decision in this regard.

In addition, to determine the screening performance char-

acteristics of this test, it should be compared to more stan-

dard diagnostic tests such as MRI and determine its sensitiv-

ity, specificity, and accuracy.

5. Conclusion:

Based on the findings of the present study, frequency of

pathologic findings in neonatal brain ultrasonography was

22%. Hemorrhage (12%) and hydrocephaly (7%) were the

most common findings. The only factor correlating with in-

creased probability of positive findings was the newborns be-

ing pre-term.

6. Appendix

6.1. Acknowledgements

Authors would like to thank all the staff of pediatric depart-

ment of Milad Hospital, Tehran, Iran.

6.2. Author contribution

All authors passed four criteria for authorship contribution

based on recommendations of the International Committee

of Medical Journal Editors.

6.3. Funding/Support

None.

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S. Nabavi et al. 4

6.4. Conflict of interest

None.

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	Introduction
	Methods
	Results
	Discussion
	Conclusion:
	Appendix
	References