A survey of the monitoring and management of neonatal seizures in Nigerian neonatal intensive care units
Keywords:
Neonatal seizures, EEG monitoring, NICU, Neurodevelopment, Nigeria healthcareAbstract
Background: Accurate diagnosis and management of neonatal seizures are critical to ensure interventions that improve survival and long-term neurological outcomes. Electroencephalography is crucial for diagnosing and managing neonatal neurologic disorders. In Low- and middleincome countries where the burden of neonatal neurologic disorders, such as birth asphyxia, is very high, the availability and use of electroencephalography are unknown.
Aim: To determine the availability, use, and expertise on the use of EEG by Nigerian neonatal medical providers and to evaluate management protocol, drug treatment, and post-discharge followup for babies managed for seizures in the neonatal intensive care unit (NICU).
Methods: Participants were recruited at a national pediatric conference. Semi-structured questionnaires were administered to assess EEG availability. Associations between EEG availability in NICUs and hospital characteristics were evaluated using the chisquare test. A p-value of < 0.05 was used to determine significance.
Results:135 participants representing 52 neonatal intensive care units (NICUs) were surveyed. There were 103 (76.3%) females, only 7.7% of 52 NICUs surveyed had access to EEG equipment, and four (3 %) respondents had formal training on EEG use. Phenobarbitone was the most used first-line drug for neonatal seizures (61.5%), followed by diazepam (26.7%), phenytoin (5.9%), and midazolam (5.9%). 76.9%of the facilities had neurodevelopmental follow-up clinics, but most hospitals discharged patients by 6 months of neonatal clinic followup.
Conclusion: Critical efficiencies still exist in neonatal seizure monitoring, management, and follow-up. The availability of EEG in Nigerian Neonatal facilities is unacceptably poor.
References
Abend AS, Jensen FE, Inder TE, Volpe JJ. Neonatal seizures. In: Volpe JJ, Inder T, Darras B, et al., editors. Volpe's Neurology of the Newborn. 6th ed. Philadelphia: PA
Elsevier; 2018. p. 275–321.
Pellegrin S, Munoz FM, Padula M, Heath PT, Meller L, Top K, et al. Neonatal seizures: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2019;37(52):7596-7609. doi:10.1016/j.vaccine.2019.05.031.
United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & trends in child mortality: Report 2022. Estimates developed by the United Nations Interagency Group for Child Mortality Estimation [Internet]. New York: United Nations Children’s Fund; 2022 [cited 2025 Jun 27]. Available from: https://childmortality.org/wpcontent/uploads/2023/01/UNIGME-Child-Mortality-Report-2022.pdf
Ogunkunle TO, Odiachi H, Chuma JR, Bello SO, Imam A. Postnatal outcomes and risk Factors for in-hospital mortality among asphyxiated newborns in a low-resource hospital setting: Experience from North-Central Nigeria. Ann Glob Health. 2020; 86(1): 63. doi:10.5334/aogh.2884.
Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multicountry prospective cohort study. Lancet Glob Health.2018;6(12):e1297-e1308. doi:10.1016/S2214-109X(18)30385-1.
Tette EMA, Nartey ET, Nuertey BD, Azusong EA, Akaateba D, Yirifere J, et al. The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross-sectional study. PLoS One. 2020;15(5):e0232406. doi: 10.1371/journal.pone.0232406. PMID:32365073; PMCID:PMC7197810.
Ikechebelu JI, Eleje GU, Onubogu CU, Ojiegbe NO, Ekwochi U, Ezebialu IU, et al. Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria. BJOG. 2024;131 Suppl 3:88-100. doi:10.1111/1471-0528.17816.
World Health Organization. Newborn mortality [Internet]. Geneva: World Health Organization; 2024 [cited 2025 Jun 20]. Available from: https://www.who.int/news-room/factsheets/detail/newbornmortality.
Pin TW, Eldridge B, GaleaMP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Eur J Paediatr Neurol. 2009;13(3):224-34. doi:10.1016/j.ejpn.2008.05.001.
Vegda H, Krishnan V, Variane G, Bagayi V, Ivain P, Pressler RM. Neonatal Seizures-Perspective in Low-and Middle-Income Countries. Indian J Pediatr. 2022;89(3):245-253. doi:10.1007/s12098-021-04039-2.
Gacio S. Amplitude-integrated electroencephalography for neonatal seizure detection. An electrophysiological point of view. ArqNeuropsiquiatr. 2019;77(2):122-130. doi:10.1590/0004-282X20180150.PMID: 30810597.
Boylan GB, Kharoshankaya L, Mathieson SR. Diagnosis of seizures and encephalopathy using conventional EEG and amplitude integrated EEG. Handb Clin Neurol. 2019;162:363-400. doi:10.1016/B978-0-444-64029-1.00018-7.
Doandes FM, Manea AM, Lungu N, Brandibur T, Cioboata D, Costescu OC, et al. The Role of Amplitude-Integrated Electroencephalography (aEEG) in Monitoring Infants with Neonatal Seizures and Predicting Their Neurodevelopmental Outcome. Children (Basel). 2023;10(5):833.doi: 10.3390/children10050833. PMID:37238381; PMCID:PMC10216913.
Tao JD, Mathur AM. Using amplitude-integrated EEG in neonatal intensive care. J Perinatol. 2010;30 Suppl:S73-81. doi: 10.1038/jp.2010.93.PMID: 20877412
Doandes FM, Manea AM, Lungu N, Cioboata D, Brandibur T, Costescu O, et al. Clinical, biological and electroencephalographic monitoring of newborns with neurological risk in the Neonatal Intensive Care Unit. Exp Ther Med. 2021;22(1):760. doi:10.3892/etm.2021.10192.
Lagunju IA, Okafor OO. An analysis of disorders seen at the Paediatric Neurology Clinic, University College Hospital, Ibadan, Nigeria. West Afr J Med. 2009;28(1):38-42. doi: 10.4314/wajm.v28i1.48424. PMID:19662744
Akodu OS, Ogunlesi TA, Adekanmbi AF, Gbadebo FA. Neurological diseases at the Pediatric Neurology Clinic in a semi-urban Nigerian tertiary hospital. Sudan J Paediatr. 2022;22(1):83-89. doi:10.24911/SJP.106-1588669565. PMID:35958080; PMCID:PMC9361490.
Ifezulike CC, Okeke KN, Onubogu CU, Echendu ST, Odita AO, Agu NV, et al. Pattern of Neurological Disorders among Children Presenting at the Neurology Unit of Tertiary Hospital in Awka. Open J EndocrMetab Dis. 2023;13(04):53–62. doi:10.4236/ojemd.2023.134006.
Pressler RM, Abend NS, Auvin S, Boylan G, Brigo F, Cilio MR, et al. Treatment of seizures in the neonate: Guidelines and consensus-based Recommendations-Special report from the ILAE Task Force on Neonatal Seizures. Epilepsia.2023;64(10):2550-2570. doi:10.1111/epi.17745.
Federal Ministry of Health, Nigeria. National guidelines for comprehensive newborn care [Internet]. Abuja: Federal Ministry of Health; 2021 [cited 2025 Jun 20]. Available from: https://newborntoolkit.org/tools/national-guidelines-fornigeria-to-reduce-neonatalmortality?language=en
Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 2008;93(3):F187–91. doi: 10.1136/
Scher MS, Alvin J, Gaus L, Minnigh B, Painter MJ. Uncoupling of EEG-clinical neonatal seizures after antiepileptic drug use. Pediatr Neurol.2003;28(4):277-80. doi:10.1016/s0887-8994(02)00621-5. PMID: 12849880.
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder -Dewan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health.2018;6(11):e1196 - e1252
Losonczy LI, Papali A, Kivlehan S, Calvello Hynes EJ, Calderon G, Laytin A, et al. White Paper on Early Critical Care Services in Low Resource Settings. Ann Glob Health. 2021;87(1):105. doi:10.5334/aogh.3377. PMID:34786353; PMCID:PMC8570193.
Dondorp AM, Iyer SS, Schultz MJ. Critical Care in Resource-Restricted Settings. JAMA.2016;315(8):753-4. doi:10.1001/jama.2016.0976.PMID: 26903331.
World Health Organization. Human resource strategies to improve newborn care in health facilities in low- and middle-income countries [Internet]. Geneva: World Health Organization; 2020 [cited 2025 Jun 28]. Available from: https://www.who.int/publications/i/item/9789240015227
Lloyd R, Goulding R, Filan P, Boylan G. Overcoming the practical challenges of electroencephalography for very preterm infants in the neonatal intensive care unit. Acta Paediatr.2015;104(2):152-7. doi:10.1111/apa.12869. PMID:25495482; PMCID:PMC5024034.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 JOURNAL OF AFRICAN NEONATOLOGY
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.