Communal Poverty Is a Significant Risk Factor for Neonatal Seizures

 

 Buy Article Permissions and Reprints

Abstract

Introduction Neonatal seizures (NS) are a severe condition with significant mortality and long-term morbidity. This study aims to identify risk factors for NS in a racially or ethnically diverse population in Israel.

Methods This is a case–control study. The cases were all newborns born between 2001 and 2019 at Emek Medical Center in Israel and admitted with NS. Two healthy controls born in the same period were matched for each case. Demographic, maternal, and neonatal variables were abstracted from the electronic medical files.

Results A total of 139 cases were matched with 278 controls. Residing in a town with lower socioeconomic status (SES), primiparity and abnormal prenatal ultrasound were significantly associated with NS. Prematurity, assisted delivery, a lower birthweight, being small for gestational age, and lower Apgar score were also associated with NS. In two different multivariable regression models, lower SES (odds ratio [OR] = 4.07) and Arab race/ethnicity (OR = 2.66) were risk factors for NS. Other significant risk factors in the multivariable regression models included an assisted mode of delivery (OR = 2.33), prematurity (OR = 2.27), and a 5-minute Apgar score below 7 (OR = 54.1).

Discussion Communal poverty, as reflected by lower SES of towns of residence, was found to be a stronger risk factor than race or ethnicity, for NS. More studies should focus on social class, as a risk factor for maternal and neonatal adverse outcomes. As SES is a modifiable variable every effort should be invested in fighting communal poverty and improving the SES of impoverished towns and population.

Ethical Approval

The research was approved by the Ethics Committee at Emek Medical Center, Afula, Israel.

Authors Contributions

O.T. and L.L. conceptualized and designed the study, drafted the manuscript, and reviewed and revised the manuscript. K.T.H.Y. and A.E. applied for the institutional review board, collected data, and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 24 August 2022

Accepted: 26 April 2023

Article published online:
15 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Lanska MJ, Lanska DJ. Neonatal seizures in the United States: results of the National Hospital Discharge Survey, 1980-1991. Neuroepidemiology 1996; 15 (03) 117-125
  CrossrefPubMedGoogle Scholar
• 2 Lanska MJ, Lanska DJ, Baumann RJ. et al. A population-based study of neonatal seizures in Fayette County, Kentucky. Neurology 1995; 45 (04) 724-732
  CrossrefPubMedGoogle Scholar
• 3 Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population-based study. J Pediatr 1999; 134 (01) 71-75
  CrossrefPubMedGoogle Scholar
• 4 Saliba RM, Annegers JF, Waller DK, Tyson JE, Mizrahi EM. Incidence of neonatal seizures in Harris County, Texas, 1992-1994. Am J Epidemiol 1999; 150 (07) 763-769
  CrossrefPubMedGoogle Scholar
• 5 Glass HC, Pham TN, Danielsen B, Towner D, Glidden D, Wu YW. Antenatal and intrapartum risk factors for seizures in term newborns: a population-based study, California 1998-2002. J Pediatr 2009; 154 (01) 24-28.e1
  CrossrefPubMedGoogle Scholar
• 6 Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med 2013; 18 (04) 185-191
  CrossrefPubMedGoogle Scholar
• 7 Aziz A, Gattoo I, Aziz M. et al. Clinical and etiological profile of neonatal seizures: a tertiary care hospital based study. Int J Res Med Sci 2015; 3: 2198-2203
  CrossrefPubMedGoogle Scholar
• 8 Pisani F, Spagnoli C. Acute symptomatic neonatal seizures in preterm neonates: etiologies and treatments. Semin Fetal Neonatal Med 2018; 23 (03) 191-196
  CrossrefPubMedGoogle Scholar
• 9 Glass HC, Shellhaas RA, Wusthoff CJ. et al. Contemporary profile of seizures in neonates: a prospective cohort study. J Pediatr 2016; 174: 98-103.e1
  CrossrefPubMedGoogle Scholar
• 10 Ching Hu S, Hung KL, Chen HJ. Neonatal seizures: incidence, etiologies, clinical features and EEG findings in the neonatal intensive care unit. Epilepsy J 2017; 03: 3-5
  CrossrefPubMedGoogle Scholar
• 11 Tanous O, Watad M, Felszer-Fisch C, Peniakov M, Miron D, Salim R. Risk factors for mortality among newborns with neonatal seizures. Neuropediatrics 2021; 52 (02) 84-91
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Badawi N, Kurinczuk JJ, Keogh JM. et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317 (7172): 1549-1553
  CrossrefPubMedGoogle Scholar
• 13 Martinez-Biarge M, Cheong JLY, Diez-Sebastian J, Mercuri E, Dubowitz LM, Cowan FM. Risk factors for neonatal arterial ischemic stroke: the importance of the intrapartum period. J Pediatr 2016; 173: 62-68.e1
  CrossrefPubMedGoogle Scholar
• 14 Hall DA, Wadwa RP, Goldenberg NA. et al. Maternal risk factors for term neonatal seizures. J Child Neurol 2006; 21: 795-798
  CrossrefPubMedGoogle Scholar
• 15 Badawi N, Kurinczuk JJ, Keogh JM. et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317 (7172): 1554-1558
  CrossrefPubMedGoogle Scholar
• 16 Kohelet D, Shochat R, Lusky A. et al. Risk factors for neonatal seizures in very low birthweight infants: population-based survey. J Child Neurol 2004; 19 (02) 123-128
  CrossrefPubMedGoogle Scholar
• 17 Saabneh A. Health inequalities between Palestinians and Jews in Israel: The role of extreme spatial segregation. Popul Space Place 2021; 28 (05) e2539
  CrossrefPubMedGoogle Scholar
• 18 CBS. Characterization and classification of geographical units by the socio-economic level of the population. Jerusalem;2019. Accessed March 22, 2022 at: https://din-online.info/pdf/lst92e.pdf
  PubMedGoogle Scholar
• 19 Rassin M, Klug E, Nathanzon H, Kan A, Silner D. Cultural differences in child delivery: comparisons between Jewish and Arab women in Israel. Int Nurs Rev 2009; 56 (01) 123-130
  CrossrefPubMedGoogle Scholar
• 20 Jaffe A, Giveon S, Rubin C, Novikov I, Ziv A, Kalter-Leibovici O. Gestational diabetes risk in a multi-ethnic population. Acta Diabetol 2020; 57 (03) 263-269
  CrossrefPubMedGoogle Scholar
• 21 Zlotogora J, Haklai Z, Rotem N, Georgi M, Rubin L. The impact of prenatal diagnosis and termination of pregnancy on the relative incidence of malformations at birth among Jews and Muslim Arabs in Israel. Isr Med Assoc J 2010; 12 (09) 539-542
  PubMedGoogle Scholar
• 22 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
  CrossrefPubMedGoogle Scholar
• 23 Pisani F, Facini C, Bianchi E. et al. Incidence of neonatal seizures, perinatal risk factors for epilepsy and mortality after neonatal seizures in the province of Parma, Italy. Epilepsia 2018; 59 (09) 1764-1773
  CrossrefPubMedGoogle Scholar
• 24 Saliba RM, Annegers FJ, Waller DK, Tyson JE, Mizrahi EM. Risk factors for neonatal seizures: a population-based study, Harris County, Texas, 1992-1994. Am J Epidemiol 2001; 154 (01) 14-20
  CrossrefPubMedGoogle Scholar
• 25 Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol 2001; 98 (01) 65-70
  PubMedGoogle Scholar
• 26 Nagahawatte NT, Goldenberg RL. Poverty, maternal health, and adverse pregnancy outcomes. Ann N Y Acad Sci 2008; 1136: 80-85
  CrossrefPubMedGoogle Scholar
• 27 Larson CP, Larson C. Poverty during pregnancy: its effects on child health outcomes. Paediatr Child Health 2007; 12 (08) 673-677
  CrossrefPubMedGoogle Scholar
• 28 Blume HK, Loch CM, Li CI. Neonatal encephalopathy and socioeconomic status: population-based case-control study. Arch Pediatr Adolesc Med 2007; 161 (07) 663-668
  CrossrefPubMedGoogle Scholar
• 29 Aftab S, Ara J, Kazi S. et al. Effects of poverty on pregnant women. Pak J Med Res 2012; 51 (01) 5-9
  PubMedGoogle Scholar
• 30 Parker JD, Schoendorf KC, Kiely JL. Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States. Ann Epidemiol 1994; 4 (04) 271-278
  CrossrefPubMedGoogle Scholar
• 31 Weightman AL, Morgan HE, Shepherd MA, Kitcher H, Roberts C, Dunstan FD. Social inequality and infant health in the UK: systematic review and meta-analyses. BMJ Open 2012; 2 (03) e000964
  CrossrefPubMedGoogle Scholar
• 32 Local Authorities CBS. Ascending order of the socio economic index 2017. 2020 . Accessed September 15, 2021 at: https://www.cbs.gov.il/he/mediarelease/doclib/2020/403/24_20_403t1.pdf
  PubMedGoogle Scholar
• 33 Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet 1990; 336 (8725): 1238-1240
  CrossrefPubMedGoogle Scholar
• 34 Muhsen K, Green MS, Soskolne V, Neumark Y. Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges. Lancet 2017; 389 (10088): 2531-2541
  CrossrefPubMedGoogle Scholar
• 35 Chernichovsky D, Bisharat B, Bowers L. et al. The health of the Arab Israeli population. Jerusalem; 2017. Accessed November 27, 2021 at: https://www.taubcenter.org.il/wp-content/uploads/2020/12/healthofthearabisraelipopulation.pdf
  PubMedGoogle Scholar
• 36 Saabneh AM. Arab-Jewish gap in life expectancy in Israel. Eur J Public Health 2016; 26 (03) 433-438
  CrossrefPubMedGoogle Scholar