Background: Seizures are frequent in neonatal period. They can be idiopathic or caused by hypoxic-ischaemic injury, structural brain malformations, infections and metabolic disorders.

Objective: To evaluate the etiologic diagnosis of newborn babies with seizures admitted in a level3 / tertiary neonatal intensive care unit.

Materials and Methods: Retrospective review of clinical files of the newborn babies admitted with seizures during a period of 3 years (Nov 2010 to Oct 2013). Data was collected on antenatal risk factors, labour and delivery complications, sepsis, neurological abnormalities and investigations including neurophysiology and imaging.

Results: 51 neonates had seizures at admission. The admission rate was 1800 in 3 years making the incidence of seizures 2.9 per 100 admissions. Neuroimaging, neurophysiology studies, infective screen and metabolic investigations were performed as appropriate. Most babies had neonatal encephalopathy due to perinatal hypoxic-ischaemic injury. Other etiology included neonatal ischaemic stroke, sepsis/meningitis, intracranial bleed and inborn errors of metabolism (IEM).

IEM disorders included pyridoxine dependent epilepsy, molybdenum co-factor deficiency and mitochondrial disorder in 1 baby each. The diagnosis of IEM was made in all 3 cases and disease specific treatment was started in 2 cases within first 4 days.

Mortality rate was 17% (9 babies died).

Conclusion: Although inborn errors of metabolism are rare as initial presentation of neonatal seizures it is important to diagnose these early as some are treatable.