Association of Mode of Delivery and Presence of Day 1 Seizures in Intramural Babies with Asphyxia

Background: Perinatal asphyxia remains a leading cause of neonatal mortality and long-term neurological morbidity worldwide. Neonatal seizures occurring on the first day of life are a critical marker of hypoxic-ischemic encephalopathy (HIE) severity and are strongly associated with adverse outcomes. Whether the mode of delivery independently influences the risk of early-onset seizures in asphyxiated neonates remains insufficiently explored. Objective: To compare the proportion of day 1 seizures in asphyxiated term neonates delivered by lower segment caesarean section (LSCS) versus vaginal delivery (VD), and to evaluate associated clinico-investigative profiles and outcomes. Methods: A descriptive longitudinal observational study was conducted from April 2023 to March 2025 in the neonatal wards of a tertiary care teaching hospital in India. One hundred and eighty term neonates with perinatal asphyxia were enrolled after excluding preterm births, major congenital malformations, and multiple gestations. Data on maternal demographics, intrapartum events, neonatal clinical parameters, investigations, and outcomes were analysed. Results: Day 1 seizures occurred in 64/180 (35.6%) neonates. The incidence was significantly lower in the LSCS group (28.6%) compared to the VD group (43.9%; p=0.031; RR 0.65, 95% CI: 0.44–0.96). After multivariate adjustment, LSCS remained protective (aOR 0.62, 95% CI: 0.39–0.97; p=0.041). The VD with seizures group had the highest mortality (33.3%)and worst composite morbidity scores. Conclusion: Caesarean section delivery is independently associated with a reduced risk of day 1 seizures in asphyxiated term neonates. Timely obstetric intervention may mitigate neurological injury in high-risk deliveries.