PEDIATRICS
Neonatal Seizures
Neonatal seizures are rarely idiopathic, and usually signify serious neurologic
disease. Additionally, persistent or prolonged seizures may damage the devel-
oping brain. Incidence of neonatal seizures is 0.5% in term infants, but can
be up to 20% in premature infants.
SYMPTOMS/EXAM
Generalized tonic-clonic seizures are uncommon in infants. Neonatal
seizures may present with autonomic dysfunction (tachycardia, apnea), or
repetitive movements of the eyes, mouth, face, or extremities.
DIFFERENTIAL
Tremor, myoclonus, or agitation from maternal narcotic withdrawal may
mimic seizure activity. Causes of neonatal seizures include:
■ Hypoglycemia
■ Encephalopathy (hypoxic-ischemic)
■ Intracranial hemorrhage
■ Infection (especially CNS)
■ Metabolic (electrolyte disturbances or in-born errors of metabolism)
DIAGNOSIS
Extensive efforts should be directed toward identifying the underlying cause
of the neonatal seizure.
■ Serum glucose
■ Serum electrolytes, including sodium, calcium, magnesium
■ Arterial blood gas, lactate, ammonia
■ Lumbar puncture
■ Head CT
■ Urine studies
■ Cultures of blood, urine, CSF
■ EEG to confirm seizure activity
■ If etiology still unclear, consider evaluation for in-born errors of metabolism.
TREATMENT
Actively seizing:
■ Stabilize airway.
■ Lorazepam 0.05–0.1 mg/kg IV (max dose 2 mg)
■ Phenobarbital 10–20 mg/kg IVPB
■ Specific treatment directed at etiology of seizure
■ Admission to hospital
COMPLICATIONS
■ Depend on etiology of seizure
■ Overall mortality 15%
■ High incidence of mental retardation and cerebral palsy
Neonatal seizures usually
signify serious neurological
disease. They rarely present
with generalized tonic-clonic
movement.