Neonatal Seizures

Neonatal seizures usually indicate significant neurological or metabolic disease. Common causes include hypoxic ischaemic injury, hypoglycaemia, hypocalcaemia, intracranial haemorrhage, stroke, meningitis and metabolic disorders.

Seizures in neonates are often subtle and may present without generalized tonic clonic activity.

Possible manifestations include:

• Repetitive facial movements
• Eye deviation
• Lip smacking
• Cycling movements
• Focal clonic jerking
• Tonic posturing
• Apnoeic episodes
• Autonomic instability

Immediately assess:

• Glucose
• Calcium
• Sodium
• Magnesium
• Sepsis and meningitis

EEG or amplitude integrated EEG is valuable because electrographic seizures frequently persist without obvious clinical movement.

Neuroimaging is indicated where structural injury is suspected.

Correct glucose, calcium and other reversible abnormalities first.

For persistent clinically significant seizures:

• Phenobarbital 20 mg/kg IV or IM loading dose.

• If seizures persist, give additional 10 mg/kg, reassessing after each dose, up to a total loading dose of 40 mg/kg.

Alternative second line therapy includes:

• Levetiracetam 30 mg/kg IV over approximately 15 minutes

or

• Phenytoin 15 mg/kg IV, infused no faster than approximately 1 mg/kg/min.

Treat the underlying cause aggressively.