Neonatal Seizures

Seizures are a common neurological emergency in the neonatal period, occurring in 1–5 per 1000 live births.1 The majority of neonatal seizures are provoked by an acute illness or brain insult with an underlying aetiology either documented or suspected, that is, these are acute provoked seizures (as opposed to epilepsy). They are also invariably focal in nature.

Clinical diagnosis of neonatal seizures is difficult. This is in part because there may be no, or very subtle, clinical features, and also because neonates frequently exhibit non-epileptic movements that can be mistaken for epileptic seizures.

The majority of neonatal seizures are due to:

  • Hypoxia
  • Stroke
  • Infections
  • Intraventricular haemorrhage (is the commonest cause inure term)
  • Other causes include cortical malformations, acute and inborn errors of metabolism, genetic aetiologies, neonatal drug withdrawal and birth-related head trauma.


Neonatal Seizure Algorithm (Yorkshire and Humber Pan-Network)

First-line Investigations in ED

  • Blood Gas – glucose + lactate
  • FBC
  • U&E, Bone Profile, Magnesium, LFT, CRP
  • Blood Culture
  • Herpes PCR
  • Ammonia – (D/W lab as needs to go down on ICE and processed quickly)
  • Lumbar Puncture – (potentially by Paeds)

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