Neonatal Seizure

Aka: Neonatal Seizure, Newborn Seizure, Seizure Disorder in Newborns

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II. Types (Order of decreasing frequency)

  1. Background
    1. Generalized tonic-clonic Seizures do not typically occur in the immature nervous system of a neonate
  2. Subtle findings
    1. Horizontal Eye Deviation
    2. Drooling
    3. Sucking
    4. Lip smacking
    5. Swimming or pedaling motion
  3. Generalized Tonic Seizure (Preterm Infants)
  4. Multifocal Clonic Seizure (Full-Term infants)
  5. Focal Clonic Seizure (Full-Term more then Preterm)
  6. Myoclonic (Both Preterm and Full-Term)
  7. Infantile Spasms (2-3% of childhood Epilepsy)
    1. Associated with serious underlying conditions (e.g. Tuberous sclerosis, Phenylketonuria, Agenesis of the Corpus Callosum)

III. Causes

  1. Asphyxia, HIE (12-24 hours after birth)
  2. Interventricular Hemorrhage
  3. Hydrocephalus
  4. Microcephaly
  5. Hypoglycemia
  6. Electrolyte imbalance
    1. Hyponatremia
    2. Hypocalcemia
    3. Hypomagnesemia
  7. Infection
    1. TORCH Infection (esp. Toxoplasmosis, CMV, HSV)
    2. Coxsachievirus
    3. Escherichia coli
    4. Group B Streptococcus (GBS Sepsis)
  8. Amino Acid disturbance (Inborn Errors of Metabolism)
  9. Drug Withdrawal
  10. Pyridoxine Deficiency (Vitamin B6)
  11. Vitamin K Deficiency
  12. Dysgenic brain
  13. Neonatal sleep Myoclonus
  14. Benign familial Neonatal Seizures
  15. Benign idiopathic Neonatal Seizures (Fifth Day Fits) or familial
    1. Onset in first 3-5 days of life
    2. Resolves in weeks

IV. Labs

  1. Bedside Fingerstick Glucose
  2. Serum Sodium
  3. Serum Calcium
  4. Serum Magnesium

V. Evaluation

  1. Requires broad evaluation (e.g. Neonatal Sepsis, Birth Trauma, inborn error of metabolism)

VI. Management

  1. Seizure abortive measures
    1. See Seizure Emergency Management
    2. Step 1: Diazepam 0.3 mg/kg rectally
    3. Step 2: Phenobarbital 20 mg/kg slow IV push (risk of respiratory depression)
      1. Risk of apnea and Hypotension
      2. Phenobarbital much higher efficacy in newborns than Levetiracetam
      3. Sharpe (2020) Pediatrics 145(6) +PMID:32385134 [PubMed]
    4. Step 3: Phenytoin or Fosphenytoin 18 mg/kg IV over 20 min (10 min for Fosphenytoin)
  2. Reversible cause management
    1. Hypoglycemia Management with D10W 2-4 ml/kg IV
    2. Other measures
      1. Severe Hyponatremia Management (6 ml/kg 3% saline)
      2. Severe Hypocalcemia management (50-100 mg/kg Calcium Gluconate over 10-20 min)
      3. Severe Hypomagnesemia management (2-4 ml 2% MgSO4)
      4. Consider Pyridoxine replacement

VII. References

  1. (2016) CALS Manual, 14th ed, p. I-210

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Related Studies

Ontology: Convulsions in the newborn (C0159020)

Concepts Disease or Syndrome (T047)
ICD9 779.0
ICD10 P90
SnomedCT 157162003, 230436006, 87476004
English Convulsions in newborn, CONVULSIONS NEONATAL, Convulsions of newborn, convulsions in newborn (diagnosis), convulsions in newborn, Convulsion neonatal, Convulsions neonatal, Neonatal convulsion, Neonatal fit, neonatal convulsion, newborn seizures, newborns seizures, neonatal convulsions, seizures newborn, seizure newborn, neonatal seizure, neonatal seizures, newborns seizure, seizures in newborn, newborn seizure, Convulsions in newborn (disorder), Convulsions in the newborn, Fits in the newborn, Seizures in the newborn, Fits in newborn, Neonatal convulsions, Neonatal seizures, Seizures in newborn, Convulsions in the newborn (disorder), convulsions; neonatal, convulsions; newborn, fit; newborn, neonatal; convulsions, newborn; convulsions, newborn; fit
Italian Convulsione neonatale, Crisi convulsiva neonatale, Convulsioni del neonato, Convulsioni neonatali, Crisi convulsive neonatali
Dutch neonatale convulsie, neonatale insulten, convulsies pasgeborene, neonataal insult, convulsies neonataal, convulsie; neonataal, convulsie; pasgeborene, neonataal; convulsie, pasgeborene; convulsie, pasgeborene; toeval, toeval; pasgeborene, Convulsies bij pasgeborene, convulsie neonataal
French Crises néonatales, Convulsion du nouveau-né, Convulsions du nouveau-né, Crise du nouveau-né, CONVULSIONS DU NOUVEAU-NE, Convulsions néonatales
German Konvulsionen neonatal, neonataler Anfall, Kraempfe des Neugeborenen, Konvulsionen bei Neugeborenen, neonatale Konvulsionen, KONVULSIONEN NEUGEBORENES, Kraempfe beim Neugeborenen, Konvulsion Neugeborenes
Portuguese Convulsões neonatais, Convulsões do recém-nascido, CONVULSOES NEONATAIS, Convulsão neonatal
Spanish Convulsiones del recién nacido, Crisis neonatal, Convulsiones neonatales, Crisis epiléptica neonatal, CONVULSIONES NEONATALES, convulsiones en el recién nacido (trastorno), convulsiones en el recién nacido, convulsiones neonatales, Convulsión neonatal, ataques en el recién nacido, paroxismos en el recién nacido, crisis convulsiva en el recién nacido
Japanese 新生児痙攣発作, 新生児発作, 新生児痙攣, ｼﾝｾｲｼﾞﾎｯｻ, ｼﾝｾｲｼﾞｹｲﾚﾝﾎｯｻ, ｼﾝｾｲｼﾞｹｲﾚﾝ
Czech Křeč novorozenecká, Novorozenecká křeč, Křeče u novorozenců, Novorozenecké křeče, Novorozenecký záchvat, Novorozenecké záchvaty
Korean 신생아 경련
Hungarian Convulsiók az újszülöttben, Újszülöttkori convulsiók, Újszülöttkori convulsio, Újszülöttkori görcsroham, Újszülöttkori görcsrohamok
Derived from the NIH UMLS (Unified Medical Language System)

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