Seizures in newborns

Disease Description (Causes and Symptoms)

• Definition: Convulsive seizures occurring during the neonatal period (birth to 1 month of age), presenting as abnormal contractions, trembling, or subtle abnormal movements of the entire body or some muscles. May be accompanied by altered consciousness, apnea, or irregular breathing.
• Main causes:
  • Perinatal hypoxic-ischemic brain injury (most common, approximately 60%).
  • Intraventricular hemorrhage, meningitis/central nervous system infection.
  • Brain malformations (developmental abnormalities) or stroke.
  • Metabolic abnormalities (hypoglycemia, hypocalcemia, hypomagnesemia, etc.) and some inborn errors of metabolism.
  • Drug or toxic exposure, or genetic epilepsy syndromes.
• Summary of pathophysiology: The neonatal brain is sensitive to electrolyte and metabolic changes and oxygen deprivation, so the balance between inhibition and excitation is easily disrupted → hyperexcitable agitation occurs, leading to clinical and electrophysiological seizures.
• Main symptoms (clinical types):
  • Subtle: upward rolling of the eyelids, lip smacking, apnea or irregular breathing, subtle vomiting or drooling.
  • Clonic: repeated convulsive contractions in a localized area or throughout the body (such as one limb).
  • Tonic: sustained stiffness affecting the entire body or a localized area.
  • Myoclonic: sudden, brief shock-like contractions.
• Differential diagnosis: Physiological trembling (which stops when the limbs are held) can be distinguished from seizures. During a seizure, the trembling continues or recurs and does not stop even when the limb is held.

Treatment

• Emergency care (priorities): Secure ABCs (airway, breathing, circulation) — maintain the airway, provide oxygen, and provide mechanical ventilation and hemodynamic support if necessary. Never feed the baby during a seizure.
• Acute drug treatment:
  • Initial treatment: Immediate seizure suppression is attempted with intravenous benzodiazepines (e.g., midazolam or lorazepam).
  • First-line maintenance medication: Traditionally, phenobarbital has been used as the first-line choice. (Levetiracetam use has increased recently; evidence continues to accumulate.)
  • If refractory: Consider intensive care-level treatment with phenytoin, levetiracetam, continuous midazolam/propofol, etc.
• Correction of the cause:
  • Administer glucose for hypoglycemia, provide calcium supplementation for hypocalcemia, provide antibiotic or antiviral treatment for infection, and correct electrolyte or metabolic abnormalities.
  • Provide appropriate specialized treatment for hemorrhage, malformations, and medical causes (in coordination with neurosurgery and pediatric neurology).
• Diagnostic tests (performed alongside treatment):
  • Immediate tests: Blood glucose, electrolytes, calcium, magnesium, blood gas analysis, CBC, blood cultures, etc.
  • Imaging: Brain ultrasound (useful for the initial evaluation of newborns), and MRI/CT if necessary.
  • Electrophysiology: EEG (to monitor ongoing seizures and confirm epileptiform activity); continuous EEG monitoring if necessary.
  • Other: Cerebrospinal fluid testing (when meningitis is suspected), and genetic or metabolic testing (when the cause is unknown or seizures recur).
• Hospitalization recommendation: Most patients require inpatient observation and treatment in a NICU or under a specialized pediatric neurology department.
• Follow-up management: The need to continue antiseizure medication is determined according to the cause and EEG findings. Neurodevelopmental follow-up is necessary.

Checkpoints Before an Outpatient Visit (Including Examples of Items to Bring and Questions)

• Items to bring:
  • Birth records (delivery records, APGAR score, etc.) and information on the mother's pregnancy and delivery history.
  • The newborn's recent test results (blood tests, imaging, EEG, etc.) and copies of the results.
  • A list of currently administered medications (including medications taken by the mother during breastfeeding).
  • Video of the seizure (smartphone video) — very important.
  • A record of the seizure onset time, duration, frequency of recurrence, and the condition before and after the seizure (breathing cessation, cyanosis, interruption of feeding, etc.).
• Checkpoints before an outpatient visit:
  • When the seizure began and the newborn's condition when it was first noticed.
  • The form of the seizure (eye, mouth, or limb movements; apnea, etc.) and the duration of the seizure.
  • Any association with feeding, activity, fever, or trauma.
  • Whether there is a family history of genetic disease or seizures.
  • Changes in the newborn's temperature, urination or bowel movements, and feeding volume.
• Priority items to check when seeking emergency care: Level of consciousness, breathing and color (cyanosis), seizure duration (if seizures recur for 1–2 minutes or longer, immediate emergency department evaluation is recommended), and whether the newborn remains unresponsive after fever or a seizure.

Examples of General Questions to Ask the Doctor

• What do you think is the exact cause of this seizure?
• What tests are currently needed (EEG, MRI, metabolic or genetic testing), and when should they be performed?
• What is the purpose of the prescribed medication (or planned medication), and what are its side effects?
• How long should antiseizure medication be continued after the seizures have stopped?
• What will the schedule be for future neurodevelopmental (motor and cognitive) assessments and follow-up?
• Can the baby continue feeding (including breastfeeding), and how will the medication affect breastfeeding?

Examples of Disease-Specific Questions

• What evaluations (EEG, clinical course, etc.) are used as the basis for discontinuing antiseizure medication? How is discontinuation carried out?
• If genetic or metabolic testing (e.g., genomic testing or metabolic screening) is necessary, which tests do you recommend, and how long is the expected time until the results are available?

(When necessary, medical staff will provide additional personalized counseling and a detailed treatment plan based on the newborn's characteristics and test results.)