Background
Seizures happen when there is a sudden, abnormal, and excessive electrical activity in the brain. In newborns, seizures can occur during a very sensitive time: the first 28 days of life for full-term infants or up to 28 days after the due date for preterm infants. Most neonatal seizures occur within the first days to the first week of the baby’s life. This period carries the highest risk of seizures across the lifespan. It’s estimated that 1 to 4 in every 1,000 live born children experience seizures during the newborn period.
Understanding Seizures in Newborns
While seizures in newborns may have visible signs, such as rhythmic twitching, posturing, or subtle movements like bicycling or eye deviation. Some seizures may not show any obvious symptoms at all. Healthy babies can also make similar movements, which can be confusing and concerning for parents. Because of this, testing is required to confirm a diagnosis.
The gold standard test is an electroencephalogram (EEG), which records the brain’s electrical activity and helps detect seizure activity. For high-risk newborns, at least 24 hours of EEG monitoring is recommended.
Other tests to determine the cause of seizures include blood and spinal fluid evaluations, magnetic resonance imaging (MRI), and genetic tests.
What Causes Neonatal Seizures?
Neonatal seizures can occur for a variety of reasons. Most seizures are a result of a brain injury or event (referred to as acute symptomatic seizures), such as:
- Lack of oxygen before or during birth (e.g., neonatal encephalopathy or hypoxic-ischemic encephalopathy, HIE)
- Stroke before or after birth
- Bleeding in the brain or surrounding areas (e.g., intracranial, intraventricular hemorrhage, IVH)
- Infections, such as bacterial meningitis and viral encephalitis
Rarely, seizures may be caused by early onset epilepsy:
- Brain birth defects (malformations)
- Genetic epilepsy (familial or non-familial forms)
Other potential causes include:
- Blood sugar or salt imbalances
- Inborn errors of metabolism
- Drug withdrawal
Understanding the cause of neonatal seizures helps guide treatment and improve outcomes.
Treatment
Neonatal seizures are typically treated with one or more anti-seizure medications, such as phenobarbital, levetiracetam, lorazepam, or phenytoin. In some cases, addressing the underlying causes, like correcting blood sugar or salt imbalances, can resolve seizures. For genetic forms of epilepsy, targeted treatments may be needed.
Outcome
The outcomes for babies who experience neonatal seizures depend on the type and cause of seizures. For some newborns, seizures may be mild, short-lived, and cause no long-lasting issues. For others, seizures may indicate serious underlying brain conditions that require longer-term care and support. Therefore, early specialized care is key to giving infants the best outcome.
Parents and caregivers may also experience significant emotional and psychological impacts while navigating their child's condition. Accessing resources early and connecting with emotional and social support groups can help parents feel empowered and better prepared to manage their child's care. Visit our Resources Page for more information and support.
Why Study Neonatal Seizures?
At the Neonatal Seizure Registry, our work is driven by the experiences of parents, families, and clinicians who care for newborns with seizures. We recognize the many questions that remain unanswered – questions that are important to clinicians and parents alike:
- What is the best treatment option?
- How long should they be treated?
- What is the long-term impact of seizures and their treatment on a child’s development?
- Can we predict which children might develop epilepsy following acute seizures?
- How can we best support parents and caregivers of children with seizures and epilepsy?
Through research and collaboration, we hope to answer these questions and improve care and outcomes for newborns with neonatal seizures.