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Show detailsContinuing Education Activity
Neonatal seizures are a commonly encountered neurologic condition in neonates. They are defined as sudden, paroxysmal, abnormal alteration of electrographic activity from birth to the end of the neonatal period. During this period, the neonatal brain is developmentally immature. Thus, neonatal seizures have unique pathophysiology and electrographic findings resulting in clinical manifestations that can be different (and more difficult to identify) compared to older age groups. This activity reviews the evaluation and treatment of neonatal seizures and highlights the role of the interprofessional team in evaluating and treating patients with this condition.
Objectives:
- Identify the etiology of neonatal seizures.
- Assess the appropriate evaluation of neonatal seizures.
- Evaluate the management options available for neonatal seizures.
- Communicate interprofessional team strategies for improving care coordination and outcomes in neonates with seizures.
Introduction
Neonatal seizures are a commonly encountered neurologic condition in neonates.[1][2][3] They are defined as sudden, paroxysmal, abnormal alterations of electrographic activity from birth to the end of the neonatal period.[3] During this period, the neonatal brain is developmentally immature.[4][5] Thus, neonatal seizures have unique pathophysiology and electrographic findings resulting in clinical manifestations that can be different (and more difficult to identify) compared to older age groups.[3][4] When a patient with neonatal seizures is encountered, it may be the first clinical sign of a serious neurologic disorder.[6] Thus, rapid recognition and evaluation are required to identify and treat the underlying etiology, prevent further brain injury, and extinguish the seizure activity.[7][8][9] The following topic provides an overview of the etiologies, clinical features, evaluation, and approach to managing a patient with neonatal seizures.
Etiology
When a neonate presents with seizure activity, a correctable underlying cause may be identified.[10]
Diagnoses that require priority evaluation and urgent treatment are categorized as follows:
- Hypoxic conditions[15]
- Hypoxic-ischemic encephalopathy
- Perinatal asphyxia
- Intracranial hemorrhage[11]
- Intraventricular
- Intraparenchymal
- Subarachnoid
- Subdural
Other conditions that should be considered include:
Epidemiology
Neonatal seizures are a commonly encountered neurologic emergency.[27][28] The incidence has been reported between 1 and 5.5 per 1000 live births in term infants, with higher incidences reported in preterm infants.[27][29][30][31] The incidence in the United States is estimated to be between 80 and 120 cases per 100,000 neonates yearly.
Pathophysiology
The neonatal brain is unique when compared to different age groups. Upon birth, it is in a state of continued brain development; thus, some areas are immature.[4] This creates a state where if the neonatal brain is pathologically provoked, a manifestation of this provocation can be seizures.[4] Seizures are abnormal, synchronous neuronal discharges within the cerebral cortex. This can be due to excessive excitatory or deficient inhibitory neuronal discharges.[1][4] Due to its immature state, the neonatal brain is prone to seizures due to an imbalance of neuronal excitation over inhibition.[1] Several factors result in this imbalance. The primary factor is the developmental state of the neonatal neuron. In mature brains, the GABA receptor creates a synaptic potential that makes the postsynaptic neuron less likely to generate an action potential. This is achieved by establishing a decreased cellular membrane potential through its modulation of chloride and potassium channels.[4] By ensuring an influx of chloride intracellularly, the cellular membrane potential is decreased, counteracting excitatory postsynaptic potentials generated by glutamate-modulated stimuli.[32][33] In the neonatal brain, however, the chloride concentration intracellularly is high, with a reversal of the chloride ion gradient. Thus, when the GABA receptor is stimulated, chloride ion channels open, there is an efflux of chloride ions, and depolarization of the neuron occurs through an influx of sodium and calcium ions.[4] Other factors involved in this imbalance include the development of excitatory synapses before inhibitory synapses and the early maturation of voltage-gated ion channels specific to depolarization.[4]
History and Physical
When a neonate presents with seizures, a thorough history and physical examination are required. As there is often an underlying provoking cause, the clinical history should focus on identifying risk factors and the likely etiologies.[1] This can determine prognosis and can guide treatment strategies. The history should include an investigation of the timing of seizure onset, maternal, birth, and family history. Seizures that occur within 12 to 24 hours after birth suggest hypoxic-ischemic encephalopathy, while seizures that occur after this timeframe indicate infection, hemorrhage, or stroke.[11] Maternal history should focus on the presence of genetic as well as acquired conditions that can provoke seizures in the neonate.[10] This may include obtaining a history of previous miscarriages (suggesting an underlying genetic syndrome), gestational diabetes (suggesting a possible difficult delivery with a birth injury or the possibility of fetal thrombotic vasculopathy), infections (sexually transmitted or maternal-fetal transmission of infection), prenatal exposure to prescription or illicit drugs, the withdrawal of prescription or illicit drugs, and the presence of inherited thrombophilias or bleeding disorders.[34][35] Birth history should focus on ruling out the possibility of anoxic brain injury and intracranial hemorrhage. For anoxic brain injury, the provider should investigate for the presence of cord prolapse, cord thrombosis, non-reassuring fetal heart rates, meconium, low APGAR scores, placental abnormalities, and if it was a planned home birth.[35][36][37] For the possibility of intracranial hemorrhage, it should be inquired if the birth placed the neonate at an increased risk of birth injuries. This includes determining if operative vaginal delivery was necessary to complete the birth or if the neonate was macrosomic or had an abnormal fetal presentation, which placed the patient at higher risk for birth injuries.[35][38] Family history is important to ensure there were no early sibling deaths that may suggest the presence of a genetic syndrome, inborn errors of metabolism, or a family history of epilepsy.[39]
Physical examination should focus on findings that may indicate an underlying etiology. This includes the general appearance of the neonate, vital signs, head circumference, mental status (and level of alertness), and the quality of the fontanelle to identify if the patient has bacterial meningitis (with or without septic shock) or acute intracranial hemorrhage.[40] If the patient is stable, a full neurologic examination should be performed focusing on the neonate’s cranial nerves, motor exam, tone, and presence of facial dysmorphisms to identify if the patient has a structural brain lesion associated with thrombosis or an underlying genetic condition.[35] A skin examination should ensure the patient has no findings suggestive of a congenital infection and an assessment of the patient’s perfusion.[40][41] Patients with inborn errors of metabolism may present with acute metabolic acidosis; thus, neonates should be evaluated for the presence of lethargy or respiratory distress, which are usual sequelae to this condition.[39] Suppose the patient has seizure activity during the examination. In that case, the provider should focus on assessing the physical features to ensure it is a true seizure and to assist in identifying the etiology.[11] The location of seizure activity may indicate a focal ischemic stroke or hemorrhage if there is focal activity or hypoxic-ischemic injury, infection, or multifocal stroke or hemorrhage if it is generalized.[7][11]
The classification of neonatal seizure types and their significant features are as follows:
- Focal clonic seizures[42]
- Manifests as repetitive rhythmic contractions
- It can involve the face, upper or lower extremities, neck, or trunk
- The physical suppression of movement or limb repositioning cannot extinguish it
- May migrate to other areas of the body within the same seizure (most commonly contralaterally but can occur ipsilaterally as well)
- If generalized, the seizure activity is diffuse, bilateral, and synchronous
- Focal tonic seizures[42]
- Manifests as a continuous but transient extremity posturing or asymmetric posturing of the trunk or neck
- This may include horizontal eye deviation
- If generalized, it may mimic decerebrate posturing (upper and lower extremity tonic extension) or decorticate posturing (upper extremity flexion and lower extremity extension)
Abrupt autonomic vital sign changes, while rare in otherwise healthy neonates, can be associated with subclinical seizure activity in neonates at risk for seizures.[44]
Evaluation
The suspected etiology directs the evaluation of neonatal seizures. Acutely, the provider should immediately rule out hypoglycemia (via blood glucose); hyponatremia, hypomagnesemia, hypocalcemia (via an electrolyte panel); (3) sepsis/meningitis/encephalitis (via a complete blood count, C reactive protein, blood cultures, and cerebral spinal fluid studies).[13] Other diagnostic studies may include computed tomography, ultrasound, or magnetic resonance imaging of the brain to determine the presence of a stroke, intracranial hemorrhage, or structural defects of the brain.[1] Laboratory work consisting of a meconium analysis may be obtained to determine the presence of illicit substances.[45] Electroencephalography (EEG) may be performed to confirm the occurrence of seizures, as it may be difficult for a bedside observer to identify clinical or subclinical seizures.[46][47] If the patient appears to have seizures that are difficult to control or other symptoms, the patient may be evaluated for inborn errors of metabolism.[48] This consists of a blood gas analysis to evaluate the metabolic state of the patient and the following additional laboratory studies: pyruvate, lactic acid, urine amino, and organic acids.[48] Another consideration is an underlying genetic or epilepsy syndrome, which can be evaluated with specific blood testing.[39][49]
Treatment / Management
After ensuring the patient has a patent airway, is hemodynamically stable, and has intravenous access, therapy should be targeted to treat the underlying condition identified. This can include therapeutic hypothermia for hypoxic-ischemic encephalopathy[50], antibiotics for sepsis/meningitis, providing dextrose if the patient is severely hypoglycemic, correction of electrolyte abnormalities, or referral to neurosurgery if the patient has evidence of an intracranial hemorrhage. If the patient is suspected of having an inborn error of metabolism, halting of feeds, correcting metabolic derangements, and empiric therapy with vitamin and cofactor replacement may be initiated.[39][48][51]
If the seizure is clinically evident and prolonged, phenobarbital is the most common first-line agent.[15][52] If seizures do not resolve after the first loading dose, repeat boluses of this medication should be given. The next agent commonly utilized is fosphenytoin.[53] Other agents include levetiracetam and lidocaine in selected settings.[52] Short-acting benzodiazepines (ie, midazolam) can be utilized if there is a delay in administering these agents. Following the initiation of the acute treatment for neonatal seizures, pediatric neurology should be contacted urgently to assist with management. Pediatric neurology can arrange for continuous electroencephalography monitoring that can confirm the presence of neonatal seizures, assist with identifying subclinical seizure activity, and participate in treating refractory seizures.[54] Pediatric neurologists can also participate in the management of long-term antiepileptic maintenance therapy in inpatient and outpatient settings. The duration of treatment is dependent on the underlying etiology.
Differential Diagnosis
Non-epileptic behaviors must be distinguished from neonatal seizures.[55] Due to the known difficulty of distinguishing these behaviors from epileptic clinical events, electroencephalography monitoring is recommended.[56] Normal newborn behaviors that could resemble seizures include sucking movements, hiccuping, and benign neonatal sleep myoclonus (physiologic myoclonus that occurs during sleep).[55] Other behaviors that occur in the presence of a systemic disease that may trigger consideration for neonatal seizures include startle disease (hyperekplexia), apnea, jitteriness, infantile spasms, clonus, and tremors.[55][57][58] Motor automatisms (ie, repetitive eye-opening, eye deviation, repetitive mouth and tongue movements, bicycling of the lower extremities, tonic posturing) can resemble seizure activity but can be distinguished by the ability to provoke them with tactile stimulation and suppress them by restraint or repositioning of the limb(s) affected.[59][60] They are considered non-epileptic but may be indicative of an underlying neurologic disease process; thus, a systematic neurologic workup may be necessary, especially if associated with other clinical signs or symptoms.[29]
- Anoxia
- Myoclonus
- Benign epilepsy syndromes
- Mitochondrial cytopathies
- Myoclonic epilepsy
- Organic acidurias
- Pyridoxine-dependent epilepsy
- Subdural hematoma
- Subarachnoid hemorrhage
- Tuberous sclerosis
- Viral encephalitis
- Viral meningitis
- Vein of Galen malformation
- Benign neonatal convulsions
- Cerebellar hemorrhage
- Herpes simplex encephalitis
- Myoclonic epilepsy
- Child abuse
- Neonatal meningitis
- Shuddering attacks
Prognosis
The prognosis of neonatal seizures depends on the underlying etiology. If EEG is normal, the prognosis is excellent, but if EEG has many abnormalities, such neonates have a poor prognosis and may develop cerebral palsy and epilepsy. The presence of spikes on EEG has a 30% risk of developing future epilepsy. The mortality rate of neonatal seizures is reported to be as high as 20%.[15] In survivors, neurologic impairment, disability, developmental delay, and epilepsy are common.[9][61][62][63]
Complications
A majority of neonatal seizure complications are associated with the adverse effects that can occur with antiepileptic medication administration. Thus, the provider should be vigilant for loss of airway with hypoxemia or hypercarbia, especially when a benzodiazepine or phenobarbital is administered.[64] This is of paramount importance as hypoxemia can commonly result in cardiac arrest in pediatric patients.[65] Medication administration of phenobarbital is associated with myocardial depression, while phenytoin is associated with cardiac dysrhythmias; thus, hemodynamic instability can occur.[64][66] The provider should be prepared to administer inotropic cardiovascular support and consider using fosphenytoin to avoid the adverse effects of phenytoin administration.[67] Antiepileptic medications can cause hepatic and renal dysfunction; therefore, close monitoring of drug levels is necessary during the acute phase as well as when the patients are prescribed maintenance drug dosing.[1][68] Other complications include:
- Cerebral palsy/spasticity
- Cerebral atrophy/hydrocephalus ex-vacuo
- Epilepsy
- Feeding difficulties
Deterrence and Patient Education
First and foremost, if the patient has a seizure that lasts longer than 5 minutes or if he or she has repeated seizures over a few minutes, emergency services must be contacted. The patient may be prescribed an emergency antiepileptic medication (ie, rectal diazepam); thus, the parents may be counseled on its use.[69] Parents should also be counseled on the prognosis of neonatal seizures, particularly the possibility of neurologic impairments in patients who survive and the importance of referral to early rehabilitation services.[70] In patients who develop long-term epilepsy, the parents should have higher vigilance in situations (ie, ensure adequate supervision) where if seizure activity should occur, the dangers can be compounded (ie, scuba diving).[71] A child with seizures should have routine clinical follow up with pediatric neurology, and the parents should be advised of the importance of medication adherence.[72]
Enhancing Healthcare Team Outcomes
The diagnosis and management of neonatal seizures require an interprofessional approach to avoid complications from the underrecognition of clinical seizures and the adverse effects of the medications administered. Referral to critical care services (neonatal or pediatric) should be performed early to place the patient under the care of neurocritical care experts and to ensure that the patient is stabilized from an oxygenation and hemodynamic standpoint.[73] Pediatric neurology should be consulted to evaluate the patient and confirm the diagnosis of neonatal seizures.[54] Electroencephalography technicians need to be readily available to initiate monitoring and screen for electrographic seizure activity that may be subclinical.[54][74] The medications utilized to control seizures must be ordered, obtained, and administered promptly. Pharmacists with pediatric expertise should be available to safely provide these medications and assist providers in understanding specific pharmacological characteristics concerning the unique renal and hepatic physiology of the pre-term or term neonate.[1] Finally, the bedside nurses are vital to helping providers identify clinically evident seizure activity, annotate pertinent events, and help ensure the patient is safe from the adverse effects some antiepileptic agents have.[75]
References
- 1.
- Glass HC. Neonatal seizures: advances in mechanisms and management. Clin Perinatol. 2014 Mar;41(1):177-90. [PMC free article: PMC3925308] [PubMed: 24524454]
- 2.
- Plouin P, Kaminska A. Neonatal seizures. Handb Clin Neurol. 2013;111:467-76. [PubMed: 23622196]
- 3.
- Abend NS, Wusthoff CJ. Neonatal seizures and status epilepticus. J Clin Neurophysiol. 2012 Oct;29(5):441-8. [PMC free article: PMC3463810] [PubMed: 23027101]
- 4.
- Jensen FE. Neonatal seizures: an update on mechanisms and management. Clin Perinatol. 2009 Dec;36(4):881-900, vii. [PMC free article: PMC2818833] [PubMed: 19944840]
- 5.
- Sanchez RM, Jensen FE. Maturational aspects of epilepsy mechanisms and consequences for the immature brain. Epilepsia. 2001 May;42(5):577-85. [PubMed: 11380563]
- 6.
- Baudou E, Cances C, Dimeglio C, Hachon Lecamus C. Etiology of neonatal seizures and maintenance therapy use: a 10-year retrospective study at Toulouse Children's hospital. BMC Pediatr. 2019 Apr 29;19(1):136. [PMC free article: PMC6487521] [PubMed: 31035972]
- 7.
- Nunes ML, Yozawitz EG, Zuberi S, Mizrahi EM, Cilio MR, Moshé SL, Plouin P, Vanhatalo S, Pressler RM., Task Force on Neonatal Seizures, ILAE Commission on Classification & Terminology. Neonatal seizures: Is there a relationship between ictal electroclinical features and etiology? A critical appraisal based on a systematic literature review. Epilepsia Open. 2019 Mar;4(1):10-29. [PMC free article: PMC6398099] [PubMed: 30868112]
- 8.
- Pisani F, Prezioso G, Spagnoli C. Neonatal seizures in preterm infants: A systematic review of mortality risk and neurological outcomes from studies in the 2000's. Seizure. 2020 Feb;75:7-17. [PubMed: 31864147]
- 9.
- Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, Volpe J, Bourgeois B, du Plessis AJ. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics. 2006 Apr;117(4):1270-80. [PubMed: 16585324]
- 10.
- Thornton MD, Chen L, Langhan ML. Neonatal seizures: soothing a burning topic. Pediatr Emerg Care. 2013 Oct;29(10):1107-10. [PMC free article: PMC3822764] [PubMed: 24084610]
- 11.
- Soul JS. Acute symptomatic seizures in term neonates: Etiologies and treatments. Semin Fetal Neonatal Med. 2018 Jun;23(3):183-190. [PMC free article: PMC6026476] [PubMed: 29433814]
- 12.
- Hall DA, Wadwa RP, Goldenberg NA, Norris JM. Maternal risk factors for term neonatal seizures: population-based study in Colorado, 1989-2003. J Child Neurol. 2006 Sep;21(9):795-8. [PubMed: 16970888]
- 13.
- Nardone R, Brigo F, Trinka E. Acute Symptomatic Seizures Caused by Electrolyte Disturbances. J Clin Neurol. 2016 Jan;12(1):21-33. [PMC free article: PMC4712283] [PubMed: 26754778]
- 14.
- Chen BB, Prasad C, Kobrzynski M, Campbell C, Filler G. Seizures Related to Hypomagnesemia: A Case Series and Review of the Literature. Child Neurol Open. 2016 Jan-Dec;3:2329048X16674834. [PMC free article: PMC5417264] [PubMed: 28503619]
- 15.
- Glass HC, Shellhaas RA, Wusthoff CJ, Chang T, Abend NS, Chu CJ, Cilio MR, Glidden DV, Bonifacio SL, Massey S, Tsuchida TN, Silverstein FS, Soul JS., Neonatal Seizure Registry Study Group. Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study. J Pediatr. 2016 Jul;174:98-103.e1. [PMC free article: PMC4925241] [PubMed: 27106855]
- 16.
- Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015 Mar;42(1):29-45, vii-viii. [PMC free article: PMC4332563] [PubMed: 25677995]
- 17.
- Caviness AC, Demmler GJ, Selwyn BJ. Clinical and laboratory features of neonatal herpes simplex virus infection: a case-control study. Pediatr Infect Dis J. 2008 May;27(5):425-30. [PubMed: 18360301]
- 18.
- Silverstein FS, Jensen FE. Neonatal seizures. Ann Neurol. 2007 Aug;62(2):112-20. [PubMed: 17683087]
- 19.
- Trevathan E. Editorial brain malformation surveillance in the Zika era. Birth Defects Res A Clin Mol Teratol. 2016 Nov;106(11):869-874. [PMC free article: PMC5132043] [PubMed: 27891785]
- 20.
- Yu JY, Pearl PL. Metabolic causes of epileptic encephalopathy. Epilepsy Res Treat. 2013;2013:124934. [PMC free article: PMC3674738] [PubMed: 23762547]
- 21.
- Govaert P, Ramenghi L, Taal R, de Vries L, Deveber G. Diagnosis of perinatal stroke I: definitions, differential diagnosis and registration. Acta Paediatr. 2009 Oct;98(10):1556-67. [PubMed: 19663912]
- 22.
- Kersbergen KJ, Groenendaal F, Benders MJ, de Vries LS. Neonatal cerebral sinovenous thrombosis: neuroimaging and long-term follow-up. J Child Neurol. 2011 Sep;26(9):1111-20. [PMC free article: PMC3674555] [PubMed: 21693652]
- 23.
- Yamamoto H, Okumura A, Fukuda M. Epilepsies and epileptic syndromes starting in the neonatal period. Brain Dev. 2011 Mar;33(3):213-20. [PubMed: 21067877]
- 24.
- Yamatogi Y, Ohtahara S. Early-infantile epileptic encephalopathy with suppression-bursts, Ohtahara syndrome; its overview referring to our 16 cases. Brain Dev. 2002 Jan;24(1):13-23. [PubMed: 11751020]
- 25.
- Gürsoy S, Erçal D. Diagnostic Approach to Genetic Causes of Early-Onset Epileptic Encephalopathy. J Child Neurol. 2016 Mar;31(4):523-32. [PubMed: 26271793]
- 26.
- Shellhaas RA, Wusthoff CJ, Tsuchida TN, Glass HC, Chu CJ, Massey SL, Soul JS, Wiwattanadittakun N, Abend NS, Cilio MR., Neonatal Seizure Registry. Profile of neonatal epilepsies: Characteristics of a prospective US cohort. Neurology. 2017 Aug 29;89(9):893-899. [PMC free article: PMC5577964] [PubMed: 28733343]
- 27.
- Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med. 2013 Aug;18(4):185-91. [PubMed: 23746578]
- 28.
- Glass HC, Pham TN, Danielsen B, Towner D, Glidden D, Wu YW. Antenatal and intrapartum risk factors for seizures in term newborns: a population-based study, California 1998-2002. J Pediatr. 2009 Jan;154(1):24-28.e1. [PMC free article: PMC2635430] [PubMed: 18760807]
- 29.
- Orivoli S, Facini C, Pisani F. Paroxysmal nonepileptic motor phenomena in newborn. Brain Dev. 2015 Oct;37(9):833-9. [PubMed: 25687201]
- 30.
- Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population-based study. J Pediatr. 1999 Jan;134(1):71-5. [PubMed: 9880452]
- 31.
- Lanska MJ, Lanska DJ, Baumann RJ, Kryscio RJ. A population-based study of neonatal seizures in Fayette County, Kentucky. Neurology. 1995 Apr;45(4):724-32. [PubMed: 7723962]
- 32.
- Dzhala VI, Talos DM, Sdrulla DA, Brumback AC, Mathews GC, Benke TA, Delpire E, Jensen FE, Staley KJ. NKCC1 transporter facilitates seizures in the developing brain. Nat Med. 2005 Nov;11(11):1205-13. [PubMed: 16227993]
- 33.
- Galanopoulou AS. Developmental patterns in the regulation of chloride homeostasis and GABA(A) receptor signaling by seizures. Epilepsia. 2007;48 Suppl 5:14-8. [PubMed: 17910576]
- 34.
- Sabzehei MK, Basiri B, Bazmamoun H. The Etiology, Clinical Type, and Short Outcome of Seizures in NewbornsHospitalized in Besat Hospital/Hamadan/ Iran. Iran J Child Neurol. 2014 Spring;8(2):24-8. [PMC free article: PMC4058061] [PubMed: 24949047]
- 35.
- Martinello K, Hart AR, Yap S, Mitra S, Robertson NJ. Management and investigation of neonatal encephalopathy: 2017 update. Arch Dis Child Fetal Neonatal Ed. 2017 Jul;102(4):F346-F358. [PMC free article: PMC5537522] [PubMed: 28389438]
- 36.
- Sayed Ahmed WA, Hamdy MA. Optimal management of umbilical cord prolapse. Int J Womens Health. 2018;10:459-465. [PMC free article: PMC6109652] [PubMed: 30174462]
- 37.
- Grünebaum A, McCullough LB, Sapra KJ, Arabin B, Chervenak FA. Planned home births: the need for additional contraindications. Am J Obstet Gynecol. 2017 Apr;216(4):401.e1-401.e8. [PubMed: 28153656]
- 38.
- Demissie K, Rhoads GG, Smulian JC, Balasubramanian BA, Gandhi K, Joseph KS, Kramer M. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis. BMJ. 2004 Jul 03;329(7456):24-9. [PMC free article: PMC443446] [PubMed: 15231617]
- 39.
- van Karnebeek CDM, Sayson B, Lee JJY, Tseng LA, Blau N, Horvath GA, Ferreira CR. Metabolic Evaluation of Epilepsy: A Diagnostic Algorithm With Focus on Treatable Conditions. Front Neurol. 2018;9:1016. [PMC free article: PMC6286965] [PubMed: 30559706]
- 40.
- Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003 Oct;112(4):793-9. [PubMed: 14523168]
- 41.
- Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol. 2015 Mar;42(1):77-103, viii. [PubMed: 25677998]
- 42.
- Volpe JJ. Neonatal seizures: current concepts and revised classification. Pediatrics. 1989 Sep;84(3):422-8. [PubMed: 2671912]
- 43.
- Sharma D, Pandita A, Murki S, Pratap OT. Neonatal seizures: an emergency condition commonly seen in neonatal intensive care unit. BMJ Case Rep. 2014 Oct 31;2014 [PMC free article: PMC4216882] [PubMed: 25362682]
- 44.
- Dang LT, Shellhaas RA. Diagnostic yield of continuous video electroencephalography for paroxysmal vital sign changes in pediatric patients. Epilepsia. 2016 Feb;57(2):272-8. [PubMed: 26660005]
- 45.
- Hudak ML, Tan RC., COMMITTEE ON DRUGS. COMMITTEE ON FETUS AND NEWBORN. American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012 Feb;129(2):e540-60. [PubMed: 22291123]
- 46.
- Bye A, Flanagan D. Electroencephalograms, clinical observations and the monitoring of neonatal seizures. J Paediatr Child Health. 1995 Dec;31(6):503-7. [PubMed: 8924300]
- 47.
- Wusthoff CJ. Diagnosing neonatal seizures and status epilepticus. J Clin Neurophysiol. 2013 Apr;30(2):115-21. [PubMed: 23545761]
- 48.
- Ficicioglu C, Bearden D. Isolated neonatal seizures: when to suspect inborn errors of metabolism. Pediatr Neurol. 2011 Nov;45(5):283-91. [PubMed: 22000307]
- 49.
- Berg AT, Coryell J, Saneto RP, Grinspan ZM, Alexander JJ, Kekis M, Sullivan JE, Wirrell EC, Shellhaas RA, Mytinger JR, Gaillard WD, Kossoff EH, Valencia I, Knupp KG, Wusthoff C, Keator C, Dobyns WB, Ryan N, Loddenkemper T, Chu CJ, Novotny EJ, Koh S. Early-Life Epilepsies and the Emerging Role of Genetic Testing. JAMA Pediatr. 2017 Sep 01;171(9):863-871. [PMC free article: PMC5710404] [PubMed: 28759667]
- 50.
- Committee on Fetus and Newborn. Papile LA, Baley JE, Benitz W, Cummings J, Carlo WA, Eichenwald E, Kumar P, Polin RA, Tan RC, Wang KS. Hypothermia and neonatal encephalopathy. Pediatrics. 2014 Jun;133(6):1146-50. [PubMed: 24864176]
- 51.
- Sharma S, Prasad AN. Inborn Errors of Metabolism and Epilepsy: Current Understanding, Diagnosis, and Treatment Approaches. Int J Mol Sci. 2017 Jul 02;18(7) [PMC free article: PMC5535877] [PubMed: 28671587]
- 52.
- van Rooij LG, van den Broek MP, Rademaker CM, de Vries LS. Clinical management of seizures in newborns : diagnosis and treatment. Paediatr Drugs. 2013 Feb;15(1):9-18. [PubMed: 23334995]
- 53.
- Painter MJ, Scher MS, Stein AD, Armatti S, Wang Z, Gardiner JC, Paneth N, Minnigh B, Alvin J. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med. 1999 Aug 12;341(7):485-9. [PubMed: 10441604]
- 54.
- Mulkey SB, Swearingen CJ. Advancing neurologic care in the neonatal intensive care unit with a neonatal neurologist. J Child Neurol. 2014 Jan;29(1):31-5. [PMC free article: PMC4178925] [PubMed: 23271754]
- 55.
- Cross JH. Differential diagnosis of epileptic seizures in infancy including the neonatal period. Semin Fetal Neonatal Med. 2013 Aug;18(4):192-5. [PubMed: 23642846]
- 56.
- Malone A, Ryan CA, Fitzgerald A, Burgoyne L, Connolly S, Boylan GB. Interobserver agreement in neonatal seizure identification. Epilepsia. 2009 Sep;50(9):2097-101. [PubMed: 19490044]
- 57.
- Chen CH, Lee HF, Chi CS. Hyperekplexia (startle disease) mimicking neonatal seizures: report of one case. Acta Paediatr Taiwan. 2007 Jan-Feb;48(1):20-2. [PubMed: 19653412]
- 58.
- Redline RW, Sagar P, King ME, Krishnamoorthy KS, Grabowski EF, Roberts DJ. Case records of the Massachusetts General Hospital. Case 12-2008. A newborn infant with intermittent apnea and seizures. N Engl J Med. 2008 Apr 17;358(16):1713-23. [PubMed: 18420504]
- 59.
- Younas A, Younas S. A 15-day-old male infant presenting with jerking movements of the limbs. BMJ Case Rep. 2012 Aug 08;2012 [PMC free article: PMC4543168] [PubMed: 22878983]
- 60.
- Mizrahi EM. Neonatal seizures: problems in diagnosis and classification. Epilepsia. 1987;28 Suppl 1:S46-55. [PubMed: 3113930]
- 61.
- Ortibus EL, Sum JM, Hahn JS. Predictive value of EEG for outcome and epilepsy following neonatal seizures. Electroencephalogr Clin Neurophysiol. 1996 Mar;98(3):175-85. [PubMed: 8631277]
- 62.
- Brunquell PJ, Glennon CM, DiMario FJ, Lerer T, Eisenfeld L. Prediction of outcome based on clinical seizure type in newborn infants. J Pediatr. 2002 Jun;140(6):707-12. [PubMed: 12072874]
- 63.
- Davis AS, Hintz SR, Van Meurs KP, Li L, Das A, Stoll BJ, Walsh MC, Pappas A, Bell EF, Laptook AR, Higgins RD., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Seizures in extremely low birth weight infants are associated with adverse outcome. J Pediatr. 2010 Nov;157(5):720-5.e1-2. [PMC free article: PMC2939969] [PubMed: 20542294]
- 64.
- Minardi C, Minacapelli R, Valastro P, Vasile F, Pitino S, Pavone P, Astuto M, Murabito P. Epilepsy in Children: From Diagnosis to Treatment with Focus on Emergency. J Clin Med. 2019 Jan 02;8(1) [PMC free article: PMC6352402] [PubMed: 30609770]
- 65.
- Tress EE, Kochanek PM, Saladino RA, Manole MD. Cardiac arrest in children. J Emerg Trauma Shock. 2010 Jul;3(3):267-72. [PMC free article: PMC2938492] [PubMed: 20930971]
- 66.
- Guldiken B, Rémi J, Noachtar S. Cardiovascular adverse effects of phenytoin. J Neurol. 2016 May;263(5):861-870. [PubMed: 26645393]
- 67.
- Bleck TP. Management approaches to prolonged seizures and status epilepticus. Epilepsia. 1999;40 Suppl 1:S59-63; discussion S64-6. [PubMed: 10421562]
- 68.
- Tulloch JK, Carr RR, Ensom MH. A systematic review of the pharmacokinetics of antiepileptic drugs in neonates with refractory seizures. J Pediatr Pharmacol Ther. 2012 Jan;17(1):31-44. [PMC free article: PMC3428186] [PubMed: 23118657]
- 69.
- O'Dell C, Shinnar S, Ballaban-Gil KR, Hornick M, Sigalova M, Kang H, Moshé SL. Rectal diazepam gel in the home management of seizures in children. Pediatr Neurol. 2005 Sep;33(3):166-72. [PubMed: 16139730]
- 70.
- Anand V, Nair PM. Neonatal seizures: Predictors of adverse outcome. J Pediatr Neurosci. 2014 May;9(2):97-9. [PMC free article: PMC4166859] [PubMed: 25250059]
- 71.
- Howard GM, Radloff M, Sevier TL. Epilepsy and sports participation. Curr Sports Med Rep. 2004 Feb;3(1):15-9. [PubMed: 14728909]
- 72.
- Jones RM, Butler JA, Thomas VA, Peveler RC, Prevett M. Adherence to treatment in patients with epilepsy: associations with seizure control and illness beliefs. Seizure. 2006 Oct;15(7):504-8. [PubMed: 16861012]
- 73.
- Horvat CM, Mtaweh H, Bell MJ. Management of the Pediatric Neurocritical Care Patient. Semin Neurol. 2016 Dec;36(6):492-501. [PMC free article: PMC5369233] [PubMed: 27907953]
- 74.
- Abend NS, Chapman KE, Gallentine WB, Goldstein J, Hyslop AE, Loddenkemper T, Nash KB, Riviello JJ, Hahn CD., Pediatric Critical Care EEG Group (PCCEG) and the Critical Care EEG Monitoring Research Consortium (CCEMRC). Electroencephalographic monitoring in the pediatric intensive care unit. Curr Neurol Neurosci Rep. 2013 Mar;13(3):330. [PMC free article: PMC3569710] [PubMed: 23335026]
- 75.
- Peloquin S, Carley A, Bonifacio SL, Glass HC. The Neurointensive Care Nursery and Evolving Roles for Nursing. Neonatal Netw. 2016;35(2):87-94. [PubMed: 27052983]
Disclosure: Conrad Krawiec declares no relevant financial relationships with ineligible companies.
Disclosure: Maria Rosaria Muzio declares no relevant financial relationships with ineligible companies.
- Electrographic Seizures in Neonates with a High Risk of Encephalopathy.[Children (Basel). 2022]Electrographic Seizures in Neonates with a High Risk of Encephalopathy.Chen WH, Chan OW, Lin JJ, Chiang MC, Hsia SH, Wang HS, Lee EP, Wang YS, Kuo CY, Lin KL, et al. Children (Basel). 2022 May 24; 9(6). Epub 2022 May 24.
- Neonatal seizures: diagnostic updates based on new definition and classification.[Clin Exp Pediatr. 2022]Neonatal seizures: diagnostic updates based on new definition and classification.Kim EH, Shin J, Lee BK. Clin Exp Pediatr. 2022 Aug; 65(8):387-397. Epub 2022 Apr 4.
- Review Controversies regarding neonatal seizure recognition.[Epileptic Disord. 2002]Review Controversies regarding neonatal seizure recognition.Scher MS. Epileptic Disord. 2002 Jun; 4(2):139-58.
- Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures.[Arch Dis Child Fetal Neonatal ...]Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures.Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Arch Dis Child Fetal Neonatal Ed. 2008 May; 93(3):F187-91. Epub 2007 Jul 11.
- Review Neonatal seizures and neonatal epileptic syndromes.[Neurol Clin. 2001]Review Neonatal seizures and neonatal epileptic syndromes.Mizrah EM. Neurol Clin. 2001 May; 19(2):427-63.
- Neonatal Seizure - StatPearlsNeonatal Seizure - StatPearls
- PLCG1 [Alligator mississippiensis]PLCG1 [Alligator mississippiensis]Gene ID:102563626Gene
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