When a newborn baby begins to have seizures, parents wonder what is causing the seizures, how neonatal seizures are treated, if seizures mean the baby has a brain injury, and if the baby will have lifelong problems. Parents also want to know if the medical team did something wrong during or near the time of birth that caused the baby to have a brain injury, resulting in seizures. Seizures are caused by abnormal electrical discharges in the brain. These discharges are due to nerve damage or problems with the brain’s chemistry, which can be caused by a brain injury. Some common causes of neonatal seizures are listed below:
1. The most common cause of neonatal seizures is hypoxic ischemic encephalopathy (HIE), which is a brain injury caused by a lack of oxygen in the baby (hypoxia) and reduced blood flow (ischemia) in the baby’s brain. HIE is often caused by an injury to the baby that takes place during or close to the time of labor and delivery. HIE can cause permanent brain damage and lifelong conditions such as cerebral palsy, developmental delays and learning disabilities.
2. Brain bleeds (extracranial and intracranial hemorrhages) can also cause neonatal seizures. Common hemorrhages in babies include subarachnoid, subdural, subgaleal and intraventricular hemorrhages (IVH). Intraventricular hemorrhages are more common in premature babies and are caused by bleeding in the germinal matrix (an area next to the ventricles that gives rise to neurons and glial cells during development). Brain bleeds can be caused by the following:
- Oxygen deprivation and hypoxic ischemic encephalopathy (HIE)
- Head trauma during delivery, which can be caused by the use of forceps or vacuum extractors
- Prolonged labor, especially if Pitocin or Cytotec are used
3. Infections such as sepsis and meningitis can cause neonatal seizures. Maternal infections can be transmitted to the baby at birth, causing the baby to become infected. Untreated and mismanaged Group B strep, herpes simplex virus, bacterial vaginosis (BV), urinary tract infections (UTI) and chorioamnionitis can cause an infection in the baby that results in sepsis and meningitis.
4. Hypoglycemia (low blood sugar) is another cause of neonatal seizures. Hypoglycemia is very easy to diagnose and treat. It is common in babies born to mothers who have diabetes and babies who have hypoxic ischemic encephalopathy and/or are small for gestational age. Prolonged or recurrent hypoglycemia can cause permanent brain damage.
5. An ischemic stroke can cause seizure activity in a baby. Babies who have low blood pressure – which often occurs when a baby is experiencing oxygen deprivation – are susceptible to strokes. In fact, strokes and hypoxic ischemic encephalopathy often occur together. Seizures caused by a stroke may cause apnea (periods in which breathing stops) in the baby.
IS IT POSSIBLE THE NEONATAL SEIZURES WERE CAUSED BY MEDICAL NEGLIGENCE?
Neonatal seizures are often caused by birth injuries, which are injuries occur during birth, shortly before birth, or shortly after delivery, when the baby is in the neonatal ICU. Hypoxic ischemic encephalopathy (HIE) is often caused by a lack of oxygen in the baby’s brain during labor and delivery, or shortly before labor. The obstetrician is supposed to perform regular prenatal tests to ensure the health of the baby. If any fetal distress is noted or there is a condition (i.e., preeclampsia) that can cause the baby to receive insufficient oxygen-rich blood, the baby should be placed under close observation and an early delivery may be indicated to prevent the baby from staying in suboptimal intrauterine conditions longer than she has to.
During labor and delivery, the baby’s heart rate should be continuously monitored with a fetal heart rate monitor. If a baby begins to experience oxygen deprivation, this will be reflected in the fetal heart tracings as “nonreassuring tracings.” Once nonreassuring tracings occur, the baby must be delivered immediately by emergency C-section, in most cases. A delayed delivery can cause oxygen deprivation to be prolonged, resulting in hypoxic ischemic encephalopathy (HIE), which often causes neonatal seizures and brain damage.
Listed below are high-risk conditions that can cause oxygen deprivation, hypoxic ischemic encephalopathy (HIE) and resultant neonatal seizures. Almost all of these obstetrical conditions require prompt delivery.
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord and cord in a true knot
- Ruptured uterus
- Preeclampsia / eclampsia
- Placental abruption
- Placenta previa
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis. This can greatly decreases the supply of oxygen-rich blood going to the baby, causing birth asphyxia.
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM) / premature birth
- Prolonged and arrested labor
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Sometimes intense contractions (hyperstimulation) caused by labor induction drugs (Pitocin and Cytotec) can cause head trauma. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put the baby at risk of experiencing birth trauma and birth asphyxia.
- Hyperstimulation caused by Pitocin and Cytotec can also cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome
- Placental insufficiency and intrauterine growth restriction (IUGR). Babies with IUGR often do not tolerate labor well.
Other conditions that, if mismanaged, can cause brain injury and seizures in a baby include the following:
- Improper management of the baby’s respiratory status after birth. This includes failure to properly manage apnea (periods of breathing cessation), failure to properly manage a baby on a breathing machine (which can cause overventilation injuries, such as hypocarbia and a hole in the lungs), and failure to give proper amounts of surfactant, which helps with lung maturity and lung compliance in premature lungs.
- Improperly treated high bilirubin levels (jaundice) that cause a form of brain damage called kernicterus.
- Improperly treated neonatal hypoglycemia (low blood sugar).
- Brain infection such as meningitis, which can be caused by infections in the mother that travel to the baby at birth. These maternal infections include the following: Group B Strep (GBS), herpes simplex virus (HSV), urinary tract infection (UTI), bacterial vaginosis (BV) and chorioamnionitis.
HOW ARE NEONATAL SEIZURES TREATED?
Babies at risk of having seizures and that have had a seizure must be closely monitored. Sometimes the only sign of seizure is activity on an EEG (electroencephalography – brain activity monitoring). Cardiopulmonary monitoring devices may also alert the medical team that the baby may be having a seizure. One sign of a neonatal seizure is apnea, and monitoring devices can detect this. In addition, respiratory rate and heart rate may change during a seizure, which also can be detected on a monitor. Sometimes a seizure can be observed. If anyone on the medical team witnesses signs of a neonatal seizure, such as the body going limp, the baby losing consciousness, or the baby staring and / or making bicycle “pedaling” movements, EEG monitoring and diagnosis of seizure activity must promptly take place.
Treatment of neonatal seizures first involves identifying and treating the underlying cause. Thus, for example, if a baby has high bilirubin levels (jaundice) or hypoglycemia, the bilirubin levels and blood sugar levels must be normalized. While the medical team is working on finding and treating the underlying cause of the neonatal seizures, seizure medication may need to be given right away. If an underlying cause is found and treated, the seizure medication may be able to be stopped. Phenobarbital is the most frequently used initial drug for seizure activity that is epileptic in origin. Other seizure medications include diazepam, lorazepam and phenytoin. Very close monitoring must occur if seizure medication is given because the drugs can be dangerous. In addition to standard monitoring, blood levels of the drugs must be monitored, as well as liver and kidney function.
Failure to timely diagnose and treat seizure activity is negligence, and this includes failure to treat the seizure’s underlying cause. Failure to properly monitor a baby that is given medication, and failure to properly administer neonatal seizure medications can be dangerous and negligent. If this negligence leads to injury in the baby, it is medical malpractice.
AWARD WINNING BIRTH INJURY / HYPOXIC ISCHEMIC ENCEPHALOPATHY LAWYERS HELPING CHILDREN WITH BIRTH INJURIES SUCH AS CEREBRAL PALSY & SEIZURES FOR ALMOST 3 DECADES
If you are seeking the help of a neonatal seizure lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, neonatal seizures or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.
VIDEO: BIRTH INJURY LAWYERS DISCUSS NEONATAL SEIZURES
Watch a video of neonatal seizure lawyers Jesse Reiter and Rebecca Walsh discussing common causes of neonatal seizures: birth asphyxia and hypoxic ischemic encephalopathy (HIE).