A: There are numerous conditions that can cause seizures in a baby. It is important to remember that seizures are abnormal electrical discharges in the baby’s brain due to an underlying cause. Treating the underlying cause often can alleviate the seizures. In many cases, seizures can be caused by birth injuries, such as those listed below.
Common Causes of Neonatal Seizures
Intracranial hemorrhage: This includes intraventricular, intracerebral, subdural, and subarachnoid hemorrhages. Treatment of intracranial bleeds mostly is supportive, although surgical intervention may be necessary in certain instances, as in the management of subdural hematomas.
When a baby suffers brain damage, the damage can extend to nerves in the brain and can also cause problems with the brain’s chemistry. This can cause the baby to have seizures. Approximately 30% of babies admitted to a neonatal intensive care unit (NICU) are at risk of developing neurological complications that can cause seizures. Since many babies have silent seizures, it is crucial to identify babies at risk so they can be very closely monitored.
Hypoxic-ischemic encephalopathy (HIE): This is the most common cause of neonatal seizures. HIE occurs as the result of oxygen deprivation, either involving a lack of blood flow or a lack of oxygen in the blood. When this happens, there is a cascade of events that can lead to uncontrolled electrical activity in the brain. Seizures resulting from HIE usually occur within the first 24 hours of life.
When a baby has HIE (especially if the HIE is moderate or severe), admittance to the NICU is necessary. Major goals include keeping the baby’s temperature, blood pressure, and heart rate stable. In addition, staff should:
- Maintain adequate ventilation (avoidance of too much or too little oxygen)
- Maintain adequate blood flow to the brain and organs
- Maintain normal metabolic status (baby’s nutrition should be kept up and blood sugar status should be kept normal)
- Avoid fluid overload in the brain (brain edema)
A baby with HIE should also be given brain cooling (hypothermia) treatment. Hypothermia is the only effective neuroprotective therapy currently available for treatment of HIE. With this type of treatment, the baby’s brain is cooled down to a few degrees below normal. The treatment should begin within six hours after birth (or after injury) and may last up to 72 hours.
Stroke: A stroke is caused by blood flow to the brain becoming blocked or restricted. Trauma to the head, which can be caused by forceps or vacuum extractors, is one cause of stroke. Treatment of a stroke must occur immediately. Physicians must take actions to ensure that the baby has adequate oxygen and good circulation. IV fluids and anti-clotting medications may be given to reduce the risk of the baby having another stroke. Hypothermia treatment may improve neurological outcome after a stroke, and this can help prevent seizures.
Brain infections: Infection of the central nervous system is a common cause of neonatal seizures and should be treated with broad-spectrum antibiotics. These types of infections include meningitis, encephalitis (including herpes encephalitis (HSV)), and cytomegalovirus.
Metabolic problems, such as hypoglycemia: Metabolic problems are a treatable common cause of seizures, and testing for these disturbances is very easy. Hypoglycemia should be corrected immediately with a glucose solution given through an IV. Maintenance glucose treatments can be given after the fist treatment. Hypocalcemia is when there is low calcium in the baby’s blood. This can easily be treated with calcium gluconate or calcium chloride. Hypomagnesemia occurs when the magnesium level in the baby’s blood is too low, and it is often associated with hypocalcemia. The treatment is to give the baby a solution of magnesium sulfate, which can be repeated until normal magnesium levels are achieved.
Hydrocephalus and similar brain problems: Hydrocephalus is swelling of the brain’s ventricles caused by too much cerebral spinal fluid (CSF). This can be treated by placing a shunt that directs flow from an area of CSF build up to the baby’s abdominal cavity, where it can be absorbed into the baby’s circulation. Magnesium sulfate may help improve outcomes in babies with hydrocephalus due to the fact that it increases circulation in the brain and helps protect the brain.
Trauma to the baby’s brain during delivery: This can cause brain bleeds, which are a significant risk factor for seizures. Traumatic injury can occur when labor is prolonged, forceps or vacuum extractors are used, labor induction drugs (such as Pitocin and Cytotec) are used, or the baby is in an abnormal position (such as breech or face presentation).
Fetal distress: Anything that causes the baby to be deprived of sufficient oxygen can cause fetal distress, which is a major cause of seizures.
Problems with the placenta or uterus, such as a ruptured uterus or placenta previa: The placenta contains blood vessels that carry oxygen-rich blood to the baby through the umbilical cord. Anything that interferes with the baby receiving sufficient oxygen can cause HIE and seizures. For more information on the transfer of maternal oxygen to the baby, click here.
Umbilical cord issues: Similarly to issues with the placenta and uterus, anything that interferes with the passage of oxygenated blood through the umbilical cord can be very dangerous to the baby, and potentially cause seizures. Some examples of complications involving the umbilical cord include nuchal cord and cord prolapse.
Trusted Birth Injury and Seizure Attorneys
The long-term effects of neonatal seizures can be devastating. It’s especially tragic when the circumstances surrounding the underlying cause of the seizures may have been preventable. If your child suffers from a permanent disability and you believe there may have been mistakes made during labor and delivery, Reiter & Walsh ABC Law Centers can help.
Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases since 1997, and most of his cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. Our lawyers 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).
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