Neonatal (Infant) Seizures: Causes, Diagnosis, Treatment, and What to Do Next
Seizures are involuntary jerking movements caused by abnormal electrical patterns in the brain from brain damage or problematic neurochemistry. Neonatal seizures – seizures in a baby – are often subtle and difficult to identify.
They can be caused by a number of factors, including hypoxic-ischemic encephalopathy (HIE), infections in newborns, and birth trauma. HIE, which is an injury which occurs when a baby does not get enough oxygen, is the most common cause. Seizures can also worsen the baby’s existing brain injury. However, seizures can be prevented if the underlying health condition or complication is addressed and promptly treated before the brain is injured.
- What are infant seizures?
- Causes of neonatal seizures
- Diagnosing infant seizures
- Treatment for infant seizures
- What do I do if my baby has a seizure?
- Get legal help for infant seizures
- Video: seizures in babies
What are infant seizures?
Although seizures are often associated with involuntary jerking movements, the signs of a seizure in an infant may be difficult to recognize, and vary based on the type of seizure a baby is having. Most infant seizures are considered “subclinical,” or subtle, which means that these babies do not have any obvious signs of seizure unless it’s seen on an electroencephalogram (EEG) monitor. Continuous EEG monitoring is critical for newborns at high risk of seizures.
The most common types of clinical seizures (i.e. those that come with clearer signs) in newborns are focal-clonic, focal-tonic, certain types of myoclonic, and epileptic spasms. (Please note that there are a variety of different systems used to classify infant seizures, and classification methods have changed over time. This is just one example.)
- Focal clonic seizures are characterized by repetitive, rhythmic movements in the limbs, face, and/or trunk. The repetition is usually slow, especially when larger muscle groups are involved.
- Focal tonic seizures are not as frequent as focal clonic seizures. They may involve unusual posturing of the trunk or extremities or abnormal movement of the eyes.
- Myoclonic seizures may involve contractions of muscle groups in the limbs, trunk, diaphragm, or face. The speed of movement varies depending on how large of muscles are involved. These seizures can be isolated events or repetitive.
- Epileptic spasms in neonates are relatively rare, and mostly involve muscles in the trunk and limbs. These seizures may come in clusters, and most often occur when the infant wakes up.
Causes of infant seizures
Neonatal seizures can be caused by a number of things, including the following birth injuries:
Seizures from hypoxic-ischemic encephalopathy (HIE)
Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. HIE is a medical condition in which a newborn does not get enough oxygen at or around the time of birth. There are many labor and delivery emergencies that could cause HIE and seizures. Some include cord compression, problems with the placenta or uterus such as a ruptured uterus or placenta previa, fetal distress, and/or prolonged labor. All of these issues can potentially deprive the baby of oxygen, which can lead to brain injury and subsequent seizures. Medical staff must plan appropriately for these kinds of obstetrical risks. They must also effectively handle situations that may arise during labor and delivery and deliver the baby in time in order to prevent the risk of HIE. If doctors or other healthcare professionals fail to do these things or act according to the standard of care, it is considered medical malpractice.
Seizures from infection
Infections in newborns that can cause seizures include sepsis, meningitis, herpes encephalitis, cytomegalovirus, and toxoplasmosis. The most common bacterial infections include Escheria coli (E. coli) and Streptococcus pneumoniae. While infants may become infected after delivery, newborn infections are often the result of an undetected and untreated infection in the mother that is transmitted to the baby through the birth canal (called vertically-transmitted infections). It is the healthcare provider’s responsibility to screen for various infections during the pregnancy and appropriately treat them. It may be considered malpractice if the doctor or medical staff fail to timely diagnose and treat a maternal infection and/or newborn infection and it leads to seizures and brain injury in a baby.
Seizures from traumatic brain injury
Traumatic birth injuries can result from a problem with the size or position of a fetus relative to the birth canal. For example, sometimes a baby’s head is too large for the mother’s pelvis (cephalopelvic disproportion) or the baby may just be very large overall (macrosomic). Traumatic brain injuries can also occur from the use of instruments like forceps or vacuum extractors during vaginal deliveries, or from prolonged labor and delivery. Babies who sustain traumatic brain injuries during the birthing process often have intracranial hemorrhages (brain bleeds), seizures, and a number of other complications. Again, it is the responsibility of the doctor or another healthcare provider to prenatally check and plan for these types of obstetrical problems.
Diagnosing infant seizures
The primary diagnostic test for verifying seizure activity and determining the part of the brain affected is an electroencephalogram (EEG). During an EEG, electrodes are temporarily attached to the baby’s head. The electrodes read the electrical activity of the baby’s brain and show the changes that occur over time. The results appear on-screen as well as on printed strips.
If anyone on the medical team witnesses signs of a seizure, such as the baby’s body going limp, the baby losing consciousness, or the baby staring and/or making bicycle “pedaling” movements, they must immediately start EEG monitoring. Devices that monitor the baby’s breathing, heart rate, and blood pressure can also alert the team that a baby is experiencing a seizure. If a seizure is diagnosed, the underlying cause must be found and treated in a timely fashion.
Treatment for infant seizures
When neonatal seizures occur, they must be treated immediately because even a single seizure can cause or worsen brain damage. Doctors must find what’s causing the seizures and address the issue quickly.
If doctors suspect that a baby has seizures due to not getting enough oxygen during or near the time of delivery (HIE), hypothermia therapy (brain cooling treatment) should be given to help minimize or attempt to prevent permanent brain injury. Treatment must be initiated within six hours of the injury for best results. In addition to finding and treating the underlying cause of seizure activity, many physicians give anti-epileptic medications to try to stop seizures from occurring. This is important because the longer the seizures last and the more frequently they occur, the more likely they are to cause permanent brain damage.
What do I do if my baby has a seizure?
It is imperative that babies with seizures receive prompt medical care and anti-seizure medications. In addition, there are certain steps parents can take during a seizure if there is no medical professional with them. These general precautions were taken from the Epilepsy Foundation website (they also provide more specific advice for dealing with certain types of seizures):
- Remain with the baby until the seizure is over
- Move hard objects (which may cause injury) out of the way
- Place the baby on a soft surface (special attention should be given to making sure that the head is protected)
- Make sure that nothing goes into the baby’s mouth
- Turn the baby to their side, with their mouth pointed toward the ground. This stops saliva from blocking the airway and helps with breathing.
- Time how long the seizure lasts
Additionally, if your baby has a history of seizures, administer anti-seizure medication as prescribed by a doctor.
Many parents want to know under which circumstances they should call 911 if their child is having a seizure. This depends on individual health circumstances, including what type of seizure they are having. If a child is having their first ever seizure, parents should always call 911. After the initial seizure, you can talk to your child’s doctor about the circumstances under which you should seek emergency medical attention for possible future seizures. The doctor’s advice should be based on individual factors (such as the type of seizure they have had) and may be different for different patients.
The CDC website recommends seeking medical attention if any of the following are true. Please keep in mind that these are very general recommendations, and your child’s doctor may tell you additional signs to watch out for.
- This is the person’s first seizure
- The seizure lasts more than five minutes
- The person has two seizures closely spaced together
- The person is struggling to breathe or not waking up after the seizure is over
- The person is hurt during the seizure (for example, if they hit their head on a hard surface)
- The seizure occurs in water
- The person has a health condition like diabetes or heart disease (pregnancy also qualifies)
Disclaimer: This page is intended solely as an educational tool for parents. It is not intended as – and should not be mistaken for – medical advice. If you have any medical concerns about your baby – such as seizures – please seek medical attention immediately. Neonatal seizures are a condition that must be evaluated by a medical professional.
Get legal help for infant seizures
Newborn seizures can be an indication of serious neurological damage from a number of birth-related injuries. If your baby or child suffers from seizures that began around the time of birth, contact ABC Law Centers. Our award-winning attorneys have helped dozens of children affected by seizures. Jesse Reiter, the firm’s president, has been focusing on birth injury cases his entire legal career, and most of Jesse’s cases involve helping children who have seizure disorders, cerebral palsy, and hypoxic-ischemic encephalopathy (HIE).
To find out if you have a case, contact our firm to speak with an experienced lawyer. We are based in Michigan, but handle cases all over the United States. Additionally, our team handles cases involving military hospitals and federally-funded clinics.
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Video: Seizures in a baby (neonatal seizures) and birth injury
- Can Infant Seizures Cause Brain Damage or Other Long Term Effects?
- What Causes Seizures in Babies?
- HIE and Seizures
- What Causes Epilepsy and Seizures?
- UptoDate: Neonatal Seizures: Clinical Features, Evaluation, and Diagnosis
- UptoDate: Neonatal Seizures: Etiology and Prognosis of Neonatal Seizures
- Medscape: Neonatal Seizures
Disclaimer: Please know that our website is owned by a medical malpractice law firm that focuses exclusively on birth injury cases. We try to provide useful medical information to our readers, but we cannot provide treatments or medical advice. If you think your child may be having a seizure, please call 911/your country’s emergency number or your doctor.