Neonatal Seizures (Infant Seizures) and Birth Injury
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.
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, and birth trauma. HIE and fetal oxygen deprivation are the most common causes. Neonatal seizures can also worsen existing brain damage.
What are neonatal seizures?
Seizures occur from abnormal electrical discharges in the brain, which can be due to brain damage, malformations, or chemical imbalances (1). Seizures can affect normal brain functioning and consciousness. In newborns, seizures must be immediately diagnosed and properly treated in order to prevent permanent harm. In addition to being a sign of existing brain damage, seizures can also cause further brain damage.
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 neonatal seizures are considered “subclinical,” or “subtle,” which means that these babies do not have any obvious signs of seizure besides those seen when doing electroencephalogram (EEG) monitoring. Therefore, 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 neonates are focal-clonic, focal-tonic, certain types of myoclonic, and epileptic spasms (2). (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 neonatal 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 (HIE or birth asphyxia) is the most common cause of neonatal seizures (3). HIE is a medical condition in which a newborn has been deprived of oxygen at or around the time of birth. Some of the medical emergencies that could result in HIE and seizures include cord compression, problems with the placenta or uterus such as a ruptured uterus or placenta previa, fetal distress, and prolonged labor. Medical staff must plan appropriately for these kinds of obstetrical risks. Furthermore, they must effectively handle situations that may arise during delivery in order to minimize the possibility of HIE. Failure of doctors or other healthcare professionals to do these things could be considered negligence.
Seizures from infection
Neonatal infections that can cause seizures include meningitis, herpes encephalitis, cytomegalovirus, and toxoplasmosis. The most common bacterial infections include Escheria coli (E. coli) and Streptococcus pneumoniae (4). While infants may become infected after delivery, neonatal 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 doctor’s or other healthcare provider’s responsibility to screen for various infections during the pregnancy and appropriately treat them.
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). Again, it is the responsibility of the doctor or another healthcare provider to prenatally check and plan for these types of obstetrical problems. 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.
Diagnosing neonatal 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 brain and show the changes that occur over time. The results appear on-screen as well as on printed strips.
What do you do if a baby has a seizure?
It is imperative that babies with seizures receive prompt medical care. 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.
Legal help for neonatal seizures
Michigan birth injury lawyers with a national presence
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 Reiter & Walsh 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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- What Causes Epilepsy and Seizures? (n.d.). Retrieved December 3, 2018, from https://www.epilepsy.com/learn/about-epilepsy-basics/what-causes-epilepsy-and-seizures
- (n.d.). Retrieved December 3, 2018, from https://www.uptodate.com/contents/clinical-features-evaluation-and-diagnosis-of-neonatal-seizures
- (n.d.). Retrieved December 3, 2018, from https://www.uptodate.com/contents/etiology-and-prognosis-of-neonatal-seizures
- Neonatal Seizures. (2018, August 09). Retrieved December 3, 2018, from https://emedicine.medscape.com/article/1177069-overview#a5