Management of Neonatal Seizures

Immediate Actions During Active Seizure

The American Academy of Pediatrics recommends positioning the newborn on their side in the recovery position to reduce aspiration risk during active seizure activity 1
The American Heart Association suggests clearing the area around the infant to prevent injury 1
The American Academy of Pediatrics advises against placing anything in the mouth or attempting oral glucose/medications during the seizure, as this causes more harm 1
The American Academy of Pediatrics recommends not restraining the seizing infant 1
The American Heart Association suggests maintaining airway patency and providing high-flow oxygen 1
The American Heart Association recommends activating emergency services immediately for any newborn with seizure, particularly infants under 6 months of age 2

The American Academy of Pediatrics recommends using blood gas analyzers with glucose modules for most accurate measurements, as handheld glucose meters have significant accuracy concerns in newborns due to interference from high hemoglobin and bilirubin levels 3
Critical hypoglycemia thresholds requiring immediate intervention include a single measurement <1 mmol/L (18 mg/dL), glucose <2 mmol/L (36 mg/dL) that remains low at next measurement, or any glucose <2.5 mmol/L (45 mg/dL) in a newborn with abnormal clinical signs like seizures 3

The American Academy of Pediatrics recommends providing D10%-containing isotonic IV solution at maintenance rate to deliver age-appropriate glucose (8 mg/kg/min in newborns) 4

The Society of Critical Care Medicine suggests checking ionized calcium concentration as part of the diagnostic workup 4
The Society of Critical Care Medicine recommends calcium replacement to normalize ionized calcium concentration if hypocalcemia is confirmed 4

The American Academy of Pediatrics recommends monitoring hourly capillary glucose, heart rate, respiratory rate, blood pressure, and neurologic status after seizure cessation 1
The American Academy of Pediatrics suggests repeating laboratory tests (electrolytes, blood glucose, blood gases) every 2-4 hours 1
The American Academy of Pediatrics recommends providing oral carbohydrates to prevent recurrence once the infant is awake and able to swallow safely 1
The American Heart Association suggests that if the newborn does not return to baseline within 5-10 minutes after seizure stops, this requires continued emergency medical intervention 2

The American Academy of Pediatrics advises against attempting oral glucose during active seizures, as this is contraindicated and dangerous 1
The Society of Critical Care Medicine recommends avoiding over-treating calcium, as toxicity may occur with elevated concentrations 4