Neonatal Convulsions: Etiologies and Management

Causes and Etiologies

Hypoxic-ischemic injury is the dominant cause of neonatal seizures, accounting for 46-65% of cases, with 90% of these seizures occurring within the first 2 days of life, according to the American Academy of Pediatrics 1
Hypoxic-ischemic encephalopathy (HIE) is the primary etiology, predominantly presenting in the first 48 hours after birth, as stated by the American Academy of Pediatrics 1
Intracranial hemorrhage and perinatal ischemic stroke combined account for 10-12% of cases, as reported by the American Academy of Pediatrics 1
Metabolic derangements, including hypoglycemia, hyponatremia, hypocalcemia, and hypomagnesemia, are also potential causes, according to the Society of Critical Care Medicine 2

Ensure patent airway, adequate breathing, and circulation; monitor heart rate, blood pressure, temperature, and oxygen saturation continuously, as recommended by the American Heart Association 3
Point-of-care glucose must be checked immediately to exclude hypoglycemia, according to the Society of Critical Care Medicine 2
Electrolytes, including sodium, calcium, and magnesium, should be monitored, as stated by the American Academy of Pediatrics 3
Head ultrasound is the initial bedside imaging if the infant is unstable or MRI is unavailable, as recommended by the American Academy of Pediatrics 3
MRI with diffusion-weighted imaging is the gold standard for identifying etiology, according to the American Academy of Neurology 3

Establish IV/IO access immediately, as recommended by the Society of Critical Care Medicine 2
Correct hypoglycemia with D10%-containing isotonic IV solution at maintenance rate, according to the Society of Critical Care Medicine 2
Correct hypocalcemia and hypomagnesemia before initiating anticonvulsants, as stated by the Society of Critical Care Medicine 2
Treat suspected infection with empirical antibiotics, according to the Infectious Diseases Society of America 2

Do not perform lumbar puncture in comatose infants without experienced physician evaluation, due to the risk of herniation, as warned by the British Medical Journal 4