Management of Neonatal Seizures

Diagnostic Approach

The American College of Radiology recommends urgent neuroimaging, including head ultrasound as initial bedside imaging if the infant is unstable or MRI is not immediately available, and MRI with diffusion-weighted imaging as the gold standard to identify etiology 1, 2
The American Academy of Pediatrics suggests that laboratory investigations, including complete blood count, electrolytes, glucose, calcium, and magnesium, should be performed 3
Blood culture should be considered if infection is suspected, according to the American College of Radiology 2
Metabolic screening and genetic testing should be considered if no clear etiology is found, as recommended by the American College of Radiology 1

The American Academy of Pediatrics recommends ensuring patent airway, adequate breathing, and circulation, and monitoring vital signs, including heart rate, blood pressure, temperature, and oxygen saturation 3
Establishing IV access for medication administration and blood sampling is essential, according to the American College of Radiology 1
For drug withdrawal-associated seizures, the specific treatment may vary based on the drug of exposure, as suggested by the American Academy of Pediatrics 4, 5
Prophylactic use of antiseizure medications in neonates without confirmed seizures is not recommended, according to the International Journal of Stroke 3

The prognosis depends primarily on the underlying etiology, as stated by the American College of Radiology 1, 2
Absence of major cerebral lesions on MRI is highly predictive of normal neurological outcome, according to the American College of Radiology 2