Management of Convulsions in Newborns

Diagnostic Evaluation

Measure blood glucose with a glucose oxidase strip in any newborn who is actively convulsing or unrousable 1
Assess for signs of meningitis, systemic illness, or altered mental status that would necessitate further investigation 2
For newborns with seizures, a lumbar puncture should almost always be performed, especially if under 12 months of age, to rule out meningitis 2
Perform lumbar puncture if any of the following are present: signs of meningism, complex convulsion, excessive drowsiness/irritability, systemic illness, or age less than 12 months 2
Brain imaging (CT or MRI) may be necessary before lumbar puncture if the newborn is comatose, to avoid the risk of brain herniation 2

EEG is not routinely indicated for all neonatal seizures but may be valuable for monitoring treatment response in refractory cases 1