Neonatal Seizures

Seizures are a frequent neonatal emergency associated with a high degree of morbidity and mortality. Seizure is the presenting symptom of a wide range of underlying pathologies. Neonatologists should be comfortable with forming a differential diagnosis, rapidly initiating preliminary evaluation, starting emergency treatment, and recognizing when subspecialty consultation is required. Seizures in the newborn may be secondary to electrolyte abnormalities, the harbinger of underlying brain injury, or the initial presentation of an underlying epilepsy. A high level of clinical suspicion and the use of electroencephalography (EEG) are necessary to distinguish a seizure from its mimickers. Once diagnosed, investigation of underlying seizure etiology should proceed in parallel with treatment. Neonatal seizures are often associated with developmental disabilities, which are driven by both underlying etiology and the burden of seizures. This chapter summarizes the identification of neonatal seizures and their common mimics, the role of neurophysiology studies, evaluation for underlying etiology, neonatal seizure management and prognosis, with a goal of providing a useful and practical resource for the general neonatologist.