55 - Seizures in Neonates

Abstract

Seizures in the newborn infant represent the most distinctive frequent manifestations of neurologic disease in the neonatal period. The incidence of seizures varies with gestational age and birth weight and is most common in the very low birth weight (VLBW) infant. Estimated incidences are 58/1000 live births in the very low birth weight (VLBW) infant and 1-3.5/1000 live births in the term infant. Compared to seizures at later developmental stages, seizures in the newborn differ in their clinical appearances, electrographic characteristics, etiologies, management, and outcomes. Since the majority of seizures during the newborn period are acute symptomatic seizures due to cerebral injury or dysfunction, seizures are an important manifestation to alert the clinician to underlying neurologic disorders. However, recognition of seizures in the newborn period can be very difficult due to subtle or absent clinical manifestations. To assist in both the accurate identification of seizures in the newborn and successful treatment with antiepileptic drug therapy, electrophysiologic monitoring—either conventional or limited channel monitoring—now plays a critical role within the neonatal intensive care unit. Treatment of neonatal seizures is generally considered necessary since experimental and human evidence suggest seizures may lead to secondary brain injury and are associated with less favorable outcomes. However, anti-seizure medications may have associated risks, and there are few data to guide evidence-based management. This chapter reviews the pathophysiology and clinical aspects of neonatal seizures with particular emphasis on the influence of the developmental characteristics of the immature brain.