Neonatal seizures
Neonatal seizures need highly specialised care. The priority is to stop the seizures quickly.
When possible, identify and treat the cause of the neonatal seizure. The most common causes are hypoxic-ischaemic encephalopathy, intracranial haemorrhage and perinatal ischaemic strokes. Treatable causes include meningitis, hypoglycaemia, hypocalcaemia, electrolyte disturbances and metabolic conditions. Some neonatal seizures are familial and benign, so ask about the family history.
As first-line treatment for controlling seizures, use:
phenobarbital (phenobarbitone) 15 to 20 mg/kg intramuscularly or intravenously, followed by phenobarbital 3 to 5 mg/kg intravenously or orally, daily. After 3 days, stop therapy if the baby has normal neurological examination, electroencephalogram and magnetic resonance imaging and has not had more seizures. neonatal seizures phenobarbital (phenobarbitone) phenobarbital (phenobarbitone) phenobarbital (phenobarbitone)
If a cause is not apparent, consider the rare syndrome of pyridoxine-dependent seizures, and give pyridoxine under expert advice. A typical regimen is:
pyridoxine 50 to 100 mg intramuscularly or intravenously, as a single dose. If seizures do not stop, repeat the dose every 5 to 15 minutes to a maximum total dose of 500 mg. neonatal seizures
If the baby responds favourably to pyridoxine, treatment must continue for life. Use:
During an acute febrile illness, the pyridoxine dose should be doubled for several days to prevent an exacerbation of seizures.