Neonatal seizures occur in babies during the first 28 days after birth and are often a sign of neurological dysfunction. They can be caused by various disorders and diseases, including metabolic disorders, infections, and genetic diseases. Antiepileptic drugs are used to treat seizures, and diagnostic tests are conducted to determine the cause.
Neonatal seizures are seizures that occur in a baby during the first 28 days after birth. If the baby was born prematurely, the neonatal period is longer and in a preterm baby it extends to 44 weeks after the date of conception, regardless of the date of birth. Fewer than half of newborns who have seizures will continue to have seizures later in life, but newborn seizures are often a sign of neurological dysfunction. They are a risk factor for neonatal mortality and the development of a cognitive or physical disability.
Seizures occur when a large group of neurons depolarize at once. Depolarization means that neurons have cell membrane changes that alter their net charge, causing cells to transmit abnormal electrical signals to one another. The result of this is a change in the electrical activity in these cells, temporarily preventing normal functioning. Different types of seizures result, depending on the pattern of abnormal electrical activity.
Neonatal seizures occur most frequently in the first 10 days after birth. Infants who have seizures often fail to thrive, are lethargic between seizures, and appear to be generally ill. Many newborns appear neurologically normal between attacks; when abnormalities are noted, they are likely to be associated with a particular neurological syndrome.
There are many disorders and diseases that can cause newborn seizures. These include metabolic disorders, infections, convulsive syndromes and genetic diseases. A common cause of seizures in newborns is ischemia, a lack of oxygen. Ischemic seizures occur when the brain is deprived of oxygen and can develop in both premature and full-term infants, most often in the first three days after birth. Another frequent cause is intracranial hemorrhage, a condition more common in premature infants.
Neonatal intracranial infections such as encephalitis and meningitis are an important cause of early neonatal seizures. Metabolic disorders that could cause seizures include dangerously low levels of blood glucose, calcium, and magnesium. These disorders most often cause neonatal seizures after the first three days. Brain deformities are a rare cause of seizures in newborns; abnormal brain structure typically causes seizures later in life, but some structural disorders can cause seizures within the first 28 days.
Seizures that occur in newborns are often treated with antiepileptic drugs even if a diagnosis has not been made. The child is then monitored for several months to determine when the drug can be safely stopped. Diagnostic tests might include an EEG to monitor patterns of electrical activity in the brain and blood tests to examine brain and body chemistry. Most children also receive additional follow-up care to determine whether the seizures are an isolated event or part of a syndrome or disorder.
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