Publication Date: June 2020 (Volume 17, Number 06)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 6/01/2023.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional approval.
Neonatal seizures are associated with high morbidity and mortality, but they can be difficult to diagnose because they often present with subtle signs and symptoms. Initial management goals in the emergency department include patient stabilization, seizure cessation, and determination of the etiology; identification of life-threatening treatable causes of the seizures should be prioritized. Further management depends on the history and physical examination findings, laboratory testing results, and imaging studies. This issue reviews common presentations and causes of neonatal seizures, considerations for emergency department management, and the evidence regarding antiepileptic medications for neonates.
Excerpt From This Issue
An EMS team brings in a 5-day-old boy with a history of a rhythmic, left-arm-shaking episode at home. The parents tell you the pregnancy was normal and the birth was a full-term, normal spontaneous vaginal delivery. The baby had been doing well until yesterday, when he started eating less and not waking up for feeds. The baby has low tone with a tense anterior fontanelle, and his temperature is 35.8˚C (96.4˚F). What workup is warranted at this time?
A mother brings in her newborn daughter, with concern for abnormal movements. The girl was born at 34 weeks' gestation; she is now 3 weeks old. The mother says the baby will often stiffen and arch her back, and she is worried because there is a family history of epilepsy. The baby has no chronic lung disease or severe complications from prematurity. There have been no recent fevers or sick contacts. The baby has been falling off the growth curve despite high-calorie formula. She often spits up, which seems to make her uncomfortable. The mother brought in a video that captures one of the episodes. You watch the video and see 10 seconds of full-body stiffening, reddening of the face, and significant back arching. The baby has a normal neurologic examination with normal tone, reflexes, and a soft, flat anterior fontanelle. Could this be a seizure disorder? What other diagnoses are on your differential?