Neonatal seizures are unusual electrical activity in the brain that happen in the first 28 days of life. They’re often a sign of serious underlying conditions that may require long-term treatment and may be life threatening.

close up of hands of mother and newborn baby who has neonatal seizures-1Share on Pinterest
Halfpoint Images/Getty Images

Seizures happen when there are changes in electrical activity in the brain. Neonatal seizures are seizures that occur during the first 28 days of life for a full-term infant or what would be 44 weeks of gestation for babies born early.

One of the most common medical emergencies in infants, neonatal seizures may be difficult to identify in children this age because the symptoms may be subtle.

Because neonatal seizures are one of the most common signs of neurological difficulties in a baby, determining their cause is key to understanding what conditions an infant has and the best way to treat them.

Learn more about seizures.

Neonatal seizures may be generalized, affecting the entire body; focal, affecting one area or limb; or multifocal, affecting more than one limb.

There are four main types of neonatal seizures:

Subtle seizures

Some infants with neonatal seizures have unusual movements, sometimes called “subtle seizures.” More common in full-term infants, these movements include behaviors such as:

  • Mouth movements: chewing, protruding tongue, smacking, sucking
  • Eye movements: eye roving or rolling, blinking or fluttering, staring, random or uncontrolled eye movements
  • Body movements: feet and leg pedaling, thrashing, struggling, long pauses between breaths

Subtle seizures may not always show on an electroencephalograph (EEG); however, they’re generally a sign of some condition that affects the function or structure of the brain.

Clonic seizures

Clonic seizures involve one or both sides of the body or one arm or leg. They are are fast, jerky movements and usually produce electrical evidence that shows up on an EEG exam.

Tonic seizures

Tonic seizures may affect the entire body or only one arm or leg. They’re characterized by sudden stiffening. Tonic seizures may show in EEG exams.

Tonic-clonic seizures

Sometimes called grand mal seizures, these episodes are what most people think of when they think of seizures. Combining the characteristics of both clonic and tonic seizures, these seizures start with the tonic phase (a sudden stiffening of the body) followed by the clonic phase (jerky, rhythmic shaking).

Myoclonic seizures

Myoclonic seizures may be either focal, affecting one limb or area of the body, or multifocal, affecting more than one limb or area. They’re typically one motion or rapid repeating nonrhythmic motions.

Like subtle seizures, myoclonic seizures may not always show on an EEG, and they’re generally a sign of conditions that affect the function or structure of the brain.

The symptoms of neonatal seizures will depend on the type of neonatal seizure an infant has. These symptoms may include:

  • repetitive, rhythmic contractions of the face, arms, legs, neck, or torso
  • continuous but brief stiffening of the neck or body
  • unusual facial expressions, eye movements, or mouth movements

Call 911

Call 911 or local emergency services if your baby is:

  • turning blue
  • having difficulty breathing
  • having symptoms that last longer than 5 minutes

Do

  • Stay with your baby and have someone call your pediatrician, 911, or local emergency services.
  • Lay your baby on their side on a firm, flat surface.
  • Loosen any blankets or clothing around the head or neck area.
  • Notice how long the episode lasts.
  • Be sure your baby’s breathing is okay.

Don’t:

  • Don’t try to stop your child’s movements – it won’t stop the seizure.
  • Don’t put anything in your baby’s mouth. They won’t swallow their tongue, and you may injury their mouth or jaw.
  • Don’t try to give your baby a bottle or nurse them.

Conditions that affect the brain cause neonatal seizures. There are many conditions that may cause them. The most common causes are:

While some neonatal seizures occur spontaneously, others have a cause or trigger. It’s very important to determine the cause of an infant’s seizures for treatment and outlook. Tests that help diagnose neonatal seizures include:

  • Continuous EEG monitoring: EEG is a test that measures the electrical activity of the brain using tiny electrodes either placed on the head in a cap or stuck to the scalp using gentle adhesive. During continuous EEG monitoring, an infant is monitored for a period of time so that symptoms may be recorded on video and correlated with EEG results.
  • MRI: Using electromagnets and radio waves, MRI produces detailed images of the brain.
  • CT scan: Using computers and X-rays, CT scans can produce detailed images of soft tissues, blood vessels, and bones.

Treatment for neonatal seizures will depend on the cause of the seizures. Some neonatal seizures may stop without treatment, but others may need treatment options such as:

  • anticonvulsant medications, including:
    • phenobarbital
    • levetiracetam
    • phenytoin
    • topiramate
    • carbamazepine
    • sodium channel blockers
  • medications for other conditions that cause neonatal seizures such as antibiotics
  • hypothermic treatment, cooling of the baby’s brain and body by a few degrees immediately after birth for several hours or days

There may be obstetric risk factors, things that occur during pregnancy and delivery, and there may be infant risk factors.

Maternal risk factors for neonatal seizures in an infant include:

The most common infant risk factors for neonatal seizure include:

Language matters

You’ll notice we use the term “maternal” in this article. While we realize this term may not match your gender experience, it’s the term used by the researchers whose data was cited. We try to be as specific as possible when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data for or may not have had participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

Depending on the cause of an infant’s neonatal seizures, the outlook may be serious. Research suggests that 18 to 25% of infants that experience neonatal seizures will go on to develop epilepsy.

The outlook for infants with neonatal seizures depends on the cause of those seizures. If a child has a normal EEG and no serious underlying conditions, the outlook is good.

However, infants with diagnoses on EEG and serious brain injury or other health conditions may need lifelong care. More than half of all infants who have neonatal seizures will have long-term health conditions such as cerebral palsy, postneonatal epilepsy, intellectual disability, or combinations thereof.

Some infants who have neonatal seizures may die. Research on infants who had neonatal seizures found that 17% of infants in their study died or were transferred to hospice care.

Depending on their cause, neonatal seizures may be an early sign of brain injury or changes in the brain. More than half of all babies who have neonatal seizures have conditions that affect them throughout their life. For some children, it may be a temporary event that has no long-term effect.

Neonatal seizures can be difficult to diagnose, and treating them may involve the use of antiepileptic medication or long-term care for serious medical conditions depending on the cause of those seizures.