Seizures are involuntary jerking movements that affect brain function, caused by abnormal electrical patterns in the brain from brain damage or problematic neurochemistry. Neonatal seizures are often subtle and difficult to identify. Seizures can be caused by a number of factors, including HIE, infections, trauma and prolonged labor. HIE is the most common cause of neonatal seizures.
Seizures occur from abnormal electrical discharges in the brain due to nerve damage or problems with the brain’s chemistry. Seizures can cause involuntary jerking movements lasting from a few seconds to a few minutes and can affect normal brain functioning. They sometimes affect consciousness. Seizures must be immediately diagnosed and properly treated in newborns in order to prevent permanent damage to the baby.
Seizures in newborns are categorized as subtle, clonic, tonic or myoclonic:
- Subtle seizures, as the name implies, are often difficult to see. They occur most frequently in premature infants and are the most frequent type, comprising about 50% of all newborn seizures. There may be some bicycling-type movement, fixation of gaze, or repetitive facial movements.
- Clonic seizures in infants are marked by a slow rhythmic jerk of one part of the body. This type of seizure represents about 25% of all seizures in newborns.
- Myoclonic seizures involve rapid twitching or jerking movements and are the most serious often, indicating severe brain damage. Premature babies are the most afflicted group.
- Tonic seizures account for about 5% of infants with seizures and cause sustained contractions. Sometimes the eyes may roll upward and breathing may stop for a period of time.
Seizures can be caused by a number of things, including:
Seizures from HIE (Hypoxic Ischemic Encephalopathy)
Hypoxic ischemic encephalopathy (HIE or birth asphyxia) is the most common cause of neonatal seizures, with an estimated 80% of cases attributed to HIE. HIE is a medical condition where a newborn has been deprived of oxygen at or around the time of birth. Cord compression; problems with the placenta or uterus such as a ruptured uterus or placenta previa (placenta is attached to the uterine wall close to or covering the cervix); fetal distress; and prolonged labor are some of the medical emergencies that could result in HIE and seizures. Medical staff must plan appropriately for these kinds of obstetrical risks. Furthermore, they must effectively handle situations that may arise during delivery in order to minimize the possibility of HIE. Failure by doctors or other health care professionals to do these things could be considered negligence.
Seizures from Infection
The most common infections occurring in newborns that can cause seizures are meningitis, Group B Streptococcus, encephalitis, cytomegalovirus and herpes simplex virus. While infants may become infected after delivery, the most common cause of neonatal infection is undetected and untreated infection in the mother that is transmitted to the baby through the birth canal. It is the doctor’s or other healthcare provider’s responsibility to screen for various infections during the pregnancy and appropriately treat them.
Seizures from Traumatic Brain Injury
Traumatic birth injuries can result from a problem with the size or position of a fetus relative to the birth canal. For example, sometimes a baby’s head is too large for the mother’s pelvis (cephalopelvic disproportion) or the baby may just be very large (macrosomic). Again, it is the responsibility of the doctor or other healthcare provider to prenatally check and plan for these types of obstetrical problems. Traumatic brain injuries can also occur from the use of instruments like forceps or vacuum extractors during vaginal deliveries. Forceps resemble tongs. Proper placement requires that the “blades” lie evenly against a baby’s head in a location where they are not likely to cause damage. If the forceps are applied unevenly to the baby’s head, skull and facial fractures as well as intracranial hemorrhages, seizures, and permanent brain damage can occur. Vacuum extractors, as the name implies, use suction to pull a baby from the birth canal during a contraction. Small plastic cups are attached to the infant’s head. If they are not correctly placed, bruising, hemorrhages and blood clots can occur. Doctors and other healthcare providers must use forceps and vacuum extractors correctly and at the right stage of labor in order to avoid irreparable damage.
Seizures from Prolonged Second Stage of Labor
The second stage of labor occurs from the time the mother is fully dilated until the baby is delivered. When this time lasts more than four hours it is considered to be a prolonged second stage. A prolonged second stage is most often associated with cephalopelvic disproportion. A C-section should be done to minimize the risks of traumatic brain injury, Erb’s Palsy, and HIE. Failure to perform a timely C-section may be considered negligence.
The primary diagnostic test for verifying seizure activity and determining the location of the brain affected is an EEG. In an EEG, electrodes are temporarily attached to the baby’s head. The electrodes read the electrical activity of the brain and shows the changes that occur over time. The results appear on-screen as well as on printed strips.
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