Neonatal Seizures: Causes, Types of Infant Seizures, and Diagnosis

Seizures are involuntary jerking movements caused by abnormal electrical patterns in the brain from brain damage or problematic neurochemistry. Neonatal seizures – seizures in a baby – are often subtle and difficult to identify.

Signs of seizures can include:

• Eye movements, blinking or eyelid fluttering, eyes rolling up, staring
• Sucking, smacking, chewing and a protruding tongue
• Bicycling or pedaling movements of the legs
• Thrashing movements
• Long pauses in breathing 

However, seizures can be prevented. If the underlying health condition or complication is addressed and promptly treated, medical staff can prevent a brain injury before it happens.

Hypoxic-ischemic encephalopathy (HIE), an injury which occurs when a baby does not get enough oxygen, is the most common cause. If a baby is delivered before suffering HIE, it will not have seizures.  Seizures can also worsen the baby’s existing brain injury.

The signs of a seizure in an infant may be difficult to recognize compared to the involuntary jerking movements of an adult seizure. The signs of neonatal seizures vary based on the type of seizure a baby is having.

Most infant seizures are considered “subclinical,” or subtle. Subclinical seizures do not have any obvious signs of seizure unless it’s seen on an electroencephalogram (EEG) monitor. Continuous EEG monitoring is critical for newborns at high risk of seizures.

Clinical seizures are seizures that come with noticeable signs. The most common types of infant seizures are focal-clonic, focal-tonic, certain types of myoclonic, and epileptic spasms. Focal seizures are seizures that involve one side of the brain and body. 

Focal clonic seizures:  

• Involve repetitive, rhythmic movements in the limbs, face, and/or torso
• Involve slow repetition of movements
• Cannot have the movements stopped by someone restraining the person having a seizure
• Have an EEG pattern that directly correlates with the seizure movements

Focal tonic seizures:

• Involve unusual posturing of the limbs or torso
• Include abnormal eye movement – usually to one side
• Are associated with focal EEG seizure activity (activity on one side of the brain)

Myoclonic seizures:

• May involve contractions of the limbs, trunk, diaphragm, or face. 
• Usually include irregular, erratic movements
• Involve variable movement speed depending on the muscles
• Can be isolated events or repetitive

Epileptic spasms:

• Are rare in infants
• Involve torso muscles and limbs
• Include movements where the muscle tenses, holds, and then relaxes
• Often occur when the baby wakes up
• Show a diffuse slowing pattern in the EEG signature

Neonatal seizures can be caused by a number of things, including the following birth injuries.

According to research on UpToDate, hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. HIE is a medical condition in which a newborn does not get enough oxygen at or around the time of birth. 

There are many labor and delivery emergencies that could cause HIE and seizures, including:

• umbilical cord compression
• a ruptured uterus
• Placental abruption
• Cord prolapse
• placenta previa
• fetal distress
• prolonged labor. 

All of these issues can potentially deprive the baby of oxygen. A lack of oxygen in the baby’s brain can lead to brain injury and subsequent seizures. 

Can Medical Malpractice Cause My Baby’s HIE? Can I call a lawyer?

Unfortunately, HIE can  be caused by medical malpractice. Medical staff must plan appropriately for these kinds of obstetrical risks and situations that may arise during labor and delivery. During an emergency, medical staff must deliver the baby in time to prevent HIE. 

If doctors or other healthcare professionals fail to act according to the standard of care, it is considered medical malpractice. 

If your baby develops a birth injury like HIE, you may feel let down by doctors and medical staff. Coping with a birth injury is stressful and confusing. At ABC Law Centers, we focus exclusively on these kinds of cases. We are prepared to help your family and answer any questions you may have about your child’s future.

Infections in newborns that can cause seizures include:

• sepsis
• Meningitis
• herpes encephalitis
• Cytomegalovirus
• toxoplasmosis 
• Bacteria like E. coli and Streptococcus pneumoniae

Usually, newborn infections are the result of an undetected and untreated infection in the mother. The infection  is transmitted to the baby through the birth canal. 

The healthcare provider should screen for various infections during the pregnancy and appropriately treat them. 

It may be considered malpractice if the doctor or medical staff fail to timely diagnose and treat a maternal infection or a newborn infection. Failure to treat these infections can lead to seizures and brain injury in a baby.

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 , or the baby may just be very large overall. 

Traumatic brain injuries can also occur from the use of instruments like forceps or vacuum extractors during vaginal deliveries, or from prolonged labor and delivery. 

Babies who sustain traumatic brain injuries during the birthing process often have intracranial hemorrhages (brain bleeds), seizures, and a number of other complications. 

Again, it is the responsibility of the doctor or another healthcare provider to prenatally check and plan for these types of obstetrical problems.

The primary diagnostic test for verifying seizure activity is an electroencephalogram (EEG). During an EEG, electrodes are temporarily attached to the baby’s head. The electrodes read the electrical activity of the baby’s brain, show the changes that occur over time, and what part of the brain is affected. The results appear on-screen as well as on printed strips.

If anyone on the medical team witnesses signs of a seizure, they must immediately start EEG monitoring. Medical staff may noticethe baby’s body going limp, the baby losing consciousness, or the baby staring and/or making bicycle “pedaling” movements.

Medical staff regularly monitors the baby’s breathing, heart rate, and blood pressure. The readings from these devices can also alert the team that a baby is experiencing a seizure. The underlying cause of a seizure must be found and treated in a timely fashion.

When neonatal seizures occur, they must be treated immediately. Even a single seizure can cause or worsen brain damage. Doctors must find what’s causing the seizures and address the issue quickly.

Seizures may be caused by not getting enough oxygen during or near the time of delivery (HIE). If doctors suspect HIE, they should use hypothermia therapy (brain cooling treatment)to help minimize or attempt to prevent permanent brain injury. Treatment must be initiated within six hours of the injury for best results. 

In addition to finding and treating the underlying cause of seizure activity, many physicians give anti-epileptic medications to prevent seizures from occurring. The longer the seizures last and the more frequently they occur, the more likely they are to cause permanent brain damage.

Babies with seizures need prompt medical care and anti-seizure medications. 

If there is no medical professional around, parents can take certain precautions during a child’s seizure. These general precautions are from the Epilepsy Foundation:

• Remain with the baby until the seizure is over
• Move hard objects (which may cause injury) out of the way
• Place the baby on a soft surface (special attention should be given to making sure that the head is protected)
• Make sure that nothing goes into the baby’s mouth
• Turn the baby to their side, with their mouth pointed toward the ground. This stops saliva from blocking the airway and helps with breathing.
• Time how long the seizure lasts

Additionally, if your baby has a history of seizures, administer anti-seizure medication as prescribed by a doctor.

Many parents want to know under which circumstances they should call 911 if their child is having a seizure. This depends on individual health circumstances, including what type of seizure they are having.

If a child is having their first ever seizure, parents should always call 911.

After the initial seizure, you can talk to your child’s doctor about the circumstances under which you should seek emergency medical attention for possible future seizures. The doctor’s advice should be based on individual factors (such as the type of seizure they have had) and may be different for different patients.

The CDC website recommends seeking medical attention if any of the following are true. Please keep in mind that these are very general recommendations, and your child’s doctor may tell you additional signs to watch out for.

• This is the person’s first seizure
• The seizure lasts more than five minutes
• The person has two seizures closely spaced together
• The person is struggling to breathe or not waking up after the seizure is over
• The person is hurt during the seizure (for example, if they hit their head on a hard surface)
• The seizure occurs in water
• The person has a health condition like diabetes or heart disease (pregnancy also qualifies)