How are neonatal seizures investigated?

Investigate urgently to find the (often treatable) cause:

• Immediate: blood glucose, calcium, magnesium, and electrolytes (sodium) - to find rapidly correctable metabolic causes
• Sepsis/infection screen: blood culture, FBC, CRP, and lumbar puncture (CSF)
• EEG/amplitude-integrated EEG; cranial ultrasound and/or MRI brain; metabolic work-up if indicated

Clinical relevance. Urgent investigation (glucose/calcium/electrolytes, infection screen, EEG, imaging) finds the often-treatable cause of neonatal seizures.

More Detail

Investigation of neonatal seizures

Investigation seeks the cause urgently, prioritising treatable conditions.

Immediate bedside/metabolic tests

• Blood glucose (exclude hypoglycaemia - check immediately), calcium, magnesium, and electrolytes (sodium) - rapidly correctable causes.
• Blood gas (acidosis), ammonia/lactate if a metabolic disorder is suspected.

Infection screen

• Blood culture, full blood count, CRP, and a lumbar puncture (CSF analysis) - to exclude meningitis/sepsis (and consider herpes).

Neurophysiology and imaging

• EEG and amplitude-integrated EEG (aEEG) - confirm seizures, detect electrographic-only seizures, and assess background activity (prognostic).
• Cranial ultrasound (haemorrhage) and MRI brain (HIE, stroke, malformations).

Further

• Metabolic/genetic work-up for inborn errors; a pyridoxine trial if seizures are refractory.

Principle

• Identify and treat reversible causes (glucose, calcium) promptly while continuing the work-up.