How are neonatal seizures managed?

First, correct reversible causes - give glucose for hypoglycaemia, calcium/magnesium for hypocalcaemia/hypomagnesaemia, and treat infection.

For ongoing seizures, give anticonvulsants - phenobarbital is first-line (then second-line agents, e.g. phenytoin, levetiracetam, or a benzodiazepine). Provide supportive care (airway, breathing, circulation, glucose), treat the underlying cause, and monitor with EEG/aEEG.

Clinical relevance. Managing neonatal seizures (correct metabolic causes, phenobarbital, treat the cause, EEG monitoring) controls seizures and addresses the underlying problem.

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Management of neonatal seizures

Management corrects reversible causes, gives anticonvulsants, and treats the cause.

Supportive care

• Airway, breathing, circulation; maintain oxygenation and normal glucose.

Correct reversible/metabolic causes first

• Hypoglycaemia - IV glucose (dextrose).
• Hypocalcaemia/hypomagnesaemia - calcium/magnesium.
• Treat infection (antibiotics +/- aciclovir) if suspected.

Anticonvulsants

• Phenobarbital - first-line.
• Second-line - phenytoin/fosphenytoin, levetiracetam, or a benzodiazepine (e.g. midazolam).
• (Pyridoxine for refractory seizures - pyridoxine-dependent seizures.)

Treat the underlying cause

• e.g. therapeutic hypothermia for HIE; manage the specific aetiology.

Monitoring

• EEG/aEEG monitoring - including for electrographic seizures after clinical seizures stop (electroclinical dissociation).