What is Neonatal care?
Neonatal care, or neonatology, is a branch of paediatric medicine that involves the support and care of newborns with serious conditions or illnesses. Those who specialise in this field are called neonatologists. All neonatologists are paediatricians with specialised training in caring for newborns with complex medical conditions.
One of the critical conditions neonatologists manage is neonatal seizures.
Understanding Neonatal Seizures
We want to preface this by stating that neonatal seizures are rare in newborns, particularly for those without underlying conditions (reported to occur in 0.1%–0.5% of newborns in a U.S. study). However, we understand that neonatal seizures can be distressing for parents and caregivers unfamiliar with managing them, as these seizures may occur suddenly and unexpectedly. In this article, we will address common questions about this condition, including the signs of neonatal seizures, the support and care provided by neonatologists (including a summary of what certain treatment and medicine helps to do) and what to expect if this situation arises.
Neonatal seizures are sudden, abnormal electrical activities in a newborn’s brain, often causing jerking or twitching movements. They typically occur within the first 28 days of a newborn’s life and are commonly caused by hypoxic-ischemic encephalopathy (HIE), a condition resulting from a lack of oxygen and blood flow to the brain.
Prompt expert care is essential, as seizures may indicate underlying conditions requiring immediate treatment to prevent brain damage and other complications. This is particularly important in Cayman, where early intervention can reduce the need to transfer newborns overseas for specialised care.
Care and Treatment for Neonatal Seizures
There are several neonatologists in Cayman practicing across various hospitals and healthcare facilities. So, what care and treatment might neonatologists administer for neonatal seizures?
Immediate Measures to Stabilize the Newborn
- Neonatologists will provide oxygen and ventilation support if needed for newborns as a first measure
- Monitoring vital signs, including heart rate, oxygen levels, and temperature
Diagnostic Tests
- EEG (electroencephalogram): Detects abnormal brain activity
- Blood Tests: Checks for infections, metabolic disorders, or electrolyte imbalances
- MRI or ultrasound: Used to obtain imaging of the brain to identify any abnormalities or brain injuries
Treatment Approaches
- Antiepileptic Drugs (AEDs): First-line treatment usually includes phenobarbital (known as the first-line drug) or levetiracetam (second-line drug)
- Treating the Underlying Cause: If seizures are due to hypoglycemia (where the newborn’s blood sugar drops too low), electrolyte imbalances, or infections, these conditions are treated accordingly
- Therapeutic Hypothermia: If seizures result from HIE, cooling therapy may be initiated to reduce brain injury. Neonatologist Dr Sara Watkin, based at Optimal Healthcare in Grand Cayman and a contributor to baby.ky, has extensive experience in managing birth asphyxia (a condition where the baby’s brain doesn’t get enough oxygen), including head and body cooling as an intervention. You can read more about this and Dr Sara’s neonatal service offering, including cooling therapy on Optimal Healthcare’s site here.
Hospital Stay Duration
The length of stay and recovery period depends on the severity and cause of the seizures. Mild cases typically require a hospital stay of 3–7 days, moderate cases (infections, mild HIE) 1–2 weeks, and severe cases (brain injury, complex epilepsy, severe infections) several weeks or longer. However, this can vary.
Newborns with underlying conditions may need to stay in the hospital for a longer period in the Neonatal Intensive Care Unit (NICU) and may require long-term follow-up for developmental assessments and ongoing seizure management.
Reassurance for Parents
While neonatal seizures can be a frightening experience for new parents, it’s important to remember that they are rare. If they do occur, you are not alone – specialist support and caring, experienced hands are here to help. With several neonatologists on the island, early intervention is available, often reducing the need to transfer newborns overseas for specialised care.
Want to learn more about neonatology in Cayman? View our previous article on having a Neonatologist present at birth in Cayman here.
