Neonatal Hypoxia and Seizures

Maria Gillam-Krakauer; Brian S. Carter

doi:10.1542/pir.33-9-387

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Maria Gillam-Krakauer, MD*
Brian S. Carter, MD^†

^*Assistant Professor of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN.
^†Professor of Pediatrics, Section of Neonatology, Children's Mercy Hospital, Kansas City, MO.

Author Disclosure
Drs Gillam-Krakauer and Carter have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AED:: antiepileptic drug
AMPA:: α-amino-3-hydroxyl-5-methyl-4-isoxazolepropionic acid
ATP:: adenosine triphosphate
CSF:: cerebrospinal fluid
HIE:: hypoxic-ischemic encephalopathy
MOCO:: molybdenum cofactor
NMDA:: N-methyl-d-aspartic acid

Educational Gap

With 1 to 3 in 1,000 term neonates experiencing seizures, pediatricians need to know how to determine the seizure cause and manage appropriately, using brain imaging and treatments such as therapeutic hypothermia, xenon, and other pharmacologic therapies, in order to minimize long-term sequelae and leverage the infant brain's tremendous capacity for repair in the first 2 years after birth.

Objectives

After completing this article, readers should be able to:

Understand the pathophysiology of neonatal seizures.
Know the many disorders associated with seizures in the newborn.
Be aware of the characteristics of different neonatal seizure syndromes.
Know how to evaluate a newborn who is having seizures.
Be aware of the treatments for neonatal seizures.
Understand the characteristics and management of hypoxic-ischemic encephalopathy.

Introduction

Seizures occur during the newborn period at an incidence of ∼1 to 3 per 1,000 infants born at term. (1)(2)(3) Numerous systemic and neurologic conditions can manifest as seizures. Cerebral hypoxia-ischemia, defined as partial lack of oxygen resulting in reduction of blood flow to the brain, is the most frequent cause of seizures in the newborn period. It is important to determine the cause of neonatal seizures and institute the appropriate therapy to minimize the long-term sequelae of both the underlying condition and the seizure.

Pathophysiology of Seizures

Seizures are paroxysmal alterations in neurologic function caused by excessive synchronous depolarization of neurons within the central nervous system. Regardless of the underlying pathology manifesting as a seizure, all seizures are due to a shift in cell energy. This shift can result from failure of the adenosine triphosphate (ATP)–dependent sodium-potassium (Na⁺-K⁺) pump, an imbalance of inhibitory and excitatory neurotransmitters, and both excessive …