Seizures in the neonatal period are not uncommon, particularly with premature infants. Neonatal period refers to the first 28 days of life for a baby. Seizures happen when there are abnormal electrical discharges in the newborn’s central nervous system. These discharges can be caused by a variety of different conditions. Some of these conditions may be relatively benign or temporary, but some seizures can be related to serious medical conditions and require urgent investigation and attention.
What Is an Infant Seizure?
An infant seizure, or neonatal seizure, refers to any seizures that happen during the first 28 days of an infant’s life, during the neonatal period. There are two categories of infant seizures; subtle seizures and motor seizures.
Subtle seizures are the most common type of infant seizure. As the name suggests, they are called subtle because the seizure characteristics imitate normal behaviour in an infant. These symptoms may appear as everyday behaviours:
- Eye movements: eyes rolling up, fluttering eyelids, fixated gaze;
- Mouth/Tongue movements: lip smacking, tongue protrusion or sticking out;
- Limb movements: repeated movements such as pedalling with legs, swimming, thrashing movements; and
- Other movements: long pauses between breathing
Because these symptoms may not be obvious as motor seizures (which are explained below), your medical team may recommend EEG (electroencephalogram) monitoring for infants to determine if the behaviors are being caused by abnormal brain activity. Subtle seizures can be caused by an existing brain injury, and ongoing infection or an underlying health condition like cerebral palsy.
Motor Seizures are broadly defined as seizures that change muscle behaviour like muscle stiffness (tonic), repeated jerking (clonic), or muscle weakness. There are three types of seizures that are common in infants and they are categorized by the type of movements seen during the seizure:.
Tonic seizures manifest as muscle stiffness. Symptoms show as a sustained contraction or stiffening such as holding the head to one side, having eyes looking on one side, holding arms or legs in an awkward position.
Clonic seizures show as repetitive jerking, or clenching, of a small area on the face or body. This repetitive jerking can be sustained for a long period of time. A clonic seizure could appear in an infant’s face, tongue, hands, finger, arms, and legs.
Myoclonic seizures have similar symptoms to clonic seizures, but the spasms happen during short periods instead of a sustained period of jerking or clenching. The repetitive jerking would appear in a baby’s face, tongue, hands, and limbs.
What Causes Seizures in Babies?
If a baby has experienced trauma or injury during labour and delivery, there is a higher likelihood of developing seizures.
Brain injury during labour and delivery
In some instances, the existence of seizures can signify a brain injury caused during labour and delivery (often due to a hypoxic-ischemic event, an inadequate supply of oxygen to the brain). In that situation, there may be other evidence of encephalopathy (a disorder or disease of the brain) such as low Apgar scores, abnormal muscle tone and reflexes, and signs of multi-organ damage.
Trauma from vacuum extractors
Vacuum extraction may take place during prolonged labour, if the baby has signs of fetal distress, or if the mother is experiencing fatigue. The tool is used by the physician to assist delivery of the baby through gentle pulling to assist in the delivery. A vacuum has a cup (either soft or rigid) and the cup is placed on the top of the baby’s head and provides suction to guide the child through the birth canal. However, there are risks to vacuum assisted deliveries. The incorrect placement of a vacuum can lead to scalp wounds, shoulder dystocia, internal bleeding in the brain, and seizures.
Other Causes of Injury Leading to Seizures
Other causes of neonatal seizures can include infection (such as meningitis or sepsis), bleeding in the brain, hypoglycemia (low blood sugar) or other metabolic disorders, or ischemic stroke (a stroke caused by a blockage of the blood flow through a blood vessel in the brain). It is critical that the underlying cause of seizures is determined in a timely manner.
Are Infant Seizures Caused by Medical Malpractice?
Seizures in a baby are not always caused by medical malpractice. Seizures can be a sign or symptom of underlying medical issues that may have been entirely unpreventable. However, in many cases the brain injury that caused the seizure could have been prevented if the expected standard of care had been provided. In these circumstances, there may be grounds for a medical malpractice claim.
Hypoxic Ischemic Brain Injury
Perhaps the most common cause of infant seizures is a brain injury caused by hypoxic ischemia during labour and delivery. These types of hypoxic-ischemic events happen when the fetus suffers reduced blood flow, causing a lack of oxygen to the brain, during labour and delivery. The loss of oxygen to the brain, if it goes on long enough, can cause a permanent brain injury known as hypoxic ischemic encephalopathy, or HIE. HIE is a preventable injury and is one of the most common grounds for birth injury medical malpractice claims.
Kernicterus happens when excessive bilirubin builds up in the baby’s body. This causes a condition known as jaundice. Jaundice is easily identified because it gives the infant’s body a yellowish colour. It is very common and is routinely treated using phototherapy (light) which makes the bilirubin non-toxic. However, if the jaundice is not properly diagnosed, the excess bilirubin can cause a brain injury, called kernicterus, and the kernicterus can be the source of infant seizures. Seizures from kernicterus are a common sign of a possible medical malpractice claim because they are a “never event”. Meaning it is a condition that should never happen if proper medical care is provided.
Congenital anomalies (sometimes referred to as birth defects or birth disorders) happen when an infant is born with an abnormal body function or body structure. Common types of congenital disorders include, but are not limited to, cleft lip and cleft palate, cystic fibrosis, heart conditions, and Down syndrome.
Congenital anomalies typically begin in the early stages of pregnancy. There are many causes for the development of a congenital disorder in an infant, the most common causes being genetic and environmental factors.
Early detection of congenital disorders is key for infants and can often be found during prenatal testing which typically starts at 10 weeks in the pregnancy. If proper testing was not done or did not detect congenital abnormalities, there may be a case for medical malpractice.
Just as with adults, pediatric brain tumours consist of masses, or growths, of abnormal cell development. Pediatric brain tumours can be either cancerous and non-cancerous. There are many factors that affect the treatment plan for pediatric brain tumours such as the age of the child, the location of the tumour, and the type of tumour. Brain tumours can be overlooked or misdiagnosed and the presence of tumors can be the source of infant seizures.
Strokes can result from a blockage of blood flow or a bleed in the brain, and strokes can happen in utero starting after 14 weeks of gestation. Commonly, strokes affect one side of the baby’s brain (called a focal injury). A typical brain injury due to oxygen deprivation usually affects both sides (called a bilateral injury). When a stroke causes a brain injury it is critical to determine the cause of the stroke, which, in some cases, can be linked to episodes of lack of oxygen during labour.
Effects of Seizures on Newborns
Neonatal seizures can be subtle and difficult to recognize clinically, so timely EEG and laboratory testing are essential in confirming the diagnosis. Cranial imaging, such as CT or MRI are also often recommended. Once the diagnosis is confirmed, early treatment of the seizures, as well as the underlying cause, is required.
The prognosis for infants with seizures will depend on the cause and the timeliness of diagnosis and treatment. It is essential that early investigation and treatment is undertaken by the appropriate medical specialists.
Frequently Asked Questions about Infant Seizures
What are the common types of birth injuries that cause infant seizures?
While not all injuries or trauma from birth cause seizures, the most common injuries that cause seizures are brain injury from HIE or kernicterus, trauma from a vacuum extractor and/or forceps, and infections.
What are the symptoms of a baby having a seizure?
The symptoms for a baby having seizures will vary depending on the type of seizure the infant is experiencing:
- A baby experiencing a subtle seizure may have symptoms that can appear to be normal behaviour for an infant like lip-smacking, pedaling legs, fluttering eyelids.
- Tonic infant seizures will display as a stiffening of muscles like holding the head to one side without releasing.
- Clonic seizures will manifest with a sustained repeated jerking or clenching motion in the face or fingers.
How does a doctor diagnose infant seizures?
If you think your infant experienced a seizure, your doctor may use the following set of tests to diagnose seizure activity:
- EEG (Electroencephalogram) is a test that determines abnormalities in the electrical activity, or brain waves, of a brain. This test is the primary way to diagnose epilepsy and seizures.
- MRI (Magnetic resonance imaging) is a test that uses a combination of magnets and radio waves to diagnose diseases or injuries especially in soft tissue.
- CT Scan (Computerized Tomography Scan) combines x-rays to create images of the body. CT scan is used to identify any brain abnormalities that may be causing seizures, such as brain tumours.
What should I tell my doctor if I think my baby had a seizure?
If you think your infant experienced a seizure, you will need to tell your doctor all of the information related to the specific episode including the length of the seizure and the symptoms you witnessed (such as twitching or jerking of an arm). It is important to explain that the symptoms were unusual or not part of your baby’s normal behaviour. In addition to that, you will want to let your doctor know if your infant has had any other behaviours like difficulty eating or breathing, lethargic movement, and/or unusual muscle spasms.
What should I do if my baby has a seizure?
It’s critical to seek medical attention if your baby is having a seizure. As a parent, guardian, or caretaker you can take the following steps to help an infant who is experiencing a seizure:
- If you are in the hospital, call a nurse or doctor. If you are home, call 911;
- Stay with your baby until the seizure is over;
- Time how long the seizure episode lasted;
- Place the baby on a soft surface, protect the babies head, and have the baby turned to the side to keep airway passages clear;
- Do not put anything in the baby’s mouth.
Contact an Experienced Newborn Seizures Lawyer
If your child has experienced neonatal seizures and has been diagnosed with a medical condition that could cause permanent disability or developmental delay, birth injury lawyers will be in a position to investigate the possibility of a malpractice claim.