Skip to main content
MedVellum
QuestionsVideosPricing

MedVellum

Fellowship exam preparation across every specialty: source-verified topics, questions in every format, and videos.

Product

  • Specialties
  • Questions
  • Videos
  • Exam tools
  • Pricing

Verification & policy

  • Verified register
  • Editorial policy
  • Privacy
  • Terms

Account

  • Sign in
  • Create account
  • Dashboard
  • Account & billing

© 2026 MedVellum. For education only — not a substitute for clinical judgement.

llms.txtPsychiatry LLM catalogSitemap

Paeds Topicsfetal-neonatal-and-perinatal

Paeds · fetal-neonatal-and-perinatal

Neonatal seizures and encephalopathy

Also known as Neonatal seizures and encephalopathy · Neonatal seizures · Neonatal encephalopathy · Hypoxic-ischaemic encephalopathy with seizures

Fellowship guide to neonatal seizures and encephalopathy: recognition, EEG-based classification, the excitotoxic cascade, the aetiological differential, the antiseizure-medication ladder and therapeutic hypothermia.

high10 referencesUpdated 12 July 202619 min readVerification in progress

Practise this topic

  • SAQ
  • Viva
  • Case

Your progress

Saved on this device.

Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP DWEMRCPCH Theory

Red flags

  • A neonatal seizure is a neurological emergency — most are provoked by a treatable brain insult, and seizure burden amplifies injury
  • Status epilepticus in a neonate may present as apnoea, tachycardia or desaturation rather than convulsion
  • Therapeutic hypothermia must start within 6 hours of life for moderate-to-severe HIE — every minute after the insult closes the window
  • Always check blood glucose first — hypoglycaemia is the fastest reversible cause of neonatal seizures

Life stages

fetalneonate

Care settings

delivery-roomnicuretrieval

Clinical exam formats

written-onlyracp-dce-long-casemrcpch-short-clinical

Board mappings

  • Neonatal seizures and encephalopathy
  • Long case: neonatal seizures and encephalopathy
  • Communication: neonatal seizures and encephalopathy
  • Patient Care: neonatal seizures and encephalopathy
  • Medical Expert: neonatal seizures and encephalopathy
On this page
Study tools

Your progress

Saved on this device.

Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP DWEMRCPCH Theory

Red flags

  • A neonatal seizure is a neurological emergency — most are provoked by a treatable brain insult, and seizure burden amplifies injury
  • Status epilepticus in a neonate may present as apnoea, tachycardia or desaturation rather than convulsion
  • Therapeutic hypothermia must start within 6 hours of life for moderate-to-severe HIE — every minute after the insult closes the window
  • Always check blood glucose first — hypoglycaemia is the fastest reversible cause of neonatal seizures

Life stages

fetalneonate

Care settings

delivery-roomnicuretrieval

Clinical exam formats

written-onlyracp-dce-long-casemrcpch-short-clinical

Board mappings

  • Neonatal seizures and encephalopathy
  • Long case: neonatal seizures and encephalopathy
  • Communication: neonatal seizures and encephalopathy
  • Patient Care: neonatal seizures and encephalopathy
  • Medical Expert: neonatal seizures and encephalopathy

Overview & Definition

A neonatal seizure is the clinical or electrographic expression of abnormal, excessive neuronal discharge in the immature brain occurring within the first 28 days of life. Unlike seizures in older children, the great majority are provoked — they are an acute symptom of an underlying brain insult, not a manifestation of epilepsy — which is why the decisive clinical task is not to stop the movements but to find and treat the cause. [5]

Neonatal encephalopathy is the broader term for a disturbance of neurological function in the newborn: altered consciousness, abnormal tone, depressed or absent reflexes, autonomic dysfunction, feeding difficulty, and (often) seizures. Hypoxic-ischaemic encephalopathy (HIE) is the commonest cause of neonatal encephalopathy and the commonest provocation for neonatal seizures, so the two are deeply linked — an encephalopathic infant must be observed for seizures, and a seizing infant must be assessed for encephalopathy and its cause. [5] [10]

What is a neonatal seizure, and what is the first task when one is suspected?

A neonatal seizure is an abnormal, excessive neuronal discharge in the immature brain, almost always provoked by a treatable insult — most often hypoxic-ischaemic encephalopathy, then stroke, haemorrhage, infection, metabolic derangement or malformation. The first tasks are to stabilise the airway and breathing, check the blood glucose, confirm the event with continuous EEG if possible, and begin the hunt for a reversible cause while giving a first-line antiseizure medication. [5]

Time-critical: hypoglycaemia, and the cooling window

Two clocks are running. Check the blood glucose immediately — hypoglycaemia is the fastest reversible cause of neonatal seizures and is treated with a bolus of 10% dextrose 2 mL/kg. And if the seizure occurs in a term infant with perinatal asphyxia, assess HIE severity at once: therapeutic hypothermia for moderate-to-severe HIE must start within 6 hours of life, and every minute after the insult closes the window. [1] [5]

Paediatrics Fellowship Pro

Continue reading

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

Sign in to continueSee pricing
References10ShowHide
  1. [1]Azzopardi DV; Strohm B; Edwards AD; Dyet L; Halliday HL; Juszczak E; Kapellou O; Levene M; Marlow N; Porter E; et al Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009.PMID 19797281
  2. [2]Shankaran S; Laptook AR; Ehrenkranz RA; Tyson JE; McDonald SA; Donovan EF; Fanaroff AA; Poole WK; Wright LL; Higgins RD; et al Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med, 2005.PMID 16221780
  3. [3]Jacobs SE; Berg M; Hunt R; Tarnow-Mordi WO; Inder TE; Davis PG Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev, 2013.PMID 23440789
  4. [4]Painter MJ; Scher MS; Stein AD; Armatti S; Wang J; Alvin JD Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med, 1999.PMID 10441604
  5. [5]Pressler RM; Abend NS; Auvin S; Boylan G; Cilio MR; Hellström-Westas L; Hsieh DT; Islam MP; Karvelas G; Lakra M; et al Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures. Epilepsia, 2023.PMID 37655702
  6. [6]Abiramalatha T, Thanigainathan S, Ramaswamy VV, et al. Anti-seizure medications for neonates with seizures. Cochrane Database Syst Rev, 2023.PMID 37873971
  7. [7]Sharpe C; Reiner GE; Davis SL; Garcia M; Hardjec K; Ip K; Jiang P; Lai YC; Legido A; Molinaro M; et al Levetiracetam Versus Phenobarbital for Neonatal Seizures: A Randomized Controlled Trial. Pediatrics, 2020.PMID 32385134
  8. [8]Shellhaas RA; Chang T; Tsuchida T; Scher MS; Riviello JJ; Abend NS; Nguyen S; Wusthoff CJ; Clancy RR The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol, 2011.PMID 22146359
  9. [9]Nyman J; Mikkonen K; Metsäranta M; Stefanovic V; Wallin-Lundqvist E; Glinianaia SV; Toiviainen-Salo S; Vanhatalo S; Hallberg B; Hellström-Westas L Poor aEEG background recovery after perinatal hypoxic ischemic encephalopathy predicts postneonatal epilepsy by age 4 years. Clin Neurophysiol, 2022.PMID 36183624
  10. [10]Basti C; Maranella E; Cimini N; Pianetti A; Agostinelli R; Ciavarra C; Dani C Seizure burden and neurodevelopmental outcome in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia: A single center observational study. Seizure, 2020.PMID 33160202

Test yourself

Practise what you just read

  • SAQ
  • Viva
  • Case
Paediatrics Fellowship Pro

$29/ monthor $279 / year

The complete Paediatrics Fellowship library, every exam format, one subscription.

  • Complete library for one chosen specialty
  • Timed MCQ mock exams and spaced review
  • Clinical cases & cross-table vivas
See pricingSign in
PreviousNeonatal resuscitation and post-resuscitation stabilisationfetal-neonatal-and-perinatalNextNeonatal skin disorders and birthmarksfetal-neonatal-and-perinatal