Background Neonatal seizures are a relatively common occurrence associated with an adverse outcome. Their recognition is difficult. The clinical signs are often subtle, and a substantial proportion are non-clinical. The introduction of cerebral function monitoring (CFM) has led to an increased recognition of seizures. Creating a guideline is difficult due to lack of evidence for the drugs used and lack of international consensus.
Aim To benchmark the management of neonatal seizures.
Method 50 neonatal intensive care units (NICU) within the UK (>4 intensive treatment unit cots) were contacted by telephone and completed a structured questionnaire.
Results 20% of units did not have a guideline. Seizure recognition: CFM was used in 36 (72%) units, EEG in 22 (44%) and video-EEG in one. Treatment: 1st line: phenobarbitone was used by all, although with variations in dosage and interval. 2nd line: 29 (73%) used phenytoin; others included midazolam, clonazepam, lignocaine. 3rd line: 14 (35%) used clonazepam; others included paraldehyde, midazolam, lignocaine, lorazepam, diazepam and sodium valproate. 4th line: 25% used paraldehyde; others included thiopentone and heminevrine. Pyridoxine: 68% of units incorporated this into their guideline. Non-clinical seizures: three units had a guideline. Only a third of units considered treating them. Imaging: 94% performed a cerebral ultrasound scan. 58% considered computed tomography scan. Only 10% obtained a magnetic resonance image in every baby.
Conclusions This study confirms there is a marked variation in the management of newborn seizures. National guidance would be welcome. Despite increased recognition with CFM, only 6% of units have guidance on the treatment of non-clinical seizures and we believe there is evidence supporting their treatment.