Comprehensive insights into neonatal seizure: etiologies, diagnostic tools, management and future directions

Neonatal seizures are a neurological emergency, particularly prevalent in very low birth weight (VLBW) infants, with incidences ranging from 58/1000 live births in VLBW to 1–3.5/1000 in term infants. These seizures are often linked to hypoxic–ischemic brain injury, intracranial haemorrhage, arterial ischemic stroke, or infection. The diagnosis relies heavily on electroencephalography (EEG) due to the high incidence of electrographic-only seizures. Common aetiologies such as hypoxic ischemic encephalopathy (HIE), hypoglycemia, stroke, and hypocalcemia significantly impact neurodevelopment and seizure recurrence. This short article discusses the causes, diagnosis and management strategies of neonatal seizures, offering practical advice on how to best manage symptomatic and subclinical seizures in babies of various gestation. It highlights the gaps in our knowledge and suggests what further research is essential to refine treatment protocols and improve prognoses for affected neonates.