NEUROLOGY · NEONATAL
The newborn brain
Neonatal brain problems arrive through a few doors - encephalopathy, seizures, abnormal tone and abnormal head growth. The skill is recognising HIE early enough to cool, and never missing a treatable cause of seizures.
BROWSE THE CONDITIONS
Conditions in this section
Hypoxic-Ischaemic Encephalopathy
Encephalopathy after perinatal asphyxia; assess early for cooling (≥35 weeks, <6h).
Craniosynostosis
Premature suture fusion vs benign positional moulding - the abnormal head shape you must not miss.
Neonatal Seizures
Often subtle; find and treat the cause - glucose, calcium, infection, HIE, stroke.
Intraventricular Haemorrhage
Preterm; often silent, or apnoea, falling Hb, bulging fontanelle, seizures.
Perinatal Stroke
Focal seizures in a well-looking term baby; diagnosed on MRI, not cooled.
The Floppy Infant
Hypotonia - distinguish central from peripheral causes by the examination.
Jitteriness vs Seizures
Stimulus-sensitive tremor that stops when you hold the limb; check glucose/calcium.
Hydrocephalus & Head Size
Rapidly crossing head centiles, bulging fontanelle, sunsetting eyes.
CNS Infection
Meningitis / encephalitis within the sepsis workup; LP, antibiotics ± aciclovir.
CLINICAL REASONING
Telling them apart at a glance
| Condition | Typical infant / timing | Key features | Discriminating clue | First step |
|---|---|---|---|---|
| HIE | Term, after an acute event | Encephalopathy, seizures, multi-organ | Acidosis + acute event + Sarnat | Assess for cooling (≥35 wks, <6h) |
When to call NETS
For HIE that meets cooling criteria, start passive cooling and call early - don't delay.
- HIE meeting cooling criteria (start passive cooling)
- Refractory or recurrent seizures
- Deteriorating conscious state or apnoea
- Need for tertiary neurology or neurosurgical input
Take-home message: Neonatal neurology comes through encephalopathy, seizures, hypotonia and abnormal head growth. Always check the glucose, look for treatable causes, and recognise HIE early - a term baby with an acute perinatal event and encephalopathy may meet cooling criteria (≥35 weeks, within 6 hours). Use cranial ultrasound and aEEG/EEG, and escalate to NETS for cooling or refractory seizures.
For educational purposes only. Always align management to current ANZCOR/NRP guidelines and your local SCN/NICU or NETS protocols.