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.
START HERE
The first few minutes
Recognise
Altered consciousness or tone, seizures, apnoea or abnormal movements; grade encephalopathy (modified Sarnat).
Stabilise
Airway, breathing, circulation; always check the glucose; maintain temperature and treat the treatable.
Find the cause
Birth history and acidosis (HIE), glucose, electrolytes, calcium, a sepsis screen, and consider metabolic disease.
Investigate
Cranial ultrasound and aEEG/EEG; MRI later; for seizures, identify and treat the underlying cause.
Escalate
For HIE meeting criteria, start passive cooling and call NETS; for refractory seizures, anticonvulsants and NICU.
BROWSE THE CONDITIONS
Conditions in this section
Hypoxic-Ischaemic Encephalopathy
Encephalopathy after perinatal asphyxia; assess early for cooling (≥35 weeks, <6h).
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) |
| Neonatal seizures | Any | Subtle (lip-smacking, cycling, apnoea), clonic, tonic | Often subtle, not always obvious | Check glucose/Ca, treat cause, EEG |
| IVH | Preterm, first days | Often silent; apnoea, falling Hb, bulging fontanelle | Preterm + sudden deterioration | Cranial ultrasound |
| Perinatal stroke | Term, days 1-3 | Focal seizures, often well between | Focal seizures in a well baby | MRI (not cooling) |
| Floppy infant | Any | Reduced tone and movement, poor feeding | Central (alert, brisk reflexes) vs peripheral | Exam-driven workup |
| Jitteriness | Any | Tremor, stimulus-sensitive, no eye deviation | Stops when you hold the limb | Check glucose/Ca, reassure |
| Hydrocephalus | Any | Large / crossing head centiles, bulging fontanelle | Rapidly increasing OFC | Cranial ultrasound, neurosurgery |
| CNS infection | Any | Encephalopathy, seizures, sepsis features | Part of the sepsis workup | LP, antibiotics ± aciclovir |
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.