The major issues for infants with seizures are the medication side
effects and the neurological challenge that is causing the seizures to
happen in ther first place.  Neonatal seizures are usually caused by
hypoxia or asphyxia in the perinatal period.  Sometimes they can be the
result of brain malformations, strokes, or hemorrhage, or scarring from
a healed insult, but most often seizures from these insults show up a
little later.  Biochemical issues such as severe hypoglycemia or
pyridoxine depency can cause seizures as well, and a metabolic screen
may be done.  If the baby has a brain injury that causes cerebral palsy
or other neurological deficit, there might be hypotonia and poor motor
control.  Good postural support is essential for any newborn, but
especially for a hypotonic one.

Phenobarbital is extremely sedating, but as the baby's liver starts to
induce enzymes to clear it, there will be less sedation.  Breastfeeding,
if the infant can be helped to latch and maintain a latch and suckle
effectively, would be safer than bottlefeeding as far as aspiration and
choking go, because it is more voluntary.  If the baby is getting ready
to seize, he will probably stop sucking.  I would be careful about using
an SNS or anything else to increase flow, a periodontal syringe or
syringe and tube would be better, so that you can carefully introduce
small boluses of milk to give the baby the idea that the breast makes
milk.  Fingerfeeding is a great idea,  I'd want to teach the parents and
staff how to follow the baby's cues as to when to deliver milk.  Showing
the staff paced bottle feeding with cueing as for breastfeeding (wait
for wide gape, etc) can be helpful as well.

Mom will also need emotional support, seizures are scary, especially in
a tiny baby.  Fear about her baby's future may be foremost in her mind,
and written instructions will help her remember what you've worked on.

Good luck.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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