Neonatal seizures in the era of therapeutic hypothermia: keeping it cool

The neonatal brain is potentially wired for seizures based on the timing and severity of disease states in the context of vulnerabilities of the immature brain.(1) Seizures in neonates are often the presenting sign of potential brain injury from multiple etiologies, including asphyxia or hypoxic ischemic encephalopathy (HIE). Seizures may also result from diverse causes of neonatal encephalopathy, with those in the neonatal period portending a worse neurodevelopmental prognosis if associated with damage to the developing brain.(2) The diagnosis of seizures in the neonatal population, however, can be challenging. Seizures are often subtle; they may be associated with autonomic symptoms or fail to display clinical manifestations coincident with electrographic seizures.(3.)