This weeks case highlights the challenges of ED management of neonatal seizures. We discussed the utility of head US vs. CT brain when able. We also discussed varying levels of comfort with doing an LP in a frequently seizing baby without respiratory symptoms or desats. We considered appropriate thresholds for AED administration in self-resolving seizures.

The infant received a dose of Ampicillin in the ED prior to transfer to the NICU and started on maintenance fluids with dextrose. The NICU performed the LP and started cetazidime and acyclovir prior to the LP. The patient continued to have clinical seizures in the ED confirmed by cEEG. MRI brain was done and AEDs were started. Neurogenetics was consulted and patient is pending results of multiple metabolic tests and whole exome sequencing. 

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