Neonatal seizure outcomes

[33-weeker]

I've been a level II nursery nurse for the better part of 16 years. I have probably only had 4 or 5 babies in all that time have seizures while actually in my care (some had them after being transferred downtown to level III, etc.). I am curious what your experiences have been when it comes to neonatal seizures.

How serious is it?

What is the typical management in level II outlying vs. Level III facility? Does it always require a transfer to level III?

Do you test first (EEG, scans, US) or control with phenobarb first & test later?

I had to bag one baby a couple of times when sats went too low for BB, but it seemed ineffective despite good mask seal, etc. I heard some level III RNs comment that they don't bag for low sats caused by seizures 'because it doesn't work anyway when they are that clamped down'. What do you say about it?

Just curious...

[BittyBabyGrower, MSN, RN]

We get referrals from level IIs for seizures. The outcome is dependent on what caused the seizure, we have had some kids that seize once and then never again, others have some sort of etiology. Many times they won't come up with bagging or increased O2, because they do clamp down. Usually as the seizure is ending, the sats will improve as the kid becomes post-ictal. We almost always load with phenobarb and then call neurology. We will reload if necessary.