Neonatal Seizures: When Can a Failure to Recognize Warning Signs Cause Preventable Harm?

Seizures in newborns can be difficult to recognize. Unlike seizures in older children or adults, neonatal seizures may involve subtle movements, brief changes in breathing, unusual eye movements, or episodes of unresponsiveness. Because a newborn cannot communicate what is happening, medical professionals must recognize concerning signs and determine whether urgent evaluation is needed.

Neonatal seizures can be a warning sign of a serious underlying problem, including a lack of oxygen around birth, a stroke, an infection, or a metabolic disorder. Prompt diagnosis and treatment can be important to protecting a baby’s developing brain. When warning signs are missed or treatment is delayed, the underlying condition may go untreated, and the risk of additional neurological injury may increase.

Not every neonatal seizure results from medical negligence, and not every delay causes preventable harm. However, when healthcare providers fail to respond appropriately to signs of a newborn’s neurological distress, families may have questions about whether the care met accepted medical standards. Kalfayan Merjanian, LLP helps California families understand their legal options when a suspected birth injury may have resulted from preventable medical errors.

What Are Neonatal Seizures?

Neonatal seizures are seizures that occur during the newborn period, generally within the first 28 days after birth for a full-term infant. They result from abnormal electrical activity in the brain. Some seizures produce visible movements, while others may be difficult to identify without specialized monitoring.

Newborns are particularly vulnerable to neurological problems because their brains are still developing. A seizure may be a symptom of an underlying condition that requires immediate attention. The medical team must assess the baby, investigate possible causes, and determine whether treatment is needed.

Recognizing seizures in newborns can be challenging even for experienced healthcare providers. Normal newborn movements, such as brief twitches during sleep, can sometimes resemble seizure activity. Conversely, a genuine seizure may not involve the dramatic shaking that many people associate with seizures. This makes careful clinical assessment and appropriate testing especially important.

What Warning Signs of Seizures Should Medical Providers Recognize?

Neonatal seizures can appear in several ways. Some involve repetitive movements that cannot easily be stopped by gently holding the affected limb. Others cause changes in muscle tone, eye movements, breathing, or responsiveness.

Possible warning signs include:

• Repeated jerking or rhythmic movements of the arms, legs, or face.
• Repeated eye deviation, unusual staring, or repetitive eyelid movements.
• Sudden stiffening, unusual limpness, or repetitive mouth movements such as chewing or sucking that do not appear related to feeding.
• Episodes involving pauses in breathing, changes in heart rate, or a sudden change in responsiveness.

These signs do not automatically mean that a newborn is having a seizure. Some can occur for other reasons, and some neonatal seizures have no obvious outward signs at all. When seizures are suspected, clinicians must consider the baby’s overall condition and use appropriate diagnostic methods rather than relying solely on observation.

Medical staff should also pay attention to patterns of concern. Repeated episodes, unusual movements accompanied by changes in alertness, or a newborn who appears increasingly unwell may warrant urgent assessment. Parents’ observations can be valuable because they may notice changes in their baby’s behavior or movements that are not apparent during a brief examination.

What Conditions Can Cause Seizures in Newborns?

A neonatal seizure is often a symptom of another medical problem. Finding the cause is essential because some underlying conditions require urgent treatment to reduce the risk of further injury.

One important cause is hypoxic-ischemic encephalopathy (HIE), a type of brain injury associated with reduced oxygen and blood flow to the brain around the time of birth. Other possible causes include a stroke, bleeding in or around the brain, and infections such as meningitis.

Seizures may also occur because of low blood sugar, abnormal levels of minerals such as calcium or sodium, certain genetic conditions, or structural differences in the brain. Some of these causes can be treated directly, which is one reason a prompt medical evaluation matters.

In some cases, seizures may be connected to complications during labor and delivery. For example, problems affecting oxygen delivery, a failure to respond appropriately to fetal distress, or delays in addressing a newborn’s breathing difficulties may be relevant to the investigation. In other cases, the cause may arise before labor or from a condition that could not have been prevented.

Determining the cause requires a careful review of the pregnancy, labor and delivery, the newborn’s condition after birth, and the medical care provided once symptoms appeared. The presence of seizures alone does not establish that a doctor or hospital caused the underlying injury.

How Are Neonatal Seizures Diagnosed?

When a newborn shows possible signs of seizure activity, healthcare providers must assess the baby’s condition and decide what testing and treatment are needed. Because some seizures have few visible signs, observing the baby alone may not be enough.

An electroencephalogram (EEG) records electrical activity in the brain and is an important tool for detecting and confirming neonatal seizures. Continuous EEG monitoring may be especially useful for babies at high risk or those whose symptoms are difficult to interpret. Other evaluations may include blood tests to check glucose and electrolyte levels, testing for infection, and brain imaging such as an MRI.

Timely diagnosis involves more than ordering a test. Medical professionals must recognize concerning changes, arrange appropriate evaluation, interpret the results, and respond to findings that indicate a serious problem. They may also need to consult neonatology or pediatric neurology specialists.

A failure to investigate repeated abnormal movements, unexplained changes in responsiveness, or other signs of neurological distress may raise questions about whether the care was appropriate. Whether a particular response was negligent depends on the baby’s symptoms, risk factors, available information, and the medical standards that applied at the time.

How Can Delayed Treatment Affect a Newborn’s Neurological Outcomes?

The effects of neonatal seizures vary widely. Some newborns recover well, particularly when the underlying cause is identified and treated promptly. Others experience lasting effects because the seizures are associated with significant brain injury or a serious medical condition.

Ongoing or repeated seizure activity can add to the concerns facing an already vulnerable newborn. Delayed treatment may also mean that a cause that could have been addressed—such as low blood sugar, an electrolyte imbalance, or an infection—continues without appropriate intervention. Clinical guidance emphasizes identifying the cause, correcting treatable problems, and controlling seizure activity to help limit further injury.

Possible long-term effects depend on the underlying condition and the extent of neurological injury. Some children may develop cerebral palsy, epilepsy, developmental delays, learning difficulties, or problems with movement, communication, or behavior. Others may have fewer lasting difficulties. A seizure does not mean that a child will necessarily develop any of these conditions.

When delays in diagnosis or treatment are suspected, doctors reviewing the case may examine whether earlier recognition would probably have changed the course of care or reduced the injury. That question is central to determining whether a medical error caused preventable harm.

When Might a Failure to Recognize Neonatal Seizures Be Medical Negligence?

Medical negligence occurs when a healthcare provider fails to meet the applicable standard of care and that failure causes injury. In a neonatal seizure case, the key question is not simply whether a seizure occurred or whether the diagnosis took time. It is whether the providers responded reasonably to the information available and whether a different response would likely have prevented or reduced the harm.

Potential concerns may include failing to recognize repeated signs of seizure activity, delaying appropriate neurological monitoring, overlooking abnormal test results, failing to investigate a treatable underlying cause, or not arranging timely specialist care when it was needed.

The investigation may also need to look at events before delivery. If a newborn’s seizures resulted from an oxygen-related brain injury, for example, relevant questions could include whether the medical team appropriately monitored the pregnancy and labor, responded to signs of fetal distress, and provided necessary care after birth.

Medical records, fetal monitoring strips, nursing notes, medication records, laboratory results, EEG findings, and brain imaging can help experts reconstruct the timeline. Qualified medical experts can assess whether the care met accepted standards and whether an earlier intervention would likely have changed the outcome.

Not every poor outcome is preventable, and healthcare providers are not negligent simply because a baby suffers a serious condition. A viable claim requires evidence of both a departure from the applicable standard of care and a causal connection between that failure and the child’s injury.

What Should Parents Do if They Suspect a Preventable Birth Injury Occurred?

Parents may be left with unanswered questions after their newborn experiences seizures or receives a diagnosis involving brain injury. Understanding what happened can take time, particularly when several medical conditions or events may have contributed.

Families can begin by requesting available medical records from pregnancy, labor and delivery, and newborn care. Records from the neonatal intensive care unit, neurological testing, imaging, and later developmental assessments may help clarify the sequence of events and the child’s needs.

It may also be important to document the child’s ongoing treatment, therapies, developmental progress, and expected future care. If the child has a lasting neurological disability, these records can help establish the practical effects of the injury and the support the child may require over time.

California medical malpractice claims are subject to specific filing deadlines, including special rules for claims involving children. The applicable deadline can depend on the circumstances, so families should seek legal advice promptly rather than assume that they can wait until a child is older.

How Can a Birth Injury Attorney Help?

Investigating suspected neonatal seizure-related negligence requires a detailed review of medical decisions made during a critical period. A legal team can obtain and organize records, consult qualified medical experts, examine whether providers responded appropriately to warning signs, and evaluate whether an earlier diagnosis or treatment would likely have reduced the harm.

If a preventable injury has left a child with long-term neurological needs, a claim may also need to account for future medical care, therapy, assistive equipment, specialized education, and other support the child may require.

Kalfayan Merjanian, LLP helps California families evaluate potential birth injury and medical negligence claims. If you believe a failure to recognize or treat your newborn’s seizures contributed to a preventable injury, contact the firm to discuss what happened and learn about your family’s legal options.