What is the next step for a 3-week-old girl with rhythmic lip-smacking movements, normal vital signs, and a normal physical exam?

From the Guidelines

The next step for a 3-week-old girl with rhythmic lip-smacking movements, normal vital signs, and a normal physical exam should be an urgent neurology consultation and electroencephalogram (EEG) to evaluate for seizure activity, as these movements can be a manifestation of neonatal seizures, specifically oral automatisms, which require prompt evaluation to identify underlying neurological disorders 1.

Key Considerations

• The infant's rhythmic lip-smacking movements are concerning for focal seizures, which can indicate underlying neurological disorders.
• Neonatal seizures require prompt evaluation to prevent potential adverse neurodevelopmental outcomes.
• The neurologist may order additional tests, including brain imaging (MRI) and laboratory studies, to identify potential causes such as electrolyte abnormalities, infections, or structural brain abnormalities.

Diagnostic Approach

• An urgent neurology consultation is necessary to evaluate the infant's condition and determine the best course of action.
• An electroencephalogram (EEG) should be performed to evaluate for seizure activity and identify any potential underlying neurological disorders.
• Parents should be advised to video record any episodes if they recur, as this can help with diagnosis.

Treatment

• No medication should be started before diagnostic confirmation, but if seizures are confirmed, the neurologist will likely prescribe an appropriate anticonvulsant medication such as phenobarbital (initial loading dose of 20 mg/kg) or levetiracetam (initial dose of 10-20 mg/kg twice daily) 1.

Prognosis

• Early identification and treatment of neonatal seizures is critical to prevent potential adverse neurodevelopmental outcomes.
• The prognosis for infants with neonatal seizures depends on the underlying cause and the promptness of treatment, highlighting the importance of urgent neurology consultation and diagnostic evaluation 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Assessment and Diagnosis

• The 3-week-old girl's symptoms of rhythmic lip-smacking movements could be indicative of a seizure disorder, such as infantile spasms 2, 3.
• Given the patient's age and presentation, it is essential to consider the possibility of seizures, even if the vital signs and physical exam are normal 4, 5.

Next Steps

• An electroencephalogram (EEG) should be considered to evaluate for seizure activity, as it is a crucial diagnostic tool in this scenario 4, 5.
• Although early EEG (within 48 hours) may not be feasible in all cases, it is still a valuable diagnostic tool in assessing seizure activity 5.
• The patient's symptoms and EEG results will guide further management and treatment, which may include antiepileptic medications such as phenobarbital or vigabatrin 4, 6, 2, 3.

Considerations

• If the patient is diagnosed with infantile spasms, vigabatrin may be considered as a treatment option, but its potential side effects, such as visual field constriction and extrapyramidal symptoms, must be carefully monitored 6, 2, 3.
• Long-term follow-up is necessary to screen for postneonatal epilepsy and support neurodevelopment, regardless of the diagnosis or treatment 4.