Heart rate changes were studied during 169 seizures in 14 neonates with severe birth asphyxia at the Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. Changes were detected during 21 seizures (12.4%) in 8 patients; heart rate was increased in 4, decreased in 1, and both patterns were observed in 3 patients. Diminished or absent beatto- beat variability ("stable baseline HR"), recognized as a poor prognostic sign, was associated with a nonsignificant trend toward increased mortality. Heart rate monitoring is of limited sensitivity for detecting postasphyxial neonatal seizures. 
COMMENT. Heart rate changes during seizures involve connections between the cerebral hemispheres and brain stem autonomic regulatory centers. Unlike adults with ictal heart rate and blood pressure changes, of value in differentiating pseudo- from epileptic seizures [2, 3], the connections that govern autonomic dysregulation are insensitive in the neonate with postasphyxial seizures.