| ID | 368 |
|---|---|
| Name | NEONATAL SEIZURES (CONVULSIONS) |
| Cause | Lack of oxygen before or during birth due to placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labor, or compression of the umbilical cord. |
| Signs Symptoms | Random or roving eye movements, eyelid blinking or fluttering, eyes rolling up, eye opening, staring. Sucking, smacking, chewing and protruding tongue. Unusual bicycling or pedalling movements of the legs. Thrashing or struggling movements. Long pauses in breathing (apnea) |
| Diagnosis | A test called an electroencephalogram (EEG) is essential for diagnosing and managing neonatal seizures. EEG records the electrical activity of the brain, and abnormalities on an EEG test (measured between seizures) can indicate a risk for seizures |
| Investigations | A test called an electroencephalogram (EEG) is essential for diagnosing and managing neonatal seizures. EEG records the electrical activity of the brain, and abnormalities on an EEG test (measured between seizures) can indicate a risk for seizures |
| Management | Management of neonatal convulsions:13-17-37 1. Maintain airway clear by oropharyngeal & naso-pharyngneal suction. 2 Therapy should be directed to the underlying cause. 3. Try first with i.v 10% dextrose 5ml/kg over 2-3 minutes and calcium gluconate 10% Iml/kg mixed with equal valume of dextrose in aqua i.v over 3 minutes (and injection pyridoxine 50-100mg i.v if available). 4. Control of convulsion- a. Inj. diazepam 0.3mg/kg/dose i.v stat, may be repeated after 10-15 minutes. If not controlled/or, b. Inj. phenobarbitne l0mg/kg i.v stat over several minutes. Maintain with i.v or i.m or oral phenobarbitone 5-8mg/kg/day in 3 to 4 divided doses, c. Phenytoin of the same dose may be added if phenobarbitone fails to control fits. 5. Investigations (minimum)- a. Full blood count (FBC), platelets & peripheral blood film (PBF). b. Urine R/E. c. Blood sugar. d. S.erum calcium, magnesium & phosphorus. Normal calcium = 8 mg/dl. Normal magnesium= 1.4 mg/dl Normal PO4 = 7.5 mg/dl e. S. electrolytes f. Blood urea, g. Lumber puncture-for C.S.F analysis. Other investigations may include- X-ray skull, E.E.G etc. depending on the individual case. Specific management: Management of individual underlying cause- see below. |
| Introduction | All types of seizures (or convulsions) occuring within the first 4 weeks of life are designated as neonatal seizures. Although it may occur at any time within the first 4 weeks but the neonatal seizures are more frequent mainly in the first week & biphasic distribution with a peak in the first 48 hours & another peak at the 5th to 7th day. |
| History | |
| Etiology | Common etiological factors: 1 Birth asphyxia & injury (cerebral anoxia)- birth onwards 2. Intracranial hemorrhage. (IVH, subdural & subarachnoid)- birth on wards 3. Hypoglycemia- few hours after birth in diabetic babies on any day in other cases. 4. Neonatal Infections a. Meningitis- within first two weeks of birth in majority cases. b. Encephalitis- a few days after birth & onwa-rds. c. Tetanus- 3 to 10 days after birth 5. Hypocalcemia-usually < 48 hours 6. Hypernatremia- after 24 hours 7 Hypomagnesemia- after 3 days 8. Hyperbilirubinemia- period of jaundice development (usually 5-7 days) 9. Pyridoxine deficiency- birthonwards 10. Drug (narcotic) withdrawal- birth onwards |
| Clinical Features | see under sign and symptoms |
| Preventions | |
| Treatment | Phenobarbital is the most commonly used AED for treating neonatal seizures. The dosage aims at reaching a level in the baby's blood (a free plasma concentration) of at least 25 micrograms per milliliter (mcg/mL). Phenytoin is the second most commonly used medication. |
| Complications | Complications from prolonged or frequent neonatal seizures include global developmental delay, cerebral palsy/spasticity with possible contractures, epilepsy later in life, feeding issues or swallowing issues |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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