Neonatal Seizuresdr.athal – 5th stage- pediatric
About 2–4/1000 live births suffers of seizure disorder. Usually occur 12–48hr after delivery.Can be generalized or focal, and tonic, clonic, or myoclonic.
Subtle seizure patterns (lip-smacking, limb-cycling, eye deviation, apnoea, etc.) can be difficult to identify or differentiate from other benign conditions that may mimic seizures as:
Startle or Moro reflexe.
Normal jittery movements (fine, fast limb movements that are abated by holding affected limb).
Sleep myoclonus (REM movements).
Etiology
Brain injury:HIE.
Intracranial haemorrhage.
Cerebral infarction (ischaemic or haemorrhagic).
Cerebral oedema.
Birth trauma.
CNS infection:
Meningitis (e.g. GBS, coliforms).
Encephalitis (e.g. HSV, CMV).
Cerebral malformations.
Kernicterus.
Metabolic:
Hypoglycaemia.
Hypo- or hypernatraemia.
Hypocalcaemia, hypomagnesia.
Pyridoxine dependent seizures.
Neonatal withdrawal from maternal medication or substance abuse.
Rare syndromes:
Benign familial neonatal seizures (autosomal dominant).
Early myoclonic encephalopathy.
Idiopathic: with improved access to neuroimaging, fewer infants are being categorized as ‘idiopathic’ seizures. Neonatal stroke is increasingly recognized.
Treatment
Immediate ABC: maintain airway, give O2, insert IV canula.
Indication anticonvulsants:
>3seizures/hr
single seizure lasting >3–5min particularly if evidence of cardio-respiratory compromise.
First-line anticonvulsant:
IV phenobarbital 20-40mg/kg bolus
Maintenance dose 5mg/kg/day.
Then treat the underlying cause.