NEONATAL SEIZURES

INTR0DUCTION

Seizures during the neonatal period are relatively common , occurring in approximately 1%
of all neonates. Neonatal seizures represent an age – specific seizure disorder which is
usually considered to be in a separate category from epilepsy . While in children seizures
often occur in the absence of another neurological disorder , neonatal seizures frequently
are a non – specific sign of an underlying disease . Neonatal seizures also have many other
characteristics that are quite different from seizures in children and adults .

DEFINITION

A seizure is an alteration in neurologic function , ie motor , behavioural or autonomic , with

or without impairement of consciousness.

TYPES

 Subtle seizures : Are the most frequently observed but inconspicuous paroxysms
seen in term and preterm neonates. Common manifestations include
 Ocular : Tonic horizontal deviation of eyes with or without jerking sustained
eye opening with ocular fixation or eyelid fluttering seen often in preterms.
 Oral buccal lingual movements : chewing , tongue thrusting , lipsmacking ,
involuntary sucking movements
 Limb movements : cycling , peddling , rowing
 Autonomic phenomena ( tachycardia or bradycardia )
 Apnea may be a rare manifestation of seizures .Convulsive apnea is often
associated with tachycardia , tonic posturing or ocular manifestations
 Tonic seizures : it may be focal or generalized.
Focal tonic seizures consist of sustained posturing of a limb or asymmetric posturing
of the trunk or neck
Generalized tonic seizure may resemble decerebrate or decorticate posturing
 Clonic seizures : Are rhythmic movements of muscle groups .They may be focal
(localized jerky movements of face or extremity on one side of body ) , multi focal
(involving several parts of body ) .
 Myoclonic seizures : These manifest as a single or multiple jerks of the upper or
lower limbs .They can be focal ( involving flexors of one extremity ) , multifocal
(asynchronous twitching of several parts of body ) or generalized ( bilateral jerks of
all limbs ).
CAUSES
1) Hypoxic ischemic encephalopathy : commonest cause of neonatal seizures
2) Intracranial haemorrhage : birth trauma , HIE and coagulation anomalies are
most frequent cause of intracranial haemorrhage.
 3) Cerebrovascular disorder : focal cerebrovascular ischemia and consequent
infarction , vascular malformations , sinus or venous occlusions can cause
neonatal seizures
4) Metabolic seizures : causes are hypoglycaemia , hypocalcemia,
hypomagnesmia , hyponatremia ,pyridoxine dependency are inborn errors
of metabolism.
5) Infections : post natal acquired bacterial meningitis as well as
meningoencephalitis , secondary to intrauterine infections may present as
seizures in the neonatal period.

ROUTINE INVESTGATIONS

Blood sugar
Haematocrit
Bilirubin
Serum Na , Ca , Mg levels
CSF examination should be done in all cases , as seizures may be the first
sign of meningitis
CSF study
CSF study may be withheld temporarily if severe cardio respiratory
compromise is present or in cases with severe birth asphyxia .

SPECIFIC INVESTIGATIONS

 Neursonography : It is an excellent tool for detection of intraventricular and

parenchymal haemorrhages particularly in preterms
 Neuro imaging
 CT scan : It can be diagnostic in sub arachnoid , subdural and parenchymal
haemorrhages.
 MRI scan : It is especially for brain stem , cerebellum , basal ganglia and spinal cord
pathology.
 Screening for congenital infections : A TORCH screen and VDRL should be
considered in the presence of hepatosplenomegaly , thrombocytopenia and growth
retardation .

MANAGEMENT

The objective are

To terminate the seizure and prevent a recurrence

To identify the underlying cause
To inistitute specific therapy where available
NURSING MANAGEMENT

Ensure a patent airway and adequate perfusion

Establish an IV access
Perform a haemo glucotest on the first drop of blood .If the blood sugar
is less than 40 mg /dl , administer 2-4 cc / kg of 10 % dextrose
intravenous , followed by a maintenance drip with a glucose infusion
rate of 8mg/kg/min.
If the patient is not actively convulsing , blood may also be collected for
electrolytes , calcium , magnesium, hematocrit.
If no hypoglycaemia and convulsion persist : IV phenobarbitone , in a
loading dose of 20mg/kg administered over 10-15 minutes.
If seizures persist , additional dose of 5mg/kg of phenobarbitone can be
repeated , to a maximum of 40mg/kg.
If seizures persist / recur : IV phenytoin 20mg/ kg at the rate of
1mg/kg/min ,to avoid disturbances in cardiac function .It should be
added to dextrose as it precipitates in it.
Avoid oral preparations
If hypocalcemia is documented the neonate should receive 2ml/kg of
10% calcium gluconate IV over 10 minutes ,under strict cardiac
monitoring.
If hypomagnesemia is documented magnesium sulphate 0.2 ml/kg of a
50% solution is administered IM.
Document any concerns which parents have and to inform to the
doctors

NURSING DIAGNOSIS

 Ineffective breathing pattern related to immature neurologic and delayed pulmonary

development
 Assess the respiratory rate and pattern
 Provide oxygen therapy
 Position the infant on a side lying
 Provide tactile stimulation during periods of apnea
 Ineffective thermoregulation related to immaturity and lack of subcutaneous and
brown fat
 Monitor the neonates body temperature
 Dry newborn thoroughly and quickly and discard the wet blanket
 Place the infant under a pre warmed radiant warmer
 Avoid placing infant on cold surface or using cold instrument in assessment
 Mummify and use thick blankets to cover the neonate
 Imbalanced nutrition less than body requirements related to ineffective suck reflex
 Assess the neonates sucking pattern
  Monitor the neonate for signs of dehydration such as poor skin turgor , dry muous
membranes , increase or concentrated urine
 Risk for infection related to vulnerability of infant, lack of normal flora environmental
hazards and open wounds
 Monitor neonates condition
 Monitor vital signs
 Practice aseptic technique whenever handling the infant
 Maintain ideal environment temperature
 Ensure that all equipment used for infant is sterile , scrupulously clean.
 Administer antibiotics and antipyretics as ordered

SUMMARY
A seizure is a paroxysmal , time limited change in motor activity or behaviour that

results from abnormal electrical activity in the brain. Neonatal seizures are abnormal

electrical discharge in the CNS of neonates usually manifesting as stereotyped

muscular activity or autonomic changes.

CONCLUSION
The cinical significance of neonatal sezures is more of an indicator of underlying

serious brain damage or dysfunction than a predictor of chronic seizures persistence

despite the recent realization that benign idiopathic cases do exist . In any case , their

significance is more of an indication of brain damage than in terms of etiology .

Pending the answers , empirical therapy and supportive treatment will remain

essential.