Convulsion and neonatal hyperthermia

1. Prepared by:
Shraddha Dahal
Roll no:25
B.Sc. Nursing 4th year

2. General Objective
At the end of this session, all the B.Sc.
Nursing 3rd year students will be able to
explain about neonatal hyperthermia and
convulsion in newborn.

3. Specific Objectives
At the end of this session, all the B.Sc. nursing
3rd year students will be able to:
• define neonatal hyperthermia.
• list out the causes of neonatal hyperthermia.
• list out the clinical features of neonatal
hyperthermia.
• list out the consequences of neonatal
hyperthermia.
• describe the management of neonatal
hyperthermia.

4. • define convulsion in newborn.
• state the incidence of convulsion in
newborn.
• explain the classification of convulsion in
newborn.
• describe the causes of convulsion in
newborn.
• identify the diagnostic measures for
convulsion in newborn .
• describe the management of convulsion in
newborn.
• discuss the prognosis of convulsion in
newborn.

5. Neonatal Hyperthermia
Neonatal hyperthermia is an alteration in
neonatal thermoregulatory state of neonates
which occurs when the axillary temperature
rises above 37.5°C (WHO, 2003).

6. Causes

7. Incubator

8. Radiant Warmer

9. Clinical Features
• Baby's axillary temperature is above
37.50C.
• Skin feels hot, flushing and perspiration
occurs.
• Breathing is rapid( >60 breaths / minute).
• Baby's heart rate is rapid (160 beats/
minute).

10. …contd
• Baby appears dehydrated.
• Lethargic, hypotonia and poor feeding
• Irritability, Weak cry

12. Sunken Fontanelle

13. Skin Turgor

15. Consequences
• Hypotension and dehydration
• Seizures and apnea
• Hypernatremia

16. Management
• Move the baby away from the source of
heat such as direct sunlight, a fire or an
electric heater.
• Place the baby in a normal temperature
environment(250C-280C).
• If the newborn is in an incubator, the air
temperature should be lowered by 0.50C in
every 15 minutes.

17. ….contd
• If the baby's temperature is more than
400C, undress the baby and sponge the
baby.
• Use lukewarm water for sponge bath.
• Cooling devices are not recommended.
• During the cooling process, the newborn’s
temperature must be monitored every 15-
30 minutes until stable.

18. ….contd
• Give frequent breast feeds or give
expressed milk by cup if the baby doesn't
suck.
• If the newborn cannot breastfeed, extra
fluids should be given intravenously or by
tube at maintainance volume according to
the baby's age.
• If the respiratory rate is more than 60
beats per minute or the baby has chest
indrawing or grunting on expiration , treat
for breathing difficulty.

19. ….contd
• If signs of sepsis appear, treat for sepsis.
• If there are signs of dehydration,correct
dehydration.
• Parental education

20. CONVULSION IN NEWBORN
• Convulsion in newborn is a paroxysmal
manifestation of neurological dysfunction
caused by abnormal electrical discharges
from the brain resulting in abnormal
involuntary, motor and sensory activities.
• Overall incidence ranges from 2 in 1000 to
14 in 1000 live births.

21. Classification of Neonatal
Convulsions

22. Tonic Convulsions

23. Causes
A. Traumatic causes
• Hypoxic-ischemic encephalopathy
• Intracranial hemorrhage

24. ….contd
B. Metabolic causes
• Hypoglycemia
• Kernicterus
• Hypocalcemia
• Hyponatremia, hypernatremia
• Hypomagnesemia
• Inborn errors of metabolism

25. ….contd
C. Infections
• High fever
• CNS infections
• Tetanus

26. ….contd
D. Other causes
• Cerebral malformations
• Neonatal epileptic syndrome
• Chromosomal syndromes
• Narcotic withdrawal

27. Schizencephaly

28. Diagnostic Measures
• History taking
• Laboratory studies
Full blood count
Blood, Urine and CSF cultures
TORCH titer
Blood biochemical estimation
Blood gas analysis

29. …..contd
• EEG
• Imaging studies

30. EEG in Newborn

31. Management
A. To control convulsions
• IV phenobarbitone( most preferred) 20 mg/kg
body weight slowly over a period of 10–15
minutes is effective.
• After 1 hour, if convulsions still persist,
another 20mg/kg body weight IV of
phenobarbitone is given.
• If convulsions still persist, another 10 mg/kg
IV of phenobarbitone can be given .
• A maintenance dose of 2.5–4 mg/kg body
weight per day administered orally or
intramuscularly for at least a period of 2
weeks or even longer.

32. ……contd
• In resistant cases IV phenytoin (Dilantin),
20 mg/kg at the rate of 1 mg/kg/min is
administered. Maintenance dose of 2.5-5
mg/kg/day divided 12 hourly.
• Pyridoxine: IV,100mg/kg/day, TDS for 7
days and the maintainance dose of oral
50-100 mg daily may be effective in
seizures that are refractory to above
medication.

33. ……contd
B. To stabilize vital functions and provide
supportive care :
• The neonate needs special care with
airway clearance, oxygen, IV line, thermal
protection, prevention of aspiration and
injury.
• Infuse normal saline or Ringer lactate 10
ml/kg over 5-10 minutes, if perfusion is
poor. Repeat the same 1-2 times over the
next 30-45 minutes, if perfusion continues
to be poor.

34. C. To treat the underlying pathology :
• Hypoglycemia : Glucose infusion, 2 ml/kg
of 10% glucose, through an intravenous
line is given over 2–3 minutes. Glucose
infusion is continued at a rate of 4-6
mg/kg/min or 60 ml/kg/day.

35. ……contd
• Hypomagnesemia: Magnesium sulfate (0.4–
0.8 mg/kg) is given IV every 12 hours until
magnesium level is normal.
• Infection: Appropriate antibiotic therapy
• Hypocalcemia: Intravenous administration of
2 ml/kg of 10% calcium gluconate taken
over 10 minutes with strict cardiac
monitoring. This is to be followed by oral
calcium chloride 250 mg with each feed for
few days.

36. ……contd
• To relieve intracranial tension— 10 ml of
20% mannitol is given intravenously over
30–60 minutes.

37. Prognosis
• It varies with the etiology.
• Hypocalcemic convulsions have an excellent
prognosis whereas convulsions secondary to
congenital malformations have poor outcome.
• The overall mortality rate has decreased but
neurological sequelae are still around 30–
40%.

39. References
• Subedi, D.,& Gautam ,S.(2017) .Midwifery nursing
part III ( 3rd ed.). Medhavi Publication ,Baneshwor,
Kathmandu,Nepal (pp:175-177).
• Uprety,K. (2017).Essential of child health nursing(1st
ed.).Akshav Publication , kathmandu,Nepal (pp: 83-
85).
• Adhikari,T.(2015). Essentials of Pediatric Nursing (2nd
ed.).Vidhyarthi Pustak Bhandar, Kathmandu, Nepal
(pp:62).
• Dutta,P.(2014).Pediatric Nursing (3rd ed.).Jaypee
Brothers Medical Publisher, New Delhi, India (pp: 83-
85,101-102).

40. • Koner,H.(Eds.).(2013).DC Dutta's textbook of
obstetrics(8th ed.).Jaypee Brothers Medical
Publishers,New Delhi,India(pp:557-558).
• Paul,V.K & Bagga.A.(2013).Ghai essential
paediatrics(8th ed.).CBS Publishers and
Distributors, New Delhi, India(pp: 552-556, 144).
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Nurses( 2nd ed.). Jyapee Brothers Medical
Publisher , New Delhi,India( pp:217).
• Thakur, L .(2012).Advanced child health nursing
(3rd ed.).Ultimate Marketing ,Lazimpat
,Kathmandu,Nepal (pp:69 ).