This document presents information on neonatal convulsions. It begins with an introduction and definitions. The causes of convulsions are then discussed, including those related to the early and late neonatal periods. The pathophysiology and signs/symptoms are described. Diagnosis involves history, investigations like blood tests and imaging. Management includes controlling seizures with medications like phenobarbitone and treating the underlying cause. Complications may include cerebral palsy and epilepsy. Prognosis depends on the etiology.
4. Convulsion can be due to asphyxia, birth
injury or hypoglycemia and also are a sign of
meningitis or neurological problems.
Overall incidence ranges from 2-14 in 1000
live births.
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5. A sudden, violent, irregular movement of the body,
caused by involuntary contraction of muscles and
associated especially with brain disorders such as
epilepsy, the presence of certain toxins or other
agents in the blood, or fever in children.
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8. The basic mechanism is excessive depolarization
(excitation ) of neurons within the CNS. Three possible
reasons for excessive depolarization are proposed:
Failure of sodium potassium pump operation.
Relative excess of excitatory neurotransmitter
compared to the inhibitory ones.
Relative deficiency of inhibitory neurotransmitters.
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11. The neurons within the CNS undergo depolarization
due to inward migration of sodium and repolarization
due to efflux of potassium.
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13. i) Generalized convulsions:
Repetitive jerking movements of limbs and face.
Continuous extension or flexion of arms and legs
either synchronous or asynchronous
Apnea
Baby may be unconscious or awake but
unresponsive.
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14. ii) Subtle convulsion:
Repetitive blinking, eye deviation or startling
Repetitive movements of mouth or tongue
Purposeless movements of the limbs as of bicycling
or swimming
Apnea
Baby may be unconscious
iii) Spasms:
Involuntary contractions of muscles that last a few
seconds to few minutes.
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15. History:
Details of delivery, Apgar score at birth, breast
feeding or not, maternal drug history, family history
of seizures, inborn errors of metabolism, withdrawl
of narcotic drugs.
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16. Investigations:
Full blood count
Blood and CSF cultures
Serum IgM & IgG- specific TORCH titres.
Blood biochemical- estimation for glucose, calcium,
magnesium, bilirubin, & electrolytes
Blood gas levels to detect acidosis & hypoxia
EEG
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17. Imaging studies:
Ultrasonography or CT scan of head- to detect
intraventricular and/or subarachnoid hemorrhage.
They are also useful to detect any congenital
malformations.
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18. The principles of management are:
To control convulsions
To stabilize the vital functions
To treat the underlying pathology
To maintain supportive therapy, nutrition, ventilation,
cardiac output, serum electrolytes and pH.
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19. To control convulsions:
Intravenous administration of phenobarbitone. 20
mg/kg body wt. slowly over a period of 10-15
minutes is effective.
The maintenance dose of 2.5-4 mg/kg body wt. per
day administered orally or intramuscularly for at least
a period of 2 weeks or even longer.
In resistant cases, iv phenytoin ( Dilantin) 20 mg/kg
at the rate of 1mg/kg/min is administered.
The maintenance dose of 5-8 mg/kg/day divided 12
hourly. Fosphenytoin is preferred.
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20. To treat the underlying causes:
Hypoglycemia: glucose infusion, 2ml/kg of 10%
glucose through iv lines is given over 2-3 minutes.
Glucose infusion is continued at a rate of 6-8/
mg/kg/min. blood glucose should be maintained at
70-100 mg/dl.
Hypomagnesemia: magnesium sulphate ( 0.4-0.8
mEq/kg) is given iv every 12 hrs until magnesium
level is normal.
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21. Infection : Appropriate antibiotic therapy following
complete septic work up.
Hypocalcemia: iv administration of 2ml/kg of 10%
calcium gluconate taken over 5 minutes. This is to be
followed by oral calcium chloride 50 mg with each
feed for few days.
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22. Pyridoxine deficiency: iv administration of 50 mg
pyridoxine is effective. To relieve intracranial
tension- 10 ml of 20% mannitol is given
intravenously over 30-60 minutes.
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23. Complications of neonatal convulsion may include the
following:
Cerebral palsy
Cerebral atrophy
Epilepsy
Feeding difficulties
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24. Varies with the etiology.
Hypocalcemia convulsions have an excellent
prognosis whereas seizures secondary to congenital
malformations have poor outcomes.
The overall mortality rate has decreased but
neurological sequelae are still around 30-40%.
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27. 1. What are the drugs used for convulsion treatment?
2. The term “Neonates” is used for the newborn upto
a) 2 months b) 1 year
c) 28 days d) 6 months
3. For diagnosing severe asphyxia , Apgar score must
be
a) 1-3 b) 7-10
c) 9-12 d) 4-9
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28. 4. Pyridoxine is also called vitamin ………………
5. EEG stands for ….…………………….
6.TORCH infection stands for ………………………
7. IgG can pass across placenta.
a) True b) False
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30. Ranabhat, R.D & Niraula, H.(2017) A textbook of
midwifery & reproductive health (1st ed.).
Kathmandu, Page no: 583-584
Tuitui, R. (2016) Manual of midwifery III (11th ed.).
Vidyarthi Pustak Bhandar, Kathmandu, Page no: 235-
237
Dutta, D.C. (2011). A textbook of obstetrics including
perinatology and contraception (7th ed.). A central
book agency(P) ltd., Hyderabad, page no: 481-482
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