Neobook — clinical reference

Four essential neonatal seizure types van be recognized: subtle, clonic, tonic and myoclonic. Tonic-clonic rarely occurs in newborns.
Subtle seizures are more common in preterm than in full term infants.
Most common presentation in both preterm and term infants are ocular phenomena, sustained eye opening with fixation in preterms and horizontal deviation in term infants.
Jitteriness, a movement disorder is often confused with a seizure. Jitteriness is a tremor, compared to clonic jerking of a seizure, is stimulus sensitive, ceases with passive flexion, not associated with abnormal eye movement and autonomic changes.

Investigations

Check glucose level immediately (glucometer and if low, send blood to lab as well)
Electrolytes: Na, ionised Ca, Mg and phosphate
FBC +diff, CRP and blood culture
LP
Cranial ultrasound
Focal seizure will need a CT scan as focal ischaemic lesions may not be detected by cranial sonar
Monitor with aEEG – assists to diagnose seizures, monitor response to treatment and to detect subclinical seizures.

Treatment: Immediate

Maintain airway and breathing, stabilise vital signs
Look for metabolic disturbances and correct them if found
- Hypoglycaemia: give glucose IVI (10% NNL 2-3ml/kg then continuous infusion at 6-8mg/kg/min
- Hypocalcaemia: give 10% Calcium gluconate (1-2ml/kg diluted with equal volume of sterile water. Give it over 5 minutes. Monitor heart rate and IVI site.
- Hypomagnesaemia: give 50% magnesium sulphate (0.1-0.2ml/kg diluted with sterile water) IVI slowly. Monitor heart rate.

Neonatal Seizures