Neonatal Convulsions
A convulsion is defined clinically
as a paroxysmal alteration in neurologic functions, ie, bebovioral, notor or
autonomic functions or all three occurring within 28 days of age.
A neonatal convulsion may be
difficult to recognize became sometimes it presents very subtly abnormal
gase, smacking of lips, blinking of the eyes, abnormal posturing, apnee spells
and stiffening of the limbs.
Causes:
A. Perinatal
complications – 25% causes of
a.
Perinatal & birth injury cerebral amoxid
b.
Intracranial – IVI+, subdural & subarachnoid
B. Inflations:
a. Meningitis
b. Enaphalitis
c. Tetanus
d. Septicemia
C. Metabolic:
a. Hypoglycemia
b. Hypocalcaemia
c. Hyponotrcemia
d. Hypomagnesaemia
e. Hyperbilirulinemia (kernicterus)
f. Pyridoxine deficiema
g. Drug
withdrawal
h. Inborn errors of metabolism.
D. Developmental of brain
E. Unknown
– 25%
1st
3 day: 1. Perinatal asphyxia, trauma
2.
Early
neonatal lypocalemia
3.
Hypoglycemia
4.
IVH
5.
S.
Electrolyte disturbance
4-10 days : 1. Septicemia, meningitis,
tetanus
2. Late neonatal hypocalcaemia
3. S. blatrolyte disturbance
4. Kernictarers
> 7 days: Storage discare
Metabolic
TORCH
infections
Evaluation:
1.
A
full prenatal history & neonatalal exam
2.
Date
wise onset of convulsion
3.
Lab,
assessments:
Blood sugar, calcium, magnesium,
sodium CBC, Blood C/S & toxic serum
CSF exam cranial USG?CT serum.
Treatment:
1.
Look
for vital signs & maintain ABC
2.
Therapy
should be directed to underlying cause
3.
Initial
measures:
1/v 10% DA → 2-4 ml/kg over 5 min
↓
No improvement
Inj. 10% calcium gluconate ml/kg
over 10 mins
↓
No improvement
Inj. phenobarleitme 10-20 mg/kg slat
over 5 mins
This may be separated once after
10-15 mins if convulsion persists
↓
No improvement
Inj.
diazpass 0.3 mg/kg – ½ star storly or 0.5 mg/kg PR Co.2 ml dilute
with 0.8 ml D normal su….
↓
No improvement
Inj.
Ampicillen 10 mg/kg + Inj. Gentamices 5 mg/kg 1/2 &
refer cif nuded)
If 1v line can not be established →
Inj. Diazepam 0.5 mg/kg –PR + Inj.
Phenobarbitone 20 mg/kg 1/m + Inj. Ampicillin & Gentamicin & refer
immediately.
Maintenance dise – Phenobarbitals 5
mg/kg daily or twice dose.
Donation:
1.neurologically normal at discharge – discontinue treatment & continue if
abnormal.
The optimal duration has not been
established. Some recommended for a prolonged period, have been absent for 2
wks.
Prognosis:
1. MR
– 15%
2. Neurologic
sequelal – (Mental retardation 30% motor definite………)
3. Normal
outcome 56%
In an individual case, prognosis is
estimated by level of maturity, Underlying iliology, EEG, neurologic exam.
& imaging study’s of brain such as CT
PNEUMONIA:http://pneumoniaofchild.blogspot.com/
