This document discusses neonatal seizures, including their definition, types, common causes, investigations, and treatment approach. It notes that seizures are more common and difficult to treat in the neonatal period. The main types discussed are subtle seizures, which are most common but easily missed; focal tonic clonic seizures; and myoclonic seizures. Common causes include perinatal asphyxia, intracranial hemorrhages, infections, and various metabolic derangements. Recommended initial investigations include blood tests and imaging studies like cranial ultrasound and EEG. The treatment approach outlined involves stabilizing the infant, collecting baseline samples, loading with phenobarbitone or phenytoin, and considering other anti-seizure medications

1. Neonatal seizures
Dr Shambhavi Sharma

2. Definition:
• Seizure is defined as a paroxysmal alterations
of neurological function including motor,
behavioral and / or autonomic functions
• More common in the neonatal period
• Under recognised and difficult to treat

3. Subtle seizures:
• Commonest – 50%
• Mild and frequently missed
• More in preterms
• Deviation of eyes
• Chewing, lip smacking
• Cycling, paddling
• Autonomic – tachycardia, bradycardia
• Apnea

4. Subtle seizures

5. Focal tonic clonic

6. Myoclonic seizures

7. Seizure like conditions:
• Jitteriness
• Tremors
• Myoclonic jerks during sleep

8. Etiology :
1) Perinata asphyxia
2) Intracranial hemorrhages
3) Infections
4) Metabolic- hypoglycemia, hypocalcemia,
hyponatremia
5) Developmental defects
6) Epileptic syndromes

9. Investigations:
• Blood sugar
• Hematocrit
• Serum electrolytes – Na, Ca, Mg
• CSF exmamination
• Blood culture
• Cranial USG
• EEG

10. Special investigations:
• Imaging- CT, MRI
• Screen for congenital infections( TORCH)
• Metabolic screen

11. Approach to seizures
• Identify and characterize seizures
• Keep in safe place
• Left lateral position
• Secure airway: clear secretions,head tilt .chin
lift,artificial airway
• optimise breathing: oxygen by mask.bag and mask
ventilation
• circulation: iv acess, iv fluids
• collect samples for baseline investigation:
CBC,RFT,RBS,LFT,CALCIUM,MAGNESIUM,CRP,ESR

12. • DRUGS: Load phenobarbitone 20 mg/kg/dose
• Repeat phenobarbitone 10 mg/kg/dose till a
maximum of 40 mg/kg
• Start phenytoin at 20 mg/kg/dose
• Repeat phenytoin 10 mg/kg/dose

13. • Consider midazolam infusion and ventilation if
required
• Consider other antiepileptic drugs
(eg valproate)
MONITOR VITALS CONTINUOUSLY
EVALUATE AND TREAT THE CAUSE

14. Neonatal sepsis

19. Clinical features

21. Investigation

22. investigations
• Blood culture
• Chest X ray
• Lumbar puncture
• Usg abdomen and pevis

24. Antibiotic therapy : intravenous
• Cefotaxime 50mg/kg
• Amikacin 15 mg/kg

26. •THANK YOU