Neonatal Seizures

1. UNDERSTANDING NEONATAL SEIZURES
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2. IMPORTANT NOTICE: MOTHER’S MILK IS BEST FOR THE BABY
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2
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3. IMPORTANT NOTICE: MOTHER’S MILK IS BEST FOR THE BABY
Breastfeeding provides the best nutrition and protection from illnesses of infants. For infants, breast milk is all that is needed for the first 6 months. Breastmilk is the best and most economical food
for baby.
Warning / Caution: Infant milk substitute is not the sole source of nourishment of an infant. Careful and hygienic preparation of infant milk substitute is most essential for health. Lactose- free infant
milk substitute should only be used in case of diarrehea due to Lactose intolerance. Lactose- free infant formula should be withdrawn, if there is no improvement in symptoms of intolerance.
Continued use of infant milk substitute should not be recommended to avoid any difficulties in reverting to breastfeeding of infants after a period of feeding by infant milk substitute. In the event
recommending infant milk substitute in addition to breastmilk or its replacement during the first 6 months, keep the costs in mind before recommending use of infant milk formula. Un-boiled water, un-
boiled bottles or incorrect dilution can make a baby ill. Always advise to follow instructions exactly.
Unnecessary introduction of partial bottle-feeding or other foods and drinks will have negative effect on breastfeeding.
Characteristics of breastmilk : Immediately after delivery, breastmilk is yellowish and sticky. The milk is called Colostrum, which is secreted during the first-week of delivery. Colostrum is more
nutritious than mature milk because it contains more proteins, more anti-infective properties, which are of great importance for the infant’s defense against dangerous neo-natal infections. It also
contains higher levels of Vitamin ‘A’.
Advantages of breastfeeding : (A) Breastfeeding is much cheaper than feeding an infant milk substitute as the cost of extra food needed by the mother is negligible as compared to cost of feeding
infant milk substitute; (B) Breastmilk is always available; (C) Breastmilk needs no utensils or water (which might carry germs) or fuel for is preparation; (D) Mothers who breastfeed usually have longer
periods of infertility after child birth than non-lactators.
Management of breastfeeding, as under:
I.Breastfeeding
A.Immediately after delivery enables the contraction of the womb and helps the mother to regain her figure quickly.
B.Is successful when the infant suckles frequently and the mother wanting to breastfeed is confident in her ability to do so.
II.In order to promote and support breastfeeding the mother's natural desire to breastfeed should always be encouraged by giving, where needed,
practical advice and making sure that she has the support of her relatives.
iii. Adequate care for the breast and nipples should be taken during pregnancy.
iv. It is also necessary to put the infant to the breast as soon as possible after delivery.
v. Let the mother and the infant stay together after the delivery, the mother and her infant should be allowed to stay together (in hospital, this is called "rooming- in").
vi. Give the infant Colostrum as it is rich in many nutrients and its anti-infective factors protect the infants from infections during the few days of its birth.
vii. The practice of discarding Colostrum and giving sugar water, honey water, butter or other concoctions instead of Colostrum should be very strongly discouraged.
viii. Let the infants suckle on demand.
ix. Every effort should be made to breastfeed the infants whenever they cry.
x. mother should keep her body and clothes and that of the infant always neat and clean.

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Table of contents
Table of
contents
Overview
Prevalence
Signs and symptoms
Management approach and role of nurses
Role of nurses in neonatal seizures
Biomedical waste management and role of
nurses
Summary

5. Overview
Neonatal seizures are defined as the
paroxysmal electroclinical phenomenon
of transient signs and symptoms caused
due to abnormal excessive or
synchronous brain neuronal activity.
They are the early signs of brain
damage which severely disturb
the infant brain development.
They occur in the first 28 days
after birth in a term neonate or
before 44 weeks of gestation
age in preterm neonates.
Acute asymptomatic seizures are the
most common emergency conditions in
newborns and are most prevalent in
neonates.
Kaminiów K, Kozak S, Paprocka J. Neonatal seizures revisited. Children (Basel). 2021;8(2):155. Doi:10.3390/children8020155
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6. Prevalence
Incidence of neonatal seizures is 1 to 5/1000 live births according to population-based studies and
8.6/1000 in NICU based study. 1
Neonatal seizures are higher in males than females 2
The risk of neonatal seizures increase with a decrease in birth weight 1
1. Pisani F, Spagnoli C, Falsaperla R, et al. Seizures in the neonate: A review of etiologies and outcomes. Seizure. 2021;85:48-56.
2. World Health Organization. Guidelines on neonatal seizures. World Health Organization; 2011.
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7. Signs and symptoms
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Subtle Seizures:
- Random or roving eye movements,
eyelid blinking or fluttering, eyes rolling
up, eye opening, staring
- Sucking, smacking, chewing, and
protruding tongue
- Unusual bicycling movements of the
legs
Clonic Seizures:
Rhythmic jerking movements that may
involve the muscles of the face, tongue,
arms, legs or other regions of the body
Tonic Seizures:
- Stiffening or tightening of the muscles
- Turning the head or eyes to one side, or
bending or stretching one or both arms
or legs
Myoclonic Seizures:
Quick, single jerking motions, involving
one arm or leg or the whole body
Pisani F, Spagnoli C, Falsaperla R, et al. Seizures in the neonate: A review of etiologies and outcomes. Seizure. 2021;85:48-56

8. Management approach
Treatment should be
initiated immediately
after diagnosis
Treatment should be
initiated immediately
after suspected
seizures even before
EEG confirmation
Basic therapy
includes hydration,
correction of
electrolyte
imbalances, or
antibiotic therapy
Kaminiów K, Kozak S, Paprocka J. Neonatal seizures revisited. Children (Basel). 2021;8(2):155. Doi:10.3390/children8020155
8

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Stepwise management of neonatal seizures (role of nurses)
Neonatal neurocritical care team is responsible for the effective implementation and
management of neurological complication in neonates.
Recognize
neurological signs
and symptoms
Interpret aEEG to
alert the physician
about electrographic
seizures/
encephalopathy
Quick setup of
cooling blankets and
EEG machines to
ensure quick care
Safe transport of
critically ill neonates
Empathetic
communication with
families
Preventing
secondary injury
Implementing
therapeutic
hypothermia
Immediate
management of
neurological
complications
Glass HC, Rowitch DH. The role of the neurointensive care nursery for neonatal encephalopathy. Clinics in perinatology. 2016 Sep 1;43(3):547-57.

10. Role of nurses in
neonatal seizures
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11. Role of nurses in neonatal neurointensive care
Peloquin S, Carley A, Bonifacio SL, et al. The neurointensive care nursery and evolving roles for nursing. Neonatal Netw. 2016;35(2):87-94.
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Accurate recognition of changes in
neurological status
Implement protocols to specifically
address the conditions
Prevent secondary injuries due to
neurological condition

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Provide brain focused care
using interprofessional team
approach
Rapid seizure response
through early recognition and
reduced time to treat
Long-term support and
follow-up care for infants at
risk and recuperation from
neurologic injury
Generate and disseminate
cutting-edge research related
to neurocare
Goals of NICN nurses
Peloquin S, Carley A, Bonifacio SL, et al. The neurointensive care nursery and evolving roles for nursing. Neonatal Netw. 2016;35(2):87-94.
NICN: Neonatal Intensive Care Nurser

13. How can nurses support in neonatal care for seizures?
Peloquin S, Carley A, Bonifacio SL, et al. The neurointensive care nursery and evolving roles for nursing. Neonatal Netw. 2016;35(2):87-94. 13
Bedside nurses are the first ones to
recognize electrographic seizures and
help in rapid diagnosis.
Begin important care procedures or
comfort measures such as patting.
•Anticipate the needs such as
mobilizing EEG or aEEG or obtaining
STAT lab works in suspected cases of
seizures.
Before MRI scanning the bedside
nursing anticipates potential apnea,
bradycardia or hypotension and can
provide proper intervention.

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Provide safe transport of neonates
to and from the MRI scanners.
Plan the supplies and equipment
such as EEG leads, oxygen
saturation probes, or core
temperature probes.
•Query resolution for family and
caregivers, supporting parents.
•Document and communicate
essential information to
interprofessional teams.
How can nurses support in neonatal care for seizures?
Peloquin S, Carley A, Bonifacio SL, et al. The neurointensive care nursery and evolving roles for nursing. Neonatal Netw. 2016;35(2):87-94.

15. BIOMEDICAL WASTE MANAGEMENT
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16. Risks Associated with Improper Disposal of
Medical Waste
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•Proliferation of disease-spreading vectors
Cotton swabs, blood bags, human or animal tissue
•Exposure to blood-borne diseases
Medical sharps
•Risk of air, water, and soil pollution
Disposed medicine, cytotoxic drugs, etc
Bio-medical Waste Management- Why Should We Be Concerned? Available at https://www.smartmedicalbuyer.com/blog/2017/06/03/bio-medical-waste-management/. Accessed on 4th Feb 2020

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Steps in Management of Biomedical Waste
Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016. Directorate General of Health Services Ministry of Health & Family Welfare. India. Available at
https://gmch.gov.in/rti/BMW.pdf . Accessed on 1st Feb 2020
Segregation
Collection
Pre-treatment
Intramural transportation
Storage
It is the exclusive responsibility of Health Care Facility (HCF) to follow the first five steps for
biomedical waste management

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SR.
NO.
CATEGORY TYPE OF WASTE COLOUR AND TYPE OF CONTAINER
1. Yellow
category
• Human/Animal Anatomical
Waste
• Soiled Waste
• Discarded or Expired Medicine
• Clinical laboratory waste
• Chemical Waste
Yellow coloured non-chlorinated Plastic Bags
2. Red Category Contaminated Waste (Recyclable) Red Coloured Non Chlorinated Plastic Bags
and Containers
Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016. Directorate General of Health Services Ministry of Health & Family Welfare. India. Available at
https://gmch.gov.in/rti/BMW.pdf . Accessed on 1st Feb 2020
COLOUR CODING AND TYPE OF CONTAINER/ BAGS TO BE USED FOR WASTE SEGREGATION & COLLECTION

19. SR.
NO.
CATEGORY TYPE OF WASTE COLOUR AND TYPE OF CONTAINER
1. White
Category
Waste Sharps including metals White coloured translucent container
2. Blue Category • Glassware
• Metallic Body Implants
Boxes or containers with blue coloured
marking
Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016. Directorate General of Health Services Ministry of Health & Family Welfare. India. Available at
https://gmch.gov.in/rti/BMW.pdf . Accessed on 1st Feb 2020
COLOUR CODING AND TYPE OF CONTAINER/ BAGS TO BE USED FOR WASTE SEGREGATION & COLLECTION

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Packaging of Waste Bags and Containers
Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016. Directorate General of Health Services Ministry of Health & Family Welfare. India. Available at
https://gmch.gov.in/rti/BMW.pdf . Accessed on 1st Feb 2020
Packaging:
• Waste bags to fill no more than 3 quarters full
• Seal and keep ready for collection
• Do not staple plastic bags; tie/seal them with plastic tag or tie

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Labeling of Waste Bags and Containers
Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016. Directorate General of Health Services Ministry of Health & Family Welfare. India. Available at
https://gmch.gov.in/rti/BMW.pdf . Accessed on 1st Feb 2020
Bio-medical waste bags /containers are required to be provided with bar code labels as per CPCB
guidelines
Bar code stickers
Symbol of Bio Hazard or Cytotoxic Hazard
Labeling: Symbol of Bio-hazard or Cytotoxic Hazard
Bar code stickers
Name of ward or room
Date
Type of waste
Waste quantity
Sender's name
Receiver's details

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Role of nurses in biomedical waste management
Proper disposal of
biomedical waste
Infection control
measures
Disinfection to ensure
complete removal of
pathogens
Reduction of bulk to
reduce storage and
transport needs
Recycling infectious
plastic waste only after
complete disinfection
Proper coding of bags as
per regulations
Nurses are responsible for effective nursing practice and are accountable for the professional
code of ethics which includes the effective and proper management of biomedical waste
(BMW).1,2
1. National guidelines for infection prevention and control in healthcare facilities. Available from
https://www.mohfw.gov.in/pdf/national%20guidelines%20for%20ipc%20in%20hcf%20-%20final%281%29.pdf
2. Role of nurses in BMW management. Available from https://www.scribd.com/document/476503155/ROLE-OF-NURSES-IN-BMW-MANAGEMENT

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Mutilation of disposal items
such as gloves, syringes to
avoid illegal packing and
reuse
Impart education to HCWs
Ensure compliance with
hospital’s BMW management
policy
Role of nurses in biomedical waste management
1. National guidelines for infection prevention and control in healthcare facilities. Available from
https://www.mohfw.gov.in/pdf/national%20guidelines%20for%20ipc%20in%20hcf%20-%20final%281%29.pdf
2. Role of nurses in BMW management. Available from https://www.scribd.com/document/476503155/ROLE-OF-NURSES-IN-BMW-MANAGEMENT

24. Summary
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1. Kaminiów K, Kozak S, Paprocka J. Neonatal seizures revisited. Children (Basel). 2021;8(2):155. Doi:10.3390/children8020155
2. Bio-medical Waste Management- Why Should We Be Concerned? Available at https://www.smartmedicalbuyer.com/blog/2017/06/03/bio-medical-waste-
management/. Accessed on 4th Feb 2020.
3. Peloquin S, Carley A, Bonifacio SL, et al. The neurointensive care nursery and evolving roles for nursing. Neonatal Netw. 2016;35(2):87-94.
Neonatal seizures have
serious health
consequences and a
detrimental effect on
brain development
resulting in impaired
cognitive disorders,
delayed development,
epilepsy or cerebral palsy.
1
There is a need for proper
management of
biomedical wastes to
minimize the risk of
proliferation of disease-
spreading vectors,
exposure to blood-borne
diseases, and air, water,
and soil pollution.2
Nursing is an integral part
of patient care in neonatal
seizures. Specialized
education and training for
neurocritical neonates
plays a pivotal role in care.
3

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Link for Neonatal seizures visuals
https://www.youtube.com/watch?v=Igj1HBT6oCQ
https://www.youtube.com/watch?v=qEMxoUNcOeY

26. Thank you!
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