This document discusses neonatal seizures. It begins by defining neonatal seizures as paroxysmal behavior caused by hyper-synchronous discharge of neurons, which is a medical emergency signaling potential brain damage. It then classifies seizures as subtle, tonic, clonic, or myoclonic and lists common causes like hypoxic-ischemic encephalopathy and infections. Diagnosis involves history, examination, and investigations like blood tests, imaging, and EEG. Management includes treating underlying causes like hypoglycemia and hypocalcemia. Anti-epileptic drugs should be considered for persisting or repeated seizures. Nursing care involves emergency response, observation, and psychosocial support of families.

1. Neonatal
Seizures
Srushti Patil
1st yr Msc
Roll no 10

2. Objectives
 To Understand about Neonatal seizures.
 Enumerates causes of Neonatal seizures.
 Explain types of Neonatal seizures.
 Describe diagnosis procedure of Neonatal
seizures
 Explain Treatment and Nursing Management of
Neonatal seizures.

3. outline
 Introduction
 Definition
 Classification of seizure
 causes of neonatal seizure
 Diagnosis
 Investigation
 Management for the neonatal seizure
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4. Introduction
 Neonatal seizures are usually the clinical
manifestation of a serious underlying disease.
Seizures constitute a medical emergency
because they signal a disease process that
may produce irreversible brain damage

5. Definition
A seizure is a paroxysmal behaviour caused
by hyper-synchronous discharge of a group
of neurons.
Neonatal seizures are the most common
overt manifestation of neurological
dysfunction in the newborn.

6. Subtitle

7. Subtle
 Specially seen in preterm and term.
 In this clinical manifestation are mild &
frequently missed.
 Usually mild paroxysmal alterations in motor,
behavior or autonomic function that are not
clearly clonic, tonic or myoclonic.
 Commonest type constitute 50% of all
seizures.

8. Tonic
 Primarily preterm.
 Characterized by flexion or extension of axial
or appendicular muscle groups.
 May be focal or generalized.
 Decerebrate - tonic extension of all limbs
 Decorticate - flexion of upper limbs &
extension of lower limbs.
 No ECG change.
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9. Clonic
 Primarily term.
 Rhythmic movement of muscle
groups.
 1-3 jerk per second.
 Associated with EEG changes
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10. MyoClonic
 Single or multiple lightning fast
jerks of the upper or lower limbs
and are usually distinguished from
clonic movements because of more
rapid speed of myoclonic jerks,
absence of slow return and
predilection for flexer muscle
group.
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11. Non-epileptic movements
• Jitteriness or tremors.
• Normal movements seen more commonly in preterm infants.
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12. Causes of neonatal seizures
• Developmental defects
• Hypoxic-ischemic encephalopathy (HIE)
• Intracranial haemorrhage
• Metabolic causes
• Infections
Miscellaneous

13. Assessment
1) History
• Seizure history
• Antenatal history
• Perinatal history
• Feeding history
• Family history
2) Examination
Vitals signs , general examination, CNS
examination , systemic examination

14.  Mandatory investigations:
 Blood Sugar, Haematocrit
 Bilirubin (if jaundice is present
clinically)
 Serum electrolytes (Na, Ca, Mg)
 Arterial blood gas, anion gap
 Cerebrospinal fluid (CSF)
examination
 Cranial ultrasound (US)
 Electroencephalography (EEG)
 Specific investigations
 Neuroimaging
 CT,
 MRI

15.  Screening for congenital infections
 TORCH screen and VDRL
 Metabolic screening
 Blood and urine ketones,
 - Urine reducing substances
 - Blood ammonia, anion gap
 - Urine and plasma aminoacidogram
 - Serum and CSF lactate/ pyruvate ratio
 Electro-encephalogram (EEG)

16. Initial medical management:
 Thermoneutral environment - Ensure airway,
breathing and circulation
 O2 inhalation
 IV access & fluid administration
 Blood test for sugar and other investigations.
 A brief relevant history should be obtained
 Quick clinical examination
Hypoglycemia
 Check glucose level-
If shows hpoglycemia,
- 2 ml/kg of 10% dextrose should be given as a
bolus injection followed by a continuous infusion
of 6-8 mg/kg/min.

17. Hypocalcemia
 After treatment of hypoglycemia give 2ml/kg of 10%
calcium gluconate IV over 10 minutes under strict
cardiac monitoring.
 If ionized calcium levels are suggestive of hypocalcemia,
the newborn should receive calcium gluconate at 8
ml/kg/d for 3 days.
 If seizures continue despite correction of hypocalcemia,
0.25 ml/kg of 50% magnesium sulfate should be given
intramuscularly (IM).
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18. Anti-epileptic drug therapy (AED)
 Anti-epileptic drug therapy (AED) Anti-epileptic drugs (AED)
should be considered in the presence of even a single clinical
seizure
 Anti-epileptic drugs (AED) should be considered in the
presence of even a single clinical seizure
 AED should be given if seizures persist even after correction of
hypoglycemia/ hypocalcemia.
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19. Emergency Care & observation during seizure:-
A nurse should be prepared for first aid measures & should instruct to the family members. This includes:
• - Lie down the child in a flat surface and Loosen tight clothes.
• - Remove dangerous object from the area.
• - Do not force in to the child's mouth.
• - Allow the seizures to run.
• - After the seizures stop turn the child to one side to drain the saliva.
• - Check breathing pattern give CPR if needed .
• - Observe child until fully conscious and Treat any injury if had.

20. Psychosocial care of family members:-
 Epilepsy caries a stigma in the society.
 Child may feel different from their peers & their parents may not allow their children to have
friendship with them.
 Child will become frustrated, epileptic child should be encouraged to do their best in school.
 Their seizures should not be used as an excuse to shirk their responsibilities.

21. AIIMS-NICU protocols
2007
Abstract:-
 Seizures in the newborn period constitute a medical emergency. Subtle
seizures are the commonest type of seizures occurring in the neonatal
period. Other types include clonic, tonic, and myoclonic seizures.
Myoclonic seizures carry the worst prognosis in terms of long-term
neuro developmental outcome. Hypoxic-ischemic encephalopathy is the
most common cause of neonatal seizures. Multiple etiologies often co-
exist in neonates and hence it is essential to rule out common causes
such as hypoglycemia, hypocalcemia, meningitis before initiating specific
therapy. A comprehensive approach for management of neonatal
seizures has been described.

22. References
National Neonatal Perinatal Database. Report for year National
NeonatologyForum, India. 2002-03.
Volpe JJ. Neonatal Seizures. In Neurology of the newborn. Philadelphia: WB
Saunders,1999; 172-225'
Painter MJ, Scher MS, Stein MD, Armatti S, Wang Z, Gardner JC et al.
Phenobarbitonec ompared with phenytoin for treatment of neonatal seizures.
N Engl J Med 1999:341:485-9
Rennie JM. Neonatal seizures. Eur J Pediatr 1997;156:83-7
Nirupama Laroia. Controversies in diagnosis and management of neonatal
seizures.Indian Pediatr 2000;37:367-72

23. Thank you
Srushti Patil