Contents Chapter Topic Page Neonatology Respiratory Cardiology

More documents

Recommendations

Info

NEONATAL SEIZURES Seizures are the most frequent manifestation of neonatal neurological diseases. It is important to recognize seizures, determine their etiology and treat them because: 1. the seizures may be related to significant diseases and may require specific treatment 2. the seizures may interfere with supportive measures e.g. feeding and assisted respiration for associated disorders 3. the seizures per se may be a cause of brain injury. Clinical A seizure is defined as a paroxysmal alteration in neurologic function that is behavioral, motor or autonomic function. This includes clinical phenomena that are associated with or without surface recorded EEG seizure activity. Epileptic phenomena can be generated at subcortical (deep limbic, diencephalic, brain stem) levels in the absence of surface recorded EEG discharges. Classification of Neonatal Seizures Clinical seizure EEG seizures Manifestation Subtle Clonic Common Ocular phenomena - tonic horizontal deviation of eyes common in term infants - sustained eye opening with fixation common in preterm infants - blinking Oral-buccal-lingual movements - chewing common in preterm infants - lip smacking, cry-grimace Limb movements - pedaling, stepping, rotary arm movements Apneic spells common in term infants Focal Common Well localized clonic jerking, infant usually not unconscious Multifocal Tonic Focal Generalized Myoclonic Focal , Multifocal Generalized Common Common Uncommon Uncommon Common Multifocal clonic movements; simultaneous or in sequence or non-ordered ( non-Jacksonian) migration Sustained posturing of a limb, asymmetrical posturing of trunk or neck Tonic extension of upper and lower limbs (mimic decerebrate posturing) Tonic flexion of upper limbs and extension of lower limbs( mimic decorticate posturing) Those with EEG correlates; autonomic phenomena e.g. increased blood pressure are prominent features. Well localized, single or multiple, migrating jerks usually of limbs Single or several bilateral synchronous jerks or flexion movement occurring more in upper than lower limbs.
Etiology Determination of etiology is critical because it gives the opportunity to treat specifically and also to make a meaningful prognosis. The most important etiology, their usual time of onset and relative frequency in preterm and term infants are shown in the table below. Major Etiologies of Neonatal Seizures in Relation to Time of Seizure Onset and Relative Frequency Time of onset * Relative frequency # Etiology 0-3 days > 3days Premature Full term Hypoxic –ischemic encephalopathy + +++ +++ Intracranial hemorrhage + + ++ + Intracranial infections + + ++ ++ Developmental defects + + ++ ++ Hypoglycaemia + + + Hypocalcaemia + + + + Other metabolic disturbances & IEM + + Epileptic Syndromes + + + * postnatal age # relative frequency of seizures among all etiologies: +++ most common, ++ less common, +least common ( From JJ Volpe: Neurology of the Newborn 4 th edition. <strong>Page</strong> 190) Notes: Hypoxic –ischemic encephalopathy (HIE) Usually 2º to perinatal asphyxia. Most common cause of neonatal seizures in both preterm and term infant Characteristically seizures occur in the first 24 hours of life Present with subtle seizures; multifocal clonic or focal clonic seizures. If focal clonic seizures may indicate associated focal cerebral infarction. Intracranial hemorrhage Hemorrhages are principally germinal matrix-intraventricular (GM-IVH), often with periventricular hemorrhagic (PVH) infarction in the premature infant. - Premature infants with severe GM-IVH; onset of seizures in first 3 days, usually generalized tonic type with subtle seizures. - Those with associated PVH usually develop seizures after 3 days of life. In term infants intracranial hemorrhages are principally subarachnoid and subdural hemorrhage. Subarachnoid hemorrhages may occur in association with HIE. Subdural hemorrhage is often associated with a traumatic event and present with focal seizures usually in the first 2 days of life. Intracranial Infection Intracranial bacterial infections commonly 2º group B streptococci and E. coli. Nonbacterial infections include toxoplasmosis, herpes simplex, coxsackie B, rubella and cytomegalovirus. Developmental Defects Commonly due to a disturbance in neuronal migration resulting in cerebral cortical dysgenesis e.g. lissencephaly, pachygyria and polymicrogyria. Metabolic Disturbances Hypoglycemia common in SGA infants and infants of diabetic mothers - occurrence of neurological symptoms is determined by the duration of hypoglycemia. This is more common in SGA infants compared to IDM - neurological symptoms include jitteriness, stupor, hypotonia, apnea and seizures. - often to establish that hypoglycemia is the cause of seizures because of frequently associated perinatal asphyxia, hypocalcaemia, hemorrhage.
Page 1 and 2:
Contents Chapter Topic Page 1 Norma
Page 3 and 4:
Dermatology 67 Atopic Dermatitis…
Page 5 and 6:
Dato’ Dr. Lim Nyok Ling Consultan
Page 7 and 8:
ISSN 1823-3856 Printed by: Perniaga
Page 9 and 10:
Foreword One of the maxims of scien
Page 11 and 12:
B. Anthropometric Measurements a) H
Page 13 and 14:
Immunisation 1. Immunisation schedu
Page 15 and 16:
2 General Notes 2.1 Many vaccines (
Page 17 and 18:
3.5.6 Rubella - Contraindicated in
Page 19 and 20:
4.8 Rubella May have rash, fever,
Page 21 and 22:
5.5 Close contacts of immuno-defici
Page 23 and 24:
Developmental Assessment Developmen
Page 25 and 26:
Hearing Assessment Warning signs fo
Page 27 and 28:
Global Developmental Delay History
Page 29 and 30:
Developmental Milestones Table AGE
Page 31 and 32: AGE Gross Motor Vision & Fine Motor
Page 33 and 34: Principles of Transport of the Sick
Page 35 and 36: 3.1 Airway Management Establish a p
Page 37 and 38: 3.7 Environment Neutral Thermal Env
Page 39 and 40: 7. Special Surgical Conditions 7.1
Page 41 and 42: • Ventilation - Most of the babie
Page 43 and 44: Neonatal Resuscitation High Risk De
Page 45 and 46: • Drugs are available (and prepar
Page 47 and 48: Meconium stained liquor: Meconium i
Page 49 and 50: Summary: Use of medications during
Page 51 and 52: Definition Premature infant: < 37 w
Page 53 and 54: 8. Supplements: a. At birth : Vitam
Page 55 and 56: Enteral Feeding in Neonates 1. Intr
Page 57 and 58: 32 weeks Well babies Start milk imm
Page 59 and 60: Total Parenteral Nutrition for Neon
Page 61 and 62: Clearance is usually monitored by m
Page 63 and 64: Daily weight Meticulous care of th
Page 65 and 66: Monitor BUSE and correct any imbala
Page 67 and 68: C. UAC and UVC care UAC position Le
Page 69 and 70: HIGH FREQUENCY OSCILLATORY VENTILAT
Page 71 and 72: 6. Infants must be monitored closel
Page 73 and 74: pH , PaCO2, PaO2, HCO3 - , Bases Ex
Page 75 and 76: Q. Name a likely diagnosis A. RDS 3
Page 77 and 78: A. Definition Birth Asphyxia There
Page 79 and 80: E. Management I. Good intrapartum c
Page 81: c. All doctors managing such infant
Page 85 and 86: FLOW CHART: MANAGEMENT OF NEONATAL
Page 87 and 88: 2. Klauss & Fanaroff: Care of The H
Page 89 and 90: D. Asymptomatic Hypoglycaemia Feed
Page 91 and 92: NEONATAL JAUNDICE What is jaundice?
Page 93 and 94: Physical examination • General co
Page 95 and 96: Once the baby is on phototherapy, v
Page 97 and 98: Reference: extracted from MOH publi
Page 99 and 100: - 1ml of 4.2% NaHCO3 given for ever
Page 101 and 102: a. If unconjugated hyperbilirubinae
Page 103 and 104: APNOEA IN THE NEWBORN Definition :
Page 105 and 106: History NEONATAL SEPSIS Septic Neon
Page 107: Antibiotic choice will depend on pr
show all

Contents Chapter Topic Page Neonatology Respiratory Cardiology

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?