Neonatal Seizure. Dr.Nawar Yahya. Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan. Supervised by:

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1 Neonatal Seizure Supervised by: Dr.Nawar Yahya Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan

2 Objectives: What is neonatal seizure Etiology Clinical presentation Differential diagnosis Management

3 What is neonatal seizure? A stereotypic, paroxysmal spell of altered neurologic function (behavior, motor, and/or autonomic function) Neonatal period limited to : first 28 days for term infants 44 weeks gestational age for pre-term (i.e. 4 wk after term).

4 Why do Neonatal seizures have unusual presentations? It takes unusual presentations because immature CNS cannot sustain a well synchronized, well orchestrated generalized seizure.

5 Etiology: at delivery room hr 1-3 days After 5 days Injection of local anesthetic into the fetal scalp Severe anoxia Hypoxic ischemic encephalopathy Intraventricular hemorrhage Hypoglycemia Hypocalcaemia& hypomagnesemia Infection bacterial or viral Drug withdrawal like Methadone, heroin Severe Congenital brain malformation SAH : sudden onset, not recur, short duration Inborn error of metabolism such as galactossemia other causes: - Benign familial seizure -Vit. B6 deficiency

6 Clinical Classification: Subtle seizure Tonic Clonic Myoclonic

7 - Subtle: common presentation among newborns. apnea, eye deviation, tongue thrusting, eye blinking, fluctuation of vital signs,and staring. continuous bedside EEG monitoring can help to identify subtle seizures. -Tonic: Focal or generalized Sustained symmetric posturing of limbs, trunk and neck May be flexor or extensor or mixed Sustained eye deviation Cannot be provoked by stimuli or suppressed by restraint.

8 Clonic: Repetitive, rhythmic contraction of muscle groups of the limbs,face, or trunk. May be focal or multifocal May appear synchronously or asynchronously in various body regions. Cannot be suppressed by restraint. -Myoclonic: Arrhythmic contractions of muscle group of the limbs, face,or the trunk Typically not repetitive or may recur at a slow rate May be generalized, focal, or multifocal May be provoked by stimulation.

9 DDx: Benign neonatal sleep myoclonus: It is a myoclonic jerks of the extremities that occur only during sleep &mimic seizures. Jitteriness or tremulousness: in newborn of diabetic mother or in newborn with narcotic withdrawal syndrome, Hypoglycemia.

10 Jitteriness Vs Seizure Clinical Features Jitteriness Seizure Abnormality of gaze or eye movement - + sensory dependent elicited by stimuli + _ Predominant movement fine rapid movement Clonic jerking Movements interrupted by holding extremity + - Autonomic changes - +

11 Benign neonatal sleep myoclonus:

12 Management Neonatal seizures represent one of the important emergencies in the newborn and require urgent management firstly we should start with ABC A-ensure airway patency. B-breathing give oxygen. C-circulation by IV line and take blood sample send for investigation which are necessary for confirmation of diagnosis.

13 History: Seizure history: A complete description of the seizure should be obtained from the attendant,if there is associated eye movements change in color of skin,autonomic phenomena & whether the infant was conscious/sleeping at the time of seizure. The day of life on which the seizure occurred may provide an important clue to its diagnosis. Antenatal is important Search for history that supports TORCH infections History of fetal distress, maternal diabetes and narcotic addiction, preeclampsia.

14 Natal history: history of Perinatal asphyxia, fetal distress, instrumental delivery, need for resuscitation in the labor room Postnatal history: Temperature and blood pressure instability may suggest infection Family history : Family history of seizures & early fetal deaths would be suggestive of inborn errors of metabolism. History of seizures in family the neonatal period may suggest benign familial neonatal convulsions (BFNC).

15 Examination: Vital signs: Heart rate, respiration, blood pressure, capillary refilling & temperature. General examination: Gestation, birth-weight and weight for age should be recorded as it may provide important clues to the etiology of the seizure. Seizures in a term well baby may be suggestive of SAH. Seizures in a large for date baby may be due to hypoglycemia The neonate should be examined for the presence of any obvious malformation or dysmorphic features.

16 CNS examination: Presence of a bulging anterior fontanelle may be suggestive of meningitis or intracranial hemorrhage. A detailed neurological examination should include assessment of consciousness (alert/drowsy/comatose), tone (hypotonia or hypertonia) and fundus examination for chorioretinitis or cataract. Systemic examination: Presence of hepatosplenomegaly or an abnormal urine odor may be suggestive of IEM.

17 INVESTIGATIONS: Laboratory: 1-immediate determination of capillary blood glucose with chemstrip. 2-blood glucose,calcium,sodium and bilirubin determination. 3-when infection is suspected CSF and blood culture. Other investigations done in selected cases: -MRI,CT scan,or ultrasound of brain. -Test for inborn error of metabolism.

18 EEG: often demonstrates seizure activity when clinical diagnosis is uncertain especially in subtle seizure

19 TREATMENT: 1-SPECIFIC: such as treatment of meningitis or correction of hypoglycemia,hypocalcaemia,hypomagnesaemia, hyponatremia, or vitamin B6. 2-Treatment of seizure: a mg/kg of Phenobarbital I.V. b mg/kg of phenytoin I.V infusion. c mg/kg of diazepam given by slow I.V because it may cause apnea and respiratory depression.

20 A newborn infant is delivered by emergent cesarean section at 41 weeks' gestation following a pregnancy complicated by a prolapsed umbilical cord and meconium-stained amniotic fluid. At 6 hours of age, the infant has a seizure. Which of the following MOST likely cause for this seizure: A. hyponatremia B. hypoxic-ischemic encephalopathy C. intracranial hemorrhage D. meningitis E. pyridoxine dependency

21 The major risk factor of neonatal seizures is All the following statements are true except: a) Prematurity b) head trauma c) Low birth weight d) Hypoxic ischemic encephalopathy

22 which of following carry good prognosis for long term neuro-developmental outcome: a)hypoglycemia b)hypocalcaemia c)cerebral malformation d)meningitis

23 What is Dx:

24 What is Dx:

25 Thank You

NEONATAL SEIZURE. IAP UG Teaching slides

NEONATAL SEIZURE. IAP UG Teaching slides NEONATAL SEIZURE 1 INTRODUCTION One of the important neonatal neurological emergencies requiring immediate medical care. Contribute to significant morbidity and mortality Incidence is around 0.5 to 0.8%