OPERATIVE OBSTETRIC NEONATAL SEIZURE IN NEWBORN

By Korir Weldon,
Msc.CLINICAL MEDICINE RH

1. Neonatal seizure

2. NEONATAL SEIZURES Definition : Abnormal synchronous electrical discharge of group neurons in the central nervous system. Status epilepticus; continuous seizures lasting 30 minutes or recurrent seizures occupying 50% of EEG recording for at least 60 minutes.

3. Causes of neonatal seizures Hypoglycemia. Perinatal asphyxia. Central nervous system (CNS) infections. Intracranial hemorrhage. Electrolyte abnormality. Neonatal abstinence syndrome/drug withdrawal. Pyridoxine deficiency.

4. Clinical manifestations Absence of seizures. Subtle: eye deviation, eyelid fluttering, buccolingual movement or pedaling of arms and legs. Focal: tonic or clonic . Generalized: multifocal rhythmic jerking, generalized posturing or myoclonic

5. Investigations Serum glucose, calcium, magnesium and sodium. Lumbar puncture if sepsis suspected. Head ultrasound. Metabolic screening (if inborn errors of metabolism are suspected).

6. Management Treat underlying cause when identified! Treat seizure with appropriate antiepileptics

7. Identify and characterize seizure Secure airway and optimize breathing, circulation and temperature Start oxygen if seizures are continuous Secure IV access Diagnostic Investigations: Serum glucose, calcium, magnesium, and sodium Lumbar puncture if sepsis suspected Head ultrasound Take blood samples for baseline investigations including blood sugar, calcium, magnesium, sodium, potassium, blood gas, FBC, sepsis screen Correct any treatable causes

8. Start Phenobarbitone 20 mg/kg IV bolus, then 5 mg/kg daily for 3 days, if Continued seizures 20 minutes after bolus is complete: Phenobarbitone 20 mg/kg IV (to total of 40 mg /kg);if Continued seizures 20 minutes after bolus is complete; switch to Phenytoin 20 mg/kg IV over 30 min; if Continued seizures 20 minutes after bolus is complete ;switch to Midazolam 200 μ g/kg IV over 3 to 5 min; if Continued seizures 20 minutes after bolus is complete Midazolam IV infusion commenced at 1 μ g/kg/minute increased by increments of μ g/kg/minute with each subsequent seizure episode to max of 5 μ g/kg/minute. If seizures persist, consider Pyridoxine 100 mg IV

9. NEWBORN ON ANTICONVULSANT THERAPY Wean all antiepileptic drugs except phenobarbitone once seizure controlled Perform neurological examination prior to discharge; if normal-stop phenobarbitone prior discharge ,if abnormal continue phenobarbital for 1month ,then after 1month repeat neurological examination at 1month;if normal taper drugs over 2wks and abnormal evaluate with EEG; If normal EEG taper drugs over 2weeks,then if abnormal EEG continue drug; reassess at 3months.