Neonatal Convulsions
How do convulsions present?
Generalised regular shaking of all limbs (generalised seizure)
Twitching of one limb or limb on one side of the body (focal seizure)
Smacking of the lips
Abnormal movements of the eyes
Causes
Meningitis (infection in the fluid around the brain)
Hypoglycaemia (low blood sugar)
Birth asphyxia (lack of oxygen to the brain around the time of delivery)
Hydrocephalus (too much fluid in the brain)
Problems with blood sodium or potassium (too high or too low)
Management of neonatal seizures
1)
2)
3)
4)
5)
6)
7)
8)
Give oxygen
5ml/kg bolus 10% dextrose
Load with iv phenobarbitone 20 mg/kg and observe for response
If seizures continue – give and additional 10mg/kg iv phenobarbitone after 30
minutes
Prescribe maintenance phenobarbitone 5mg/kg iv or po for the next 5 days and
keep the child in hospital
Ensure that they are receiving appropriate antibiotics to treat suspected
infection in the brain i.e. ceftriaxone and cloxacillin + gentamicin (if not already
received 5 days treatment)
Admit the baby to special care unit for observation
Ensure baby is reviewed by a doctor as soon as possible
Birth Asphyxia
Birth asphyxia is also known as Hypoxic Ischaemic Encephalopathy (HIE). It can be caused by a
number of reasons and is defined as ‘deprivation of oxygen that lasts for long enough to cause
physical damage, usually to the brain’.
How do you know a baby is at risk of birth asphyxia?
History of difficult delivery
APGAR scores recorded <7 at 5 minutes age
History of decreased fetal movements prior to delivery
Significant blood loss or ante-partum haemorrhage (APH) in the mother
What signs to you look for to determine if a baby has birth asphyxia
Altered tone (very floppy or very stiff)
Absence of newborn reflexes – moro reflex, rooting, pupil responses to light
Absence of suck or gag reflexes ( N.B. this can also be due to prematurity only)
Recurrent apnoeas (pauses in breathing > 10 seconds duration)
Hyperalert state
Does not sleep
Eyes wide open all the time
Very sleepy or lethargic or coma (unable to wake)
No response to stimulation
Convulsions
Babies can be divided into mild, moderate and severe birth asphyxia.
See table below for how to grade birth asphyxia.
MILD
No convulsions
Hyperalert
Does not sleep
Irritable
Symptoms last <24 hours
MODERATE
Lethargic (difficult to wake)
Reduced tone of body
and/or arms and legs
Absent sucking/gag reflexes
or pupillary reflexes
Possible convulsions
SEVERE
Little response to stimulation/
unable to wake
Floppy tone of body and limbs
No suck/gag or pupil
responses
Apnoea or irregular, shallow
breathing
Convulsions
It is important to advise parents of the importance of remaining in hospital for a few days if birth
asphyxia is suspected in order to monitor the baby for signs of asphyxia and treat seizures that may
develop in the first few days.
A baby with severe birth asphyxia is very unlikely to develop normally if it survives. It is therefore
important that parents know to bring their child back for outpatient review by a paediatrician to
monitor the progress of the baby.