Seizures – Neonatal
Seizures – Neonatal: Excerpt from In A Page: Pediatric Signs and Symptoms
Seizures in the newborn are often difficult to diagnose, because there may only be subtle manifestations. Any insult that affects the brain in this age group can present with seizures, thus the differential diagnosis is quite extensive. One also has to rule out several mimics such as jitteriness, sleep myoclonus, and gastroesophageal reflux.
Differential Diagnosis
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Hypoxic ishemic encephalopathy
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Bacterial meningitis/sepsis
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Stroke
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Cerebral dysgenesis
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Electrolyte disturbances
–Hypoglycemia
–Hyponatremia
–Hypomagnesemia
–Hypocalcemia
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Maternal drug use
–Drug withdrawal after delivery
–Direct effect of drugs, such as cocaine
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Congenital infections (TORCH)
–Toxoplasmosis
–Syphilis
–Rubella
–CMV
–HSV - HSV encephalitis
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Intracranial hemorrhage
–Subdural hemorrhage
–Intraparenchymal hemorrhage
–Intraventricular hemorrhage in the premature infant
–Subarachnoid hemorrhage
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Urea cycle disturbances
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Smith-Lemli-Opitz syndrome
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Nonketotic hyperglycinemia
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Pyridoxine deficiency
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Fructose dysmetabolism
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Amino acidurias
–Maple syrup urine disease
–Proprionic acidemia
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Molybdenum cofactor deficiency
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Mitochondrial encephalopathy
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Glucose transporter deficiency
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Benign etiologies
–Benign idiopathic neonatal seizures (fifth day fits)
–Benign familial neonatal seizures
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Movements commonly mistaken for seizures
–Benign neonatal sleep myoclonus
–Jitteriness (may be secondary to
hypoglycemia, drug withdrawal, or
idiopathic)
–Gastroesophageal reflux (arching, writhing)
–Breath-holding spell
Workup and Diagnosis
- History: Previous pregnancies, fetal movements, infections, blood pressure problems during pregnancy, maternal drug/medication use, family history, Apgar scores, nuchal cord, birth weight, feeding problems, association of the spells to feeding and sleep
- Physical exam
–Deformities, dermatoglyphics, skin lesions, hepatosplenomegaly, funduscopic exam, corneal opacities
–Mental status: Spontaneous level of activity of the infant; responsiveness to light, sound, and touch
–Muscle tone: Passive manipulation of limbs
–Primary neonatal reflexes (Moro, palmar grasp, tonic
neck response) and muscle stretch reflexes
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Labs: Glucose, electrolytes, lactate, liver function tests, ammonia, TORCH titers, pyruvate, chromosomes, 17-hydroxycorticosteroid, serum amino acids, copper
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Neuroimaging: CT or MRI
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Lumbar puncture for meningitis and encephalitis, including HSV, glucose transporter deficiency, nonketotic hyperglycinemia
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EEG: Critical in making the diagnosis of seizures in the newborn; monitoring of the child during one of the spells is the best way to make the diagnosis of seizures
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If gastroesophageal reflux is suspected, pH/thermistor monitoring is helpful to document a temporal relation
Treatment
-
Evaluate and secure airway, breathing, and circulation
–Benzodiazepines or phenobarbital infused
intravenously can stop the seizures
-
If there is reason to suspect hypoglycemia, even if blood glucose level cannot be quickly established, treat with glucose intravenously
-
Treat hypocalcemia with calcium gluconate
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Treat hypomagnesemia with magnesium sulfate
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Meningitis and HSV encephalitis require intravenous antibiotics and acyclovir, respectively
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Depending on the etiology, the infant may stay on phenobarbital for varying duration of time
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Glucose transporter deficiency can be treated with ketogenic diet
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For pyridoxine deficiency, pyridoxine 50–100 mg injected intravenously during an EEG recording can be both diagnostic and therapeutic
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Neonatal myasthenia
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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