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Seizures – Neonatal

Contents
  1. Read book excerpt
  2. Restless Legs Syndrome: Introduction
  3. Restless Legs Syndrome Misdiagnosis
  4. Restless Legs Syndrome Causes
  5. Restless Legs Syndrome Complications
  6. Restless Legs Syndrome Treatments
  7. Clinical trials
  8. Diagnosis of Restless Legs Syndrome
  9. Restless Legs Syndrome Overview
  10. More book excerpts for Restless Legs Syndrome

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

  • Hypoxic ishemic encephalopathy
  • Bacterial meningitis/sepsis
  • Stroke
  • Cerebral dysgenesis
  • Electrolyte disturbances
    –Hypoglycemia
    –Hyponatremia
    –Hypomagnesemia
    –Hypocalcemia
  • Maternal drug use
    –Drug withdrawal after delivery
    –Direct effect of drugs, such as cocaine
  • Congenital infections (TORCH)
    –Toxoplasmosis
    –Syphilis
    –Rubella
    –CMV
    –HSV
  • HSV encephalitis
    • Intracranial hemorrhage
      –Subdural hemorrhage
      –Intraparenchymal hemorrhage
      –Intraventricular hemorrhage in the premature infant
      –Subarachnoid hemorrhage
  • Urea cycle disturbances
  • Smith-Lemli-Opitz syndrome
  • Nonketotic hyperglycinemia
  • Pyridoxine deficiency
  • Fructose dysmetabolism
  • Amino acidurias
    –Maple syrup urine disease
    –Proprionic acidemia
  • Molybdenum cofactor deficiency
  • Mitochondrial encephalopathy
  • Glucose transporter deficiency
    • Benign etiologies
      –Benign idiopathic neonatal seizures (fifth day fits)
      –Benign familial neonatal seizures
  • 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
  • Labs: Glucose, electrolytes, lactate, liver function tests, ammonia, TORCH titers, pyruvate, chromosomes, 17-hydroxycorticosteroid, serum amino acids, copper
  • Neuroimaging: CT or MRI
  • Lumbar puncture for meningitis and encephalitis, including HSV, glucose transporter deficiency, nonketotic hyperglycinemia
  • 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
  • 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
  • Treat hypomagnesemia with magnesium sulfate
  • Meningitis and HSV encephalitis require intravenous antibiotics and acyclovir, respectively
  • Depending on the etiology, the infant may stay on phenobarbital for varying duration of time
  • Glucose transporter deficiency can be treated with ketogenic diet
  • 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 Restless Legs Syndrome

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  • JOINT PAIN
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  • Chest Pain
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  • MYOCLONUS
  • "Differential Diagnosis in Primary Care" (2007)
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  • "Differential Diagnosis in Primary Care" (2007)
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  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
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  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
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  • Myoclonus
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Arm pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Back pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Chest pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Eye pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Flank pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Jaw pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Neck pain
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  • Rectal pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Seizures
  • "A Pocket Manual of Differential Diagnosis" (1999)
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  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
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  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
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  • Myoclonus
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Arm pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Back pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Chest pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Facial pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Seizures
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Chest Pain, Atypical
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Low Back Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Abdominal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Calf Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Seizures
  • "Field Guide to Bedside Diagnosis" (2007)
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  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
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  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
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  • Myoclonus
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Myoclonus
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Seizures
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Myoclonus
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



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

 » Next page: Abdominal Pain (In A Page: Pediatric Signs and Symptoms)

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