Module 7 Unit C

Question 1

How can the nurse midwife distinguish newborn jitteriness from seizure activity?

Answer 1

jitteriness is usually stimulus-induced and can be stopped by holding the extremity still; seizures occur spontaneously, and motor activity is felt even when the extremity is held still.

Question 2

What conditions in the newborn can result in neonatal seizures?

Answer 2

Primary intracranial process (eg, meningitis, ischemic stroke, encephalitis, intracranial hemorrhage, tumor, malformation)

Systemic problem (eg, hypoxia-ischemia, hypoglycemia, hypocalcemia, hyponatremia, other disorders of metabolism)

Electrolyte imbalances (calcium, potassium, magnesium, sodium), acidosis, hyperbilirubinemia, viruses (CMV), sepsis

Question 3

What is the clinical presentation of subtle seizures?

Answer 3

Eye: staring, deviation, blinking, fluttering, fixed open stare.
Oral: chewing, sucking, lip-smacking, tongue thrusting

Limbs: cycling, swimming, rowing, boxing, pedalling

Systemic: apnea, tachycardia, blood pressure alterations

Question 4

What is the clinical presentation of clonic seizures?

Answer 4

Primarily preterm

Usually, involve one limb or one side of the body jerking rhythmically at 1-4 times per second.
Consciousness usually preserved.
Multifocal, simultaneous or sequence
Non-ordered/nonJacksonian migration

Question 5

What is the clinical presentation of myoclonic seizures?

Answer 5

Rapid isolated jerking of muscles.
Generalized
May be focal or multifocal

Usually not unconscious.

Question 6

What is the clinical presentation of tonic seizures?

Answer 6

Rare
Sustained posturing of the limbs or trunk or deviation of the head.
It may mimic decerebrate or decorticate posturing.
Only 30% have EEG correlates.
Generalized: extensions of upper and lower limbs accompanied by pronation of arms and clenching of fists
Focal: sustained posturing of limb (rare)

Question 7

What level of interprofessional collaboration is warranted for newborn seizure activity?

Answer 7

Refer

Question 8

What is hypoxic ischemic encephalopathy?

Answer 8

The pathologic findings that result in a term infant who has experienced a significant episode of antepartum, intrapartum, or postnatal asphyxia. Damage from HIE may depend on the gestational age of the infant.

Question 9

What clinical conditions can lead to hypoxic ischemic encephalopathy?

Answer 9

Asphyxia

Question 10

What is the clinical presentation for newborn hypoxic ischemic encephalopathy?

Answer 10

Signs of moderate encephalopathy -

Neonates with mild to moderate HIE may have more subtle symptoms

Lethargy, hypotonia, decreased spontaneous movement, seizures

Signs of severe encephalopathy -

Usually recognized as stuporous and flaccid, with poor or no respiratory effort early on

Question 11

What are the short term neonatal consequences of hypoxic ischemic encephalopathy?

Answer 11

Timing of the reperfusion phase - the reperfusion phase usually begins 6-12 hours or more after the initial insult and is characterized by hyperexcitability, cytotoxic edema, and damage from the release of free oxygen radicals and NO, inflammatory changes and imbalances in inhibitory and excitatory neurotransmitters

Question 12

What are the long term neo natal consequences of hypoxic ischemic encephalopathy?

Answer 12

Outcomes vary with severity and location of injury. A major consequence of HIE is cerebral palsy, which is more common in preterm infants. Term infants with moderate to severe HIE have a higher mortality rate, as well as long term cognitive and motor problems