Wk 8: Neonatal seizures/neonatal encephalopathy

Question 1

Are neonatal seizures common?

Answer 1

Yes, relatively. Due to their immature nervous system.
- often miss diagnosed as tremors, jitteriness, startle reflex and

Question 2

What are neonatal sezirues?

Answer 2

= paradoxical alterations in neurological function occurring in the first 28 days of life.

Question 3

What are common causes of neonatal seziures?

Answer 3

• Hypoxic-ischaemic encephalopathy (HIE) (49 per cent)
• Cerebral infarction (12 per cent)
• Cerebral trauma (7 per cent)
• Central nervous system infection (5 per cent)
• Metabolic abnormalities including hypoglycaemia (3 per cent)
• Maple syrup urine disease
• Fatty acid oxidation defects (screened in Newborn Blood - Spot test in Postnatal period)
• Narcotic drug withdrawal (4 per cent).
• Congenital intracranial anomalies (4 per cent)
• AV malformation

Question 4

What are some signs of a seziure?

Answer 4

• lip smacking
• ocular movements
• apnoea
• hypertension
• tachy or brady
• desat

Question 5

What are the four types of neonatal seziures?

Answer 5

Subtle
Tonic
Myoclonic
Clonic

Question 6

What are some signs of a subtle seziure?

Answer 6

Eye: staring, deviation, blinking etc.

Oral: chewing, sucking, lip smacking

Limbs: cycling, swimming rowing

Systemic: apnoea, tachycardia, blood pressure alterations

Question 7

What are some signs of a clonic seziure?

Answer 7

• one limb or one side of the body jerking rhythmically at 1-4 times per second.
• Consciousness usually preserved.

Question 8

What are some signs of a myoclonic seziure?

Answer 8

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

Question 9

What are some signs of a tonic seziure?

Answer 9

• Sustained posturing of the limbs or trunk or deviation of the head.
• It may mimic decerebrate or decorticate posturing. c

Question 10

What is the management of neonatal seziures?

Answer 10

• monitor
• investigate underlying cause e.g. hypoglycemia

Give anticonvulsant if
- seizure is prolonger >3mins
- Frequent >2-3 per hour
associated with cardio-resp disturbance

Question 11

Define hypoxic ischaemic encephalopathy (HIE)

Answer 11

= a type of neonatal encephalopathy caused by systemic hypoxaemia and/or reduced cerebral blood flow resulting from an acute peripartum or intrapartum event. (SCV 2019)
= Lack of sufficient oxygen to the brain and a diminished amount of blood perfusing the brain. This results in suppression of electrical activity and cortical depression (RCH 2019)

Question 12

What can HIE cause?

Answer 12

• vision loss
• hearing loss
• speech delays
• cognitive issues
• speech delay
• epilepsy

Question 13

What are some causes of HIE?

Answer 13

• any event the compromises Os supply to fetus (cord prolapse, placenta abruption, uterine rupture, uterine rupture)
• Asphyxia at birth, perinataly or as a neonate
• Anything that causes asphyxia e.g. placenta abruption
• Trauma

Question 14

What is the management of HIE?

Answer 14

• therapeutic cooling
• transfer to NICU

Question 15

What makes a baby eligible for scalp ccoling?

Answer 15

• > 35 weeks
• <6hrs post birth

Asphyxia by a least 2 of the following?
- </5 apgars at 10mins
- continued PPV needed
- any acute episode of hypoxia e.g. cord prolapse
- cord pH or <7

Question 16

What is the goal temp of theraputic cooling?

Answer 16

33-34 degrees

15/60 temps

Question 17

What should the timing of cooling be?

Answer 17

The total period of cooling and rewarming is for 84 hours, consists of 2 phases:
- Active cooling- for 72 hours from the initiation of cooling.
- Rewarming- 12 hours of active gradual rewarming time after completion of 72hrs of cooling.

Question 18

What are some complications of therapeutic cooling?

Answer 18

• increased pulmonary pressure
• increased O2 requirements
• reduced surfactant production
  -Electrolyte imbalance: hypokalaemia, hypo magnesia, hypophosphatemia

Question 19

What is one type of neonata encelopathy?

Answer 19

Hypoxic-ischaemic encelopathy

Question 20

What are some causes of neonatal encephalopathy?

Answer 20

Stroke
IVH
Congenital brain malformation
Genetic syndromes
Infection

Question 21

Explain the patho phys of HIE

Answer 21

Phase 1: primary neurological injury
- sever cellular hypoxia during insult= exhaustion of high energy metabolism (primary energy failure)-> immediate primary neuronal death
- Reperfusion of the ischemic brain with resuscitation is followed by a latent period of at least 6 hours when energy levels “pseudo normalise”
- before the secondary energy failure and delayed neuronal death begin

Phase 2: delayed neuronal death
- A secondary loss of neurons
- Occurs 6 to 100 hours post the insult
- Cells loss is mediated by complex cellular mechanisms including apoptosis
- This phase is associated with encephalopathy & increased seizure activity
- Accounts for a significant proportion of final cell loss

Question 22

What is Lissencephaly

Answer 22

A cerebral malformation

(meaning “smooth brain”) is a set of rare brain disorders where the whole or parts of the surface of the brain appear smooth. It is caused by defective neuronal migration during the 12th to 24th weeks of gestation resulting in a lack of development of brain folds (gyri) and grooves (sulci)

Question 23

What is Polymicrogyria

Answer 23

a condition characterized by abnormal development of the brain before birth. The surface of the brain normally has many ridges or folds, called gyri. In people with polymicrogyria, the brain develops too many folds, and the folds are unusually small.

Question 24

What is Schizencephaly

Answer 24

a developmental birth defect. It is characterized by abnormal slits or clefts in the cerebral hemispheres of the brain. People with clefts in both hemispheres commonly have developmental delays, delays in speech and language skills, seizures, and problems with brain-spinal cord communication.