An article on Neonatal convulsions

Neonatal convulsions is usually a visible manifestations of some underlying pathology. The common causes of convulsions in new born are hypoxic ischaemic injury.
Intracranial injury

Biochemical :

Hypoglycemia and hyperglycemia
Kernicterus
Hypocalcaemia and hypernatraemia
Inborn errors of metabolism
Hyponatremia and hypernatraemia
Hypomagnesaemia
Pyridoxine dependence

Infective :

High fever
Meningitis
TORCH infection
Tetanus

Iatrogenic:

Respiratory stimulants
Analeptic drugs
Drug toxicity and drug withdrawal

Others:

Cerebral malformations
Hyperthermia

Diagnosis :

History of method of delivery
Apgar score at birth
Administration of analeptic or respiratory stimulants

Types of feeding ( breastfeeding or not)

Laboratory studies:

Complete blood count ( CBC)
Blood,urine and CSF culture
Serum Igm and IgG specific TORCH titers
Biochemical blood tests glucose, calcium, magnesium, bilirubin and electrolytes as needed.
Blood gas levels to detects acidosis and hypoxemia
Ultrasonography and CT scan of the head to detect interventricular
Electroencephalogram

Treatment:

Glucose infusion to maintain blood glucose level at 40 mg / dl and above

Hypomagnesaemia :

Magnesium sulphate may be given IV every 6 hours until magnesium level is normal.

Appropriate antibiotics therapy following complete blood work up

Calcium gluconate intravenously initially and followed by oral calcium.

Intravenous administration of pyridoxine.

Nursing Management:

Get assistance form physicians while ensuring that the baby has a clear airway and adequate ventilation.
Turn the neonate to the semi prone position with the head neither hyper flexed nor hyper extended.
Genital oral and nasal suction to remove any milk or mucus.
Oxygen via mask if the baby is cyanosed.
Nurse baby in incubator without covering blankets for observation and maintenance of thermo neutral environment.
Accurate recording of convulsions observed example type of movement,the areas affected, the duration, any colour change and change in heart rate, respiratory rate or blood pressure
Honest, clear explanation about the baby’s condition to parents and followed up discussion
Supportive care to parents should be given.