CONVULSION, SPASM AND

UNCONSCIOUSNESS
 CONVULSION &
UNCONSCIOUSNESS

Sign of serious neurological disease

Preterm and term
Indicate serious underlying cause

< 2 days ==== associated with birth

complication
> 2 days ===== infection
Problem
A newborn having :
abnormal shaking, jerking or
twitching movement
abnormal mouth and eye
movement
decreased level of consciousness

Between convulsion lethargic,

unscious or irritable
Diagnostic approached

History and ask about :

Birth asphixia or resuscitation effort

Injuries at birth
Preterm and or Small infants
Feeding problem
time onset and duration of sign
Immunization status of mother for
tetanus
Environment Hygiene & Sanitation
Diagnostic approached

Clinical signs :

Abnormal movement : convulsion, spasm,

jitterness
unconscious
floppy or lethargy
companying signs :
* central cyanosis
* pallor, bleeding
* congenital anomalies
Diagnostic approached

Clinical signs :

Rigidity of abdomen muscle

Opistotonus, trismus, fish mouth
High pitched cry
Carpopedal spasm
Supporting Examination

* Laboratorium :
- Glucose is the first prerequisite .
- Electrolyte
-Septic work up
* Imaging examination : USG, CT
* EEG
Differential Diagnosis

1. Brain injury or intraventricular

bleeding
2. Hypoxic ischemic injury
3. Metabolic Abnormalities :
A. Hypoglycemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyponatremia or Hypernatremia
E. Pyridoxin dependence
Differential Diagnosis

4. Infection : - Meningitis,
Sepsis,TORCH
5. Neonatal Tetanus
6. Kernicterus or bilirubin
encephalopathy
7. Congenital brain abnormality
Initial Management
General Management

Check airways: keep clean and open

Keep in warm
Giving oxygen if baby become cyanotic
Stop convulsion ==== anticonvulsion
Measure blood glucose, electrolyte
Establish IV line
Stop convulsion ==== anticonvulsion

Give phenobarbital 20 mg/kgBW IV

over 5 10 mnts,if , if IV can not
established , give IM injection
Monitor breathing, RR < 20 x/mnt ---stop
15 mnts not controlled give another
dose of phenobarb
Convulsion stop ---- maintenance dose
of phenobarb 5 mg/kgBW daily p.o.
If not controlled after another 15 mnts
------ phenytoin 20 mg/kgBW IM/IV
Stop convulsion ==== anticonvulsion
(continued)

If convulsion are controlled ---- maintenance

dose of phenobarb 5 mg/kgBW daily p.o
If still not controlled ------ refer to NICU

Diazepam is not recommended

for treating convulsion, except
For Neonatal Tetanus
Controversy in Diazepam

is only used when immediate

cessation of convulsion is needed
synergistically with phenobarb to
increase the risk of provoking
respiratory arrest
contains sodium benzoate ---
interfere the binding of bilirubin to
albumin
Adminestered afterdilution : 1 mg (0,2 ml)
with 0,8 ml normal saline
Dose : 0,1 0,3 ml/kgBW given slowly until
convulsion stop
Specific condition needs Specific treatment

Hypoxic ischemic injury :

* secondary to birth asphyxia
* present 6 18 hrs of age
* Careful observation
* Prophylactic Phenobarb ----- even still
controversial
* IV line
* Oxygen therapy
* Convulsion starting----- managed
Metabolic convulsion

Hypoglycemia :

* Asymptomatic :
- Early feeding (espc.term baby)
- Draw a blood sample
- If glucose level < 25 mg/dl : start
glucose infusion : 6 -8 mg/kg/mnt
- Check glucose level every
30 60 mnt
- If glucosee level 25 45 mg : give
early feeding : breast milk or
formula
 Hypoglycemia :

* Symptomatic

Draw a blood sample

Insert IV line ---- start glucose infusion ,
mini bolus : D 10% 2ml/kgBW ,
rate 1 ml/mnt ---- continuous
glucose infusion: 6 8 mg/kgBW /mnt
----- Check glucose level every 30 60
mnt
The highest concentration : 12.5%
for peripheral line , more
concentrated ----- central line
Hypocalcaemia

Emegency Calcium therapy :

Give 1 2 ml/kgBW Calcium
gluconate 10% by IV infusion
over 5 mnts
Monitor heart rate and infusion site
Repeate dose if there is no clinical
response
Following initial dose ---- give
maintenance : 200 800 mg/kg
Calcium gluconate 10% parenteral
or orally
Neonatal Tetanus
Motality rate > 50%
Give Diazepam drip 40 mg/kgBW/24 hrs
and give bolus diazepam 0,2 mg /kgBW for
every episodeof spasm
If RR < 30 x/mnt check airway, give O2
Give tetanus toxoid 0,5 ml
Give tetanus antitoxin (ATS) 10 000 IU,
if available antitetanus immunoglobulin
500 U IM
Give Benzylpenicillin G 100.000 IU/kgBW, IV
or Procaine Penicillin 100.000 IU kgBW
IM
Neonatal Tetanus
(continued)

Care for the infant in a quiet room, dark room

is not needed anymore, make sure not
neglected
Continue IV fluids at daily maintenance
Appropriate care of umbilical cord
When spasm subside ------ fed the baby