it 18 - kejang pada bayi baru lahir - her

7/25/2019 IT 18 - Kejang Pada Bayi Baru Lahir - HER

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Neonatal Seizures


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Learning Objectives

1. Define seizures and differentiate

between epileptic and non-epileptic

seizures.

2. Know the incidence of neonatal seizures.

3. Describe the four types of seizures and

their clinical pictures.

4. Identify benign moements that are notseizures.


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Learning Objectives (cont)

!. "ist the causes of neonatal seizures#

both common and less common

etiologies.

$. Diagnose neonatal seizures.

%. &reat neonatal seizures.

'. Inform parents of the neonate(s

prognosis.


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)eizures are transient disturbances in

brain function manifesting as episodicimpairments in consciousness in

association with abnormal motor or

automatic actiity.

Definition of Seizure


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Epileptic and Non-Epileptic

Seizures*pileptic seizures originate from the

cortical neurons and are associated

with **+ changes.,on-epileptic seizures are initiated in

the subcortical area and are not usually

associated with any **+ changes.- prooed by stimuli and ameliorated

by restraint and body repositioning.


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Incidence of Neonatal Seizures

&he oerall incidence is .!/ of all term

and preterm neonates.

&he incidence is higher in preterm

neonates 03./ if gestational age 3wees.


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Tpes and !linical "resentations

of Neonatal Seizures#our tpes of seizures are fre$uentl

encountered in neonates%

Tonic Seizures

!lonic Seizures

&oclonic Seizures

Subtle (#rag'entar) Seizures


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Tonic Seizures

Tonic seizures can be eiter generalized or focal

*eneralized tonic seizures%

- ainly manifest in preterm neonates 0 2!grams.

- &onic fle5ion or e5tension of the upper

e5tremities# nec# or trun and are associated

with tonic e5tension of the lower e5tremities.

- In '!/ of cases are not associated with any

autonomic changes such as increases in heart

rate or blood pressure# or sin flushing.


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#ocal Tonic Seizures6resent with asymmetrical posturing of

one of the limbs or trun or with tonic

head or eye deiation.

ostly occur with diffuse central

nerous system disease andintraentricular hemorrhage.


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!lonic Seizures

7onsist of slow 01-3 8minute rhythmic9ering moements of the e5tremities.

&hey may be focal or multi-focal. *achmoement is composed of a rapidphase followed by a slow one.

7hanging the position or holding the

moing limb does not suppress themoements. &hey are commonly seenin full-term neonates :2! grams


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!lonic Seizures(cont)

&here is no loss of consciousness and

they are associated with focal trauma#

infarction or metabolic disturbances.


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&oclonic Seizures

yoclonic seizures can be focal# multifocal or generalized.

;ocal myoclonic seizures typicallyinole the fle5or muscles of thee5tremities.

ulti-focal myoclonic seizures presentas asynchronous twitching of seeralparts of the body.


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&oclonic Seizures(cont)

+eneralized myoclonic seizures

present as massie fle5ion of the headand trun with e5tension or fle5ion of

the e5tremities. &hey are associated

with diffuse 7,) pathology.


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Subtle (#rag'entar) Seizures


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Subtle (#rag'entar) Seizures(cont)

Drooling# sucing or chewing

moements.

>pnea or sudden changes in respiratory

patterns.

?hythmic fluctuations in ital signs.


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+enign &ove'ents tat are

Not Seizures

,itteriness

Sleep apnea

Isolated sucing 'ove'ents

+enign neonatal sleep

'oclonus


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,itteriness

,itteriness is often 'isdiagnosed as

clonic seizures !linicall te differ

fro' clonic seizures in te follo.ingaspects%


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,itteriness (cont)

&he fle5ion and e5tension phases are e@ualin amplitude.

,eonates are generally alert# with noabnormal gaze or eye moements.

6assie fle5ion or repositioning of the limbdiminishes the tremors. &remors are

prooed by tactile stimulation# though theymay be spontaneous.

,o **+ abnormalities.


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often seen in neonates with

hypoglycemia# drug withdrawal#

hypocalcemia# hypothermia and in0)+> neonates.

spontaneously resole within few wees.

,itteriness (cont)


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Sleep /pnea

,ot associated with abnormalmoements and is usually associated

with bradycardia.

Ahen seizures are present with apnea

abnormal moements# tachycardia andincreased blood pressure are present aswell.


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Isolated Sucing

&ove'ents

?andom# infre@uent and not wellsustained sucing moements are not

seizures.


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+enign Neonatal Sleep

&ove'ents 6redominantly seen in pretermneonates during sleep. &hey can be

focal# multi-focal# or generalized. &heydo not stop with restraint.

resole spontaneously within a few

minutes and re@uire no medication.


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+enign Neonatal Sleep

&ove'ents (cont)&hey differ from myoclonic seizures in

the following=

can be triggered by noise or motion.

suppressed by the waing state.

not associated with any autonomic

changes.


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&ost !o''on !auses of

SeizuresBI*

Infections 0&C?7B# meningitis#

septicemia

Bypoglycemia# hypocalcemia#

hypomagnesemia

7,) bleed 0intraentricular# subdural#

trauma# etc.


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Less !o''on !auses of

Seizures 7ongenital brain anomalies

Inborn errors of metabolism

aternal drug withdrawal 0heroin#barbiturates# methadone# cocaine# etc.

Kernicterus

6yrido5ine 0$ dependency# and

hyponatremia

more than one underlying cause


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Diagnosis of Seizures

Cbtain a good maternal and obstetric

history


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Laborator Investigations

"ri'ar tests

lood glucose

lood calcium and magnesium

7omplete blood count# differential leuocytic

count and platelet count

*lectrolytes

>rterial blood gas 7erebral spinal fluid analysis and cultures

lood cultures


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Laborator Investigations(cont)

&C?7B titers# ammonia leel# headsonogram and amino acids in urine.

**+,ormal in about 183 of cases

7ranial ultrasound

;or hemorrhage and scarring

7& &o diagnose cerebral malformations and

hemorrhage


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&anage'ent of Seizures

anagement goals

>chiee systemic homeostasis0airway# breathing and circulation.

7orrect the underlying cause if

possible.


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&edical &anage'ent of

Seizures 1/ de5trose solution 02cc8g IE empirically to

any seizing neonate.

7alcium gluconate 02mg8g IE# if

hypocalcemia is suspected .

agnesuim sulfate !/# .2ml8g or 2ml *@8g.

>ntibiotics in suspected sepsis.

In pyrido5ine dependency gie pyrido5ine !mgIE as a therapeutic trial. )eizures will stop

within minutes .


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Stopping Seizures .it

/nticonvulsants


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/nticonvulsants (cont)


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/nticonvulsants (cont)


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"rognosis

est prognosis with=

Aorse prognosis

with=

)e@uelae=

Bypocalcemia 6yrido5ine dependency )ubarachnoid

hemorrhage

Bypoglycemia>no5ia rain malformation

7hronic seizures 1!-2/

ental retardation


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TERIMAKASIH

it 18 - kejang pada bayi baru lahir - her

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