CASE REPORT:

Neonatal Seizure

Faradina Santi, S.Ked

Novel Gultom, S.Ked
Sonya Andzil M. Tori, S.Ked

Supervisor:
DR. dr. Dewi Anggraini Wisnumurti, Sp. A (K), IBCLC

PEDIATRIC DEPARTMENT
FACULTY MEDICINE OF RIAU UNIVERSITY
2020
 INTRODUCTION

• 1–5 newborn each 1000 birth

• Caused by ↑↑ excitation of brain & imbalance of neurotransmitters activities
• Clinical diagnosis
• Etiology and clinical manifestation
• An emergency-> permanent damage and death
• Investigation, diagnosis, and treatment is crucial

Widiastuti D, et. al. 2006, Plouin P, et al. 2013, Mizrahi EM. 2010, Vasudevan C, et al. 2013, Sarosa GI. 2014, and Kanhere S. 2014.
 LITERATURE REVIEW
DEFINITION
Paroxysmal alteration of neurologic function (behaviour, motoric, and/or
autonomic function) which associated +/- abnormal neurotransmitter release at
first 28 days life (aterm) and 44 w gestation (premature)

EPIDEMIOLOGY
Incidence-> 5 each 1000 livebirth, higher in premature and low birth weight

Kanhere S. 2014 and Vasudevan C, et al. 2014.

 LITERATURE REVIEW
ETIOLOGY

• HIE (60-65%)
• Metabolic disturbance-> hypoglycemia (3%)
• Intracranial hemorrhage (17%)
• Stroke (1-15%)
• Infection (5-10%)
• etc
Sarosa GI. 2014, Boylan G, et al. 2005, and Handryastuti S. 2007.
 LITERATURE REVIEW
PATOPHYSIOLOGY

Jensen FE. 2009.

 LITERATURE REVIEW

CLINICAL DIAGNOSIS:
MANIFESTATION:
• History of mother (pregnancy & delivery) and
• Subtle child (birth & illness)
• Tonic • Physical examination
• Clonic • Laboratory finding
• Spasm • EEG dan aEEG
• Myoclonic • Radiology

Kanhere S. 2014, Sarosa. 2014, Mikati, et al. 2020, Crisp S, et al. 2013, and Chau V, et al. 2009.
 LITERATURE REVIEW
TREATMENT
Is the neonate having a seizure?
(Based on clinical description)

No
Yes

Is this the first seizure?

Jitteriness
Recurrent or ongoing seizures
REM Sleep
Normal activity
Apnea
Yes

LP if susp meningitis
Stabilize vital signs–A, B, C
EEG-Video EEG /aEEG Seizures continue Collect blood for BSL, Ca, Mg, Na, K, hematocrit, sepsis screen
or stop Start IV access
Neuroimaging USG, CT/MRI if Treat correctable metabolic conditions: Dextrose, Ca,
indicated Mg, electrolytes

Investigations including EEG Seizures continue

Abnormal Normal Normal except

+/- EEG including EEG Abnormal EEGl Start IV phenobarbital 20mg/kg

Treat the cause. Treat seizure. Neonatal epilepsy

Kanhere S. 2014. Hypoglycemia, HIE, meningitis Investigate syndrome. Seizures stopped
hypocalcemia further for Treat with Seizure continue
Add AED IEM +/ AED
 CASE REPORT
IDENTITY
• Name : Rahmayuni's baby
• Age : 2 days old
• MR : 01030931
• DOA (ER) : Dec 10th 2019 (10.25 pm)
• DOA (SCN) : Dec 11th 2019 (00.35 am)
• Date of examination : Dec 15th 2019
• Date of discharge : Dec 20th 2019
• Patient status : Alive

Main complaint : Neonatal seizure at age 2 days old (referred from Annisa
Hospital with seizure history to the Arifin Achmad Hospital emergency room)
 HISTORY OF ILLNESS
Annisa AA Hospital 1st week 2nd week Follow up
Hospital 10/12/19 11-15/12/19 16-20/12/19 03/01/20
-SC -> Gemeli 2 ER -Seizure (-) -Seizure (-) -Seizure (-)
-BW 2600 gr -BG : 87 mg/dL -BG 30-102 -BG stable -Oral nutrition
-AS 6/7 2 hours mg/dL -Enteral nutrition 20 60cc 4-5 times +
-Seizure once SCN (11/12/19) -D12,5% 11,9cc -> 90cc/3h breastmilk
-Blood glucose -BG : 14 mg/dL -Enteral -Weight: 2795->2933 -weight: 2100
(BG) : 44 mg/dL -D10% IV inj + D10% IVFD nutrition gram gram ( AA Hospital
- 20cc/3h 30/12/19)
-BG : 33 mg/dL - + fortison Lab (18/12/19)
-D10% IV inj + D10% IVFD -Weight: 2430- Hb : 15,3 g/dL
-Bactesin, gentamisin, sibital >2795 gram Ht : 46,2%
Leu : 8.330/mm
Lab (11/12/19) IT ratio : 0,19
Hb : 16,3 g/dL CRP : 10,9
Ht : 49,4% T3 : 1,62 nmol/L
Leu : 7.390/mm TSH : 11,46 μIU
Trom : 130.000/mm T4 : 138,85 nmol/L
IT ratio: 0,21
CRP reaktif : 1,4
IMPORTANT THINGS FROM MOTHER:
Multigravida, ante natal care 4 times, and had sectio caesarea caused by gemelli 2.
IMPORTANT THINGS FROM BABY
A neonate, boy, with 36-38 weeks gestation, birth weight 2600 gram, temperature 37oC,
with seizure history and recurrent hypoglycemia.

WORKING DIAGNOSIS
1.Aterm (36−38 weeks) - NBW (2600 grams).
2.Neonatal seizure et causa hypoglycemia et causa suspect septic neonatorum
PROGNOSIS
Quo ad vitam : dubia ad bonam
Quo ad functionam : dubia ad bonam
 DISCUSSION
THEORY THEORY THEORY THEORY
• Hypoglycemia-> Na+K+ • Aterm neonatal needs a 100–
Eye fixated to 1 direction & limb Septic neonatorum-
pump disturbance and its RF >↑ peripheral 120 kcal/kg/day of calorie
movement-> subtle, often
includes gemelli • The ideal weight gain for aterm
->aterm and preterm, w/ <3 days glucose utilization ->
• Gemelli-> storage & enzyme 15-30 gram/day Neonate should be
of age hypoglycemia->
system for gluconeogenesis routinely controlled to
↑↑ limbic structures neonatal seizure
not fully developed CASE health facility -> neonate’s
development & the connections CASE AA HOSPITAL: growth, development
CASE
to the diencephalon & brain • No seizure, BG stabilized at 2nd achievement & to get
Gemelli 2, had clinical Had clinical
stem -> oral-buccal-lingual, week after the calorie immunization on schedule
manifestation of manifestation of
occular movements hypoglycemia & BG: 44 increased from 37-91 to 84–
septic neonatorum 246 kcal/kg/days,
mg/dL.
& IT ratio: 0,21 • Weight gain: 505 grams->25,25
CASE
grams/day
Eye fixated to the left and limb DISCHARGED:
movement, aged 2 days old, and • Weight reduction 835 grams at
aterm home w/ 69 kcal/kg/day

Blood culture: sterile and after

treated w/ AB IT ratio: 0,19
Electrolyte were not examined
Thank You