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

1. Widiastuti D, et. al. 2006.

2. Plouin P, et al. 2013.
3. Mizrahi EM. 2010.
4. Vasudevan C, et al. 2013
5. Sarosa GI. 2014.
6. 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

1. Kanhere S. 2014.
2. 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

1. Sarosa GI. 2014.

2. Boylan G, et al. 2005.
3. 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
• Myoclonic • Radiology

1. Kanhere S. 2014.
2. Sarosa. 2014.
3. Mikati, et al. 2020.
4. Crisp S, et al. 2013.
5. Chau V, et al. 2009.
 LITERATURE REVIEW
TREATMENT

Kanhere S. 2014.
 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
ER
-BG : 87 mg/dL -Seizure (-) -Seizure (-) -Seizure (-)
-SC -> Gemeli 2
2 hours -BG 30-102 -BG stable -Oral nutrition
-BW 2600 gr
NCI (11/12/19) mg/dL -Enteral nutrition 20 60cc 4-5 times +
-AS 6/7
-BG : 14 mg/dL -D12,5% 11,9cc -> 90cc/3h breastmilk
-Seizure once
-D10% IV inj + D10% -Enteral -weight: 2795->2933 -weight: 2100
-Blood glucose
IVFD nutrition gram gram ( AA Hospital
(BG) : 44 mg/dL
20cc/3h 30/12/19)
-
-BG : 33 mg/dL -Weight: 2430- Lab (18/12/19)
-D10% IV inj >2795 gram Hb : 15,3 g/dL
Ht : 46,2%
Lab (11/12/19) Leu : 8.330/mm
Hb : 16,3 g/dL IT ratio : 0,19
Ht : 49,4% CRP : 10,9
Leu : 7.390/mm T3 : 1,62 nmol/L
Trom : 130.000/mm TSH : 11,46 μIU
IT ratio: 0,21 T4 : 138,85 nmol/L
CRP reaktif : 1,4
IMPORTANT THINGS FROM MOTHER:
Multigravida, ante natal care 4 times, and had sectio caesarea caused by gemelli.
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

THEORY
• ↓ glycogen supply, & ↓ calorie intake
caused by difficult feeding->
hypoglycemia-> ATP depletion->Na +K+
pump disturbance and its RF includes
gemelli
• Gemelli-> ↓ liver glycogen, muscle
protein,lipid storage & enzyme system
for gluconeogenesis not fully developed
CASE
The neonate was born gemelli 2, had
clinical manifestation of hypoglycemia &
BG: 44 mg/dL.
THEORY
Aterm neonatal needs a 100–120
kcal/kg/day of calorie
CASE
AA HOSPITAL:
• No seizure, BG stabilized at 2nd week
after the calorie increased from 37-91
to 84–246 kcal/kg/days,
• Weight gain at 1st week 28,5 gram/day
-> 2nd week 45 gram/day
Discussion
THEORY THEORY
Neonatal seizure can be caused by Septic neonatorum->↑ peripheral glucose
hypoglycemia and septic neonatorum
utilization -> hypoglycemia-> neonatal seizure
CASE CASE
A boy, 2 days aged, aterm, normal birthweight, The neonate had clinical manifestation of septic
gemelli 2 referred from Annisa Hospital with neonatorum & IT ratio: 0,21
seizure history, hypoglycemia, and suspect
sepsis
Blood culture and electrolyte were not
THEORY examined and after treated w/ AB IT
ratio: 0,19
It is called subtle neonatal seizure eye fixated to one
direction and limb movement,often found in both
aterm and preterm, w/ <3 days of age
↑↑ limbic structures development & the connections
to the diencephalon & brain stem -> oral-buccal-
lingual movements
CASE
Neonate had eye fixated to the left and limb
movement, aged 2 days old, and aterm
Neonate should be routinely controlled to
health facility to know the neonate’s
growth achievement and to get
immunization on schedule
Condition of the neonate when control :
Weight gain weren’t achieved optimally
because the calorie intake reduced to 69
kcal/kg/day
Thank You