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