Neonatal Seizures
Most Common cause : HIE ( Hypoxic Ischemic Encephalopathy )
Many neonatal seizures are Metabolic.
Day 1 :
- Hypo-Glycemia
- Hypo-Calcemia
- Hypo-Magnesemia
- IVH
- Rarely - Pyridoxine dependent seizures.
Day 3 - 7 :
- Late Onset sepsis
- Late Onset Hypo-Calcemia
- Tetanus Neonatorum
- Kernicterus
Most Common type : Subte Seizures
- Vacant Stare
- Paddling movements
Because :
- Myelination is not completed in NewBorn
- Arborization of neurons is not completed
DOC : Phenobarbitone (But 1st check Glucose , Calcium , Magnesium )
Not Diazepam - it has Benzyl Alconium Chloride (preservative) which binds to albumin and displaces bilirubin - therefore can precipitate Kernicterus.
Pyridoxine dependent seizures : (AR)
Diagnosis of exclusion
Previously diagnosed by response of IV or Oral Pyridoxine ( Used in India Now also )
Diagnosed Now by : CSF or Plasma - Pyridoxine-5-phosphate.
GABA is formed from Pyridoxine
Therefore if decreased Pyridoxine - decreased GABA - Therefore decrease Inhibitory stimulus.
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