What does seizures in newborns look like? Convulsions in infants: symptoms, how to recognize, causes. Febrile seizures in a baby

Some diseases of newborns are accompanied by convulsions: sometimes such manifestations are clearly expressed, and parents can immediately recognize them, and sometimes contractions skeletal muscles barely noticeable. Most often, neonatal seizures occur in diseases such as hypoxic-ischemic or bilirubinemic encephalopathy, hypoglycemia, hypocalcemia, hypoparathyroidism, meningitis and leucinosis. Also, the causes of seizures in infants may be genetic metabolic pathologies and neonatal abstinence.

On this page you will learn how seizures manifest in infants due to various diseases, and how such diseases are treated.

Why do newborns experience hypoglycemic seizures?

Hypoglycemic seizures in infants are caused by a decrease in blood glucose: in full-term - below 2 mmol/l (less than 35 mg/100 ml), in premature - below 1.4 mmol/l (25 mg/100 ml). A repeated decrease in glucose below 2.6 mmol/l is potentially dangerous for the newborn.

Transient hypoglycemia of newborns is caused by the pathology of pregnancy (preeclampsia, placental circulation disorders, multiple pregnancies), fetal distress, perinatal hypoxia, diseases of newborns - HFRT, infectious-toxic diseases, sepsis, meningitis, RDS, iatrogenic causes - introduction to pregnant and parturient women large quantity glucose, the use of tocolytics - β-agonists, sudden cessation of parenteral administration of hypertonic glucose solutions to a newborn, replacement blood transfusion in the treatment of tension-type headache, late application to the breast.

Another reason why a newborn experiences hypoglycemic convulsions may be the mother's treatment with anti-diabetic sulfonamides.

Causes of persistent hypoglycemia: intrauterine hypotrophy, Beckwitt-Wiedemann syndrome, hereditary metabolic diseases (leucinosis, galactosemia, mitochondrial diseases, type I glycogenosis, fructose intolerance), adrenogenital syndrome and hemorrhages in the adrenal glands, tension-type headache, maternal diabetes mellitus.

The following clinical forms of neonatal hypoglycemia are distinguished: transient neonatal hypoglycemia - with diabetic fetopathy, prematurity, intrauterine growth retardation, hypothermia; persistent neonatal hypoglycemia occurs with hyperinsulinism (nisidioblastosis, Wiedemann-Beckwith syndrome, islet cell adenoma of Langerhans), hypofunction of the pituitary gland, adrenal glands, thyroid gland, glucagon deficiency, with hereditary disorders of carbohydrate, fat and amino acid metabolism.

The danger of hypoglycemia lies in a generalized disruption of metabolic processes due to energy deficiency, which can lead to neurological disorders. Hypoglycemia is extremely dangerous in the early neonatal period for premature babies also because, by causing a compensatory increase in cerebral blood flow, it can contribute to the occurrence and progression of intraventricular hemorrhages.

Clinical picture. Beckwitt-Wiedemann syndrome is a genetically determined pathology, the syndrome of a large child with a large tongue, umbilical hernia and divergence of the rectus abdominis muscles, folded ears, visceromegaly (enlarged liver, kidneys, heart). Due to macroglossia, the child may experience respiratory disorders, difficulty sucking, and hypoglycemia.

Treatment consists of correcting hypoglycemia by intravenous administration of glucose, and in severe cases, administration of insulin antagonists; ensuring adequate nutrition; maintaining temperature comfort, correcting hypothermia.

If hypoglycemia develops, a 10% dextrose solution is prescribed - intravenously, in a stream for 2-4 minutes, 2 ml/kg (200 mg/kg), then intravenously slowly at a rate of 3-5 ml/(kg h) (6-8 mg/( kg min)), until the condition stabilizes and the full volume of feeding is introduced.

If there is no effect (disappearance of hypoglycemia), contrainsular hormones are prescribed for 4-6 hours: hydrocortisone - intravenously 5-10 mg/(kg day) in 1-3 injections, until blood glucose levels normalize or glucagon intramuscularly 0.025 mg/kg (maximum single dose 1 mg) or prednisolone - intravenously 2-3 mg/(kg day) in 1-3 injections, until blood glucose levels normalize.

For persistent severe hypoglycemia medicine choice - diazoxide (orally 5-15 mg/kg in 3 doses, until blood glucose levels normalize).

After normalization of glucose levels hormone therapy should be discontinued and the administration of dextrose continued for a while.

Hypoxic-ischemic convulsions in infants: how to recognize and what to do

Most common reasons seizures in newborns are hypoxic-ischemic and traumatic lesions brain, the second place in frequency is occupied by perinatal, including intrauterine infections.

Clinical picture. With hypoxic-ischemic encephalopathy, it is usually not difficult to recognize seizures in infants: they occur several hours after birth (sometimes several days), are more often focal or multifocal clonic, and are combined with rhythmic nystagmus and apnea. Such spasms in newborns look like flexor spasms.

Involuntary “local” movements are often observed - the equivalent of cramps in an infant, as well as muscle hypotonia with general depression. Sometimes muscle tone is increased and the child is excited. There is an increase in the activity of creatine kinase B in the blood plasma, and an increase in the concentration of lactates in the cerebrospinal fluid.

Ultrasound and CT scans of the brain reveal focal areas of reduced density or a diffuse decrease in brain density.

Intracranial hemorrhages are observed in children with low birth weight. With intracranial hemorrhages, generalized or focal convulsions are combined with nystagmus, muscle hypotonia, abnormal pupillary reactions, sometimes opisthotonus or floppy baby syndrome. Cardiovascular and respiratory disorders (neurogenic RDS) are common. To detect hemorrhages, ultrasound of the brain is used as a screening test. CT confirms the diagnosis, nuclear magnetic resonance imaging (NMRI) can identify vascular abnormalities of the brain as a possible basis for hemorrhages. The cerebrospinal fluid is xanthochromic, 1 μl contains from 100 to several thousand red blood cells, the protein content exceeds 200 mg/100 ml, the glucose level is steadily reduced - less than 30 mg/100 ml.

Treatment. Anticonvulsants are used - intravenously and intramuscularly: 0.5-1% solution of seduxen at 0.3-0.5 mg/kg, 0.25% solution of droperidol at 0.3-0.5 mg/kg, 20% solution of hydroxybutyrate sodium 50-100 mg/kg.

What else do doctors do for such cramps in infants? Dehydration therapy is carried out: Lasix is administered intravenously or intramuscularly at 1-3 mg/(kg day), intravenously 10-20 ml of 20% glucose solution, concentrated plasma (diluted with bidistilled water in a ratio of 2:1), antihemorrhagic agents: vikasol, aminocaproic acid , vitamin C.

What hypocalcemic seizures look like in infants: symptoms and treatment

Hypocalcemia occurs when the total calcium level in the blood plasma decreases below 1.75 mmol/l. It can be early, appearing on the 2nd-3rd days of life, or late - on the 5-14th day of life. The risk of developing early hypocalcemia is especially high in premature infants and children with intrauterine malnutrition, born with asphyxia and with HFRT, as well as in newborns from mothers with diabetes mellitus.

Clinical picture. For early hypocalcemia, the most typical are generalized convulsions with episodes of cyanosis, shortness of breath or apnea, a high-pitched cry, and hyperesthesia. Sometimes hypocalcemic seizures in infants appear as small tremors of the chin and fingers, accompanied by laryngospasm. Focal seizures are also possible. Hypocalcemia can be practically asymptomatic or manifest itself in the form of hypotension and apnea attacks.

The causes of late hypocalcemic seizures in a newborn baby are hypoparathyroidism and pseudohypoparathyroidism, congenital vitamin D-resistant rickets, acute renal failure, artificial feeding mixtures of cow's milk containing significant amounts of phosphates. Also, the cause of hypocalcemic seizures in infants is diarrhea with metabolic acidosis. Congenital aplasia of the parathyroid glands and thymus gland is characteristic of Di George syndrome.

A decrease in the level of ionized calcium in plasma is caused by citrates (during exchange transfusions of blood stabilized with citrates), intralipid administered during parenteral nutrition (increases the level of free calcium in the blood). fatty acids calcium binding). Alkalosis with hyperventilation and kidney disease contributes to the manifestation of hypocalcemia.

With late hypocalcemia, along with convulsions in a newborn child, hyperexcitability, hyperesthesia, tremor, muscle twitching, a high-pitched cry, and tachycardia are more often observed. Possible manifestations include laryngospasm with short-term cessation of breathing, tetany with carpopedal spasm, positive symptoms Khvostek, Trousseau, Lusta. Obstetrician's hand, inspiratory stridor, vomiting, bloating, gastrointestinal bleeding, and tonic convulsions are noted.

Diagnosis can be assumed from clinical data; confirmation is a decrease in the level of total calcium in the blood serum of less than 2 mmol/l in full-term infants and less than 1.75 mmol/l in premature infants. Hypocalcemia is also confirmed by lengthening QT interval more than 0.2 seconds (according to ECG results).

Treatment. Early hypocalcemia in the absence of clinical symptoms usually does not require treatment. In the presence of clinical symptoms or a pronounced decrease in calcium concentration, a 10% solution of calcium gluconate is administered intravenously at 0.5-1 ml/kg (no more than 10 ml) at a rate of 1 ml/min under control of heart rate (rapid administration leads to bradycardia). If the dose is ineffective, repeat the administration after 15 minutes.

When treating hypocalcemic seizures in newborns, calcium preparations should not be mixed with sodium bicarbonate solutions. Introduction of calcium solutions into umbilical artery may cause the development of necrotizing enterocolitis. If it is not possible to relieve increased neuromuscular excitability with calcium preparations, it is advisable to administer intramuscularly a 25% solution of magnesium sulfate at a dose of 0.25 ml/kg.

How to identify seizures in an infant with hypoparathyroidism?

Hypoparathyroidism is a syndrome that occurs when there is a lack of parathyroid hormone - the hormone of the parathyroid glands. Neonatal hypoparathyroidism develops due to organic pathology parathyroid glands, which arose in the prenatal period of fetal development during the formation of embryopathy; may be transient in nature. When the level of parathyroid hormone decreases, the absorption of calcium in the intestine and the excretion of phosphorus decreases, and the reabsorption of phosphorus in the renal tubules increases. The result is hypocalcemia and hyperphosphatemia.

Neonatal hypoparathyroidism is most often transient state accompanied by neonatal tetany, hypocalcemia and hyperphosphatemia.

Clinical picture. It is not difficult to identify such convulsions in an infant - they manifest themselves as tetany with carpopedal spasm, positive symptoms of Khvostek, Trousseau, Lyust. Often there is laryngospasm with short-term cessation of breathing. The activity of the parathyroid hormone in the blood is reduced. On radiographs tubular bones double contours of the epiphyses are visible.

Treatment. The tactics for relieving convulsions in an infant are the same as for hypocalcemic convulsions, but to eliminate hypoparathyroidism and relapses of convulsive syndrome, the administration of parathyroid hormone in a dose of 0.1-0.2 ml (2 units) intramuscularly and the administration of vitamin D (100,000 IU) are indicated. Hypoparathyroidism in these cases is eliminated within a few weeks.

What do cramps look like in babies with meningitis: symptoms with video

Convulsions in newborns can be generalized, tonic and clonic.

Clinical picture. Usually, tremor, sometimes hemiparesis, bulging of a large fontanel, unstable fever, decreased reactions to the environment, and stupor are detected. Often, cramps during meningitis in infants are accompanied by a symptom such as vomiting. Crucial for diagnosis is the study of cerebrospinal fluid (Gram staining of smears, determination of glucose, protein, cell counting). Bacteriological examination (culture) of blood, latex agglutination with antibodies against group B and K streptococcus, and E. coli antigen are required.

Treatment based on parenteral administration antibiotics, the choice of which is determined by the etiology of meningitis, anticonvulsant and other syndromic therapy.

This video shows the symptoms of seizures in infants with meningitis:

How to recognize seizures in an infant with DiGeorge syndrome?

Persistent congenital hypoparathyroidism manifests itself as Di George syndrome, aplasia of the parathyroid glands and thymus gland. Neonatal tetany develops against the background of severe combined immune deficiency (sepsis).

Clinical picture. Recognizing such convulsions in an infant is usually not difficult. Di George's syndrome is characterized by paresthesia of the skin of the extremities and face, periodically recurring tremor, carpopedal spasm, and laryngospasm. Symptoms of intoxication, dystrophy and other manifestations of the septic process are noted. The level of calcium in the blood is reduced.

Treatment. Urgent Care is aimed at eliminating convulsive syndrome (Seduxen, GHB, etc.), but treatment continues constantly.

Convulsions in a newborn with pyridoxine deficiency: symptoms and treatment

Pyridoxine deficiency in newborns and children early age may be accompanied by seizures caused by congenital deficiency of the enzyme pyridoxalkinase. Due to tissue deficiency of active forms of pyridoxal, the synthesis of neurotransmitters - minobutyric acid, glycine, serotonin - is disrupted, which leads to the development of seizures.

Clinical picture. Symptoms of clonic-tonic convulsions in newborns with pyridoxine deficiency are severe muscle spasms in the a short time and rhythmic muscle twitching. Such convulsions are not stopped by the administration of anticonvulsants, calcium supplements and disappear after the administration of pyridoxine. The calcium and glucose levels in the blood are normal.

Treatment. Anticonvulsants (seduxen, sodium hydroxybutyrate, etc.). If anticonvulsant therapy is ineffective in the absence of hypoglycemia or hypocalcemia, a solution of pyridoxine should be administered intravenously in a single dose of 5-10 mg (1 ml of 5% solution for injection contains 50 mg of pyridoxine hydrochloride).

How can you tell if your baby is having seizures due to bilirubinemic encephalopathy?

Bilirubinemic encephalopathy develops with a significant increase in the concentration of free (indirect) bilirubin in the blood of newborns due to hemolysis (HDN due to incompatibility of the blood of mother and fetus by group or Rh factor, congenital hemolytic anemia, deficiency of glucose-6-phosphate dehydrogenase), massive blood transfusions , as well as for hypothyroidism.

Clinical picture. Against the background of prolonged jaundice, clonic or tonic convulsions occur. You can tell that a baby is having convulsions by large-scale tremor of the limbs, or in severe cases by opisthotonus. Children are agitated or sleepy. The liver is enlarged. The critical threshold for the level of bilirubin in the blood plasma of full-term infants is considered to be 342 µmol/l, for premature infants - 256 µmol/l. If the hourly increase in the concentration of bilirubin in the blood plasma is more than 10 µmol/l in full-term infants and more than 8 µmol/l in premature infants, then replacement blood transfusion should be started.

Treatment. Intravenous administration of anticonvulsants is indicated: 0.5% seduxen solution (0.3-0.5 mg/kg), 20% sodium hydroxybutyrate solution (50 mg/kg), phenobarbital 5-10 mg/(kg day). Diuretics are used: Lasix 1-3 mg/(kg day) intravenously, intramuscularly. Conduct a security clearance.

How do seizures manifest in infants with hereditary metabolic diseases?

Neonatal seizures in newborns can occur with hereditary metabolic diseases. Some hereditary metabolic diseases manifest themselves in the newborn period as a formidable symptom complex of neurodistress syndrome or acute neurological disorder syndrome with the sudden development after a few days of apparent well-being in the child’s health.

Clinical picture. Convulsions, persistent vomiting, respiratory distress, sometimes liver enlargement. Coma develops quickly.

Diagnosis established by gas chromatography-mass spectrometry methods. The content of lactic acid in the blood serum is increased, ketone bodies are detected in the blood and urine.

Treatment. Anticonvulsants are administered intravenously, intramuscularly: 0.5% solution of seduxen at 0.3-0.5 mg/kg, 20% solution of sodium hydroxybutyrate at 50 mg/kg, diuretics: lasix at 1-3 mg/(kg day) . Correct metabolic disorders, prescribe antioxidants - ascorbic acid, vitamin E, coenzyme Q10.

What do seizures look like in a baby with leucinosis (with video)

Convulsive syndrome in newborns with leucinosis. Leucnosis is a hereditary disease characterized by impaired metabolism of branched carbon chain amino acids (leucine, isoleucine, valine).

Clinical picture. Convulsions with leucinosis in infants look like constantly recurring muscle spasms. Urine has a peculiar odor, reminiscent of maple syrup or hay. An increase in the level of branched carbon chain amino acids - leucine, valine, isoleucine - is detected in the blood; as well as hypoglycemia, hyperammonemia, metabolic acidosis.

The main symptoms of seizures with leucinosis in infants are shown in this video:

Treatment. Anticonvulsants (seduxen, droperidol, sodium hydroxybutyrate), thiamine; transferring the child to feeding with special formulas with a low content of leucine and its analogues.

Convulsions in infants during neonatal abstinence: causes and symptoms

Neonatal seizures may be a manifestation of “withdrawal syndrome” or neonatal abstinence. Withdrawal syndrome with convulsions develops in newborns whose mothers suffer from drug addiction, alcoholism or are forced to take medicinal purposes antidepressants, anticonvulsants (phenytoin).

Clinical picture. Generalized seizures in a child develop in the first 24 hours after birth. There is an increase in sensitivity to light and sound stimuli, sleep disturbance, general anxiety. Often, cramps in infants are accompanied by a symptom such as increased muscle tone. Some patients have loose stools from birth.

In the first days of life, a baby (even a child under five years old) can often experience seizures. Sometimes spasms indicate that a child under one year of age has serious pathologies. Let's consider the most typical causes of seizures in children under one year of age, signs and possible ways treatment.

The phenomenon often occurs in premature babies - up to three to five years of age. Statistics say that every fifth premature baby is subject to some degree of seizure syndrome. Mothers who gave birth to a premature baby need to be attentive to his health.

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Types of seizures in newborns and children under three years of age

In children under one year of age, in older children (up to three and five years old), seizures show a different character. The latter is associated with the characteristics of the functioning of the brain and nervous system(the nervous system of newborn children is at the stage of formation). Doctors divide seizures into three years into a number of types.

Minor convulsions (spasms). Dangerous, considered to be a harbinger of the development of a dangerous disorder of brain development. The phenomenon is easy to identify - minor twitching or blinking of the eyes, facial muscles, skeletal muscles. Sometimes a slight, unexpressed blue discoloration of the skin is noticed.
Minor spasms in an infant
Tonic types of seizures. The newborn's entire body tenses. The typical posture of a newborn baby is: extension, head thrown back. Short-term apnea (breath holding) may occur. The duration of a tonic convulsion is no more than a minute. Tonic convulsions are most typical for premature babies (they also occur before the age of three years).
Clonic types of seizures. Not found in premature infants. Spasms are characterized by frequent rhythmic twitching of a certain part of the body (1-3 contractions per second).
Myoclonic spasms are extremely rare in newborns and children under 5 years of age. Often characteristic of older people - up to five years of age. With myoclonic spasms, rhythmic twitching of a specific limb or the entire body occurs. Possible participation in head movements. Seizures indicate severe brain damage. Often the lesion is congenital or genetic in nature.

Is it possible to independently determine the nature of seizures in a newborn and a child under three years of age?

The manifestations of seizures in children under one year of age are ambiguous and differ in a particular case. Parents will not be able to independently medical care determine the nature of the child’s seizure, relying solely on one’s own experience or on information gleaned from medical sources. Not in every case, rhythmic muscle twitching is considered a seizure.

Seizures in a newborn and a child under three years of age are determined exclusively in a hospital setting. Doctors use using the latest methods diagnostics, in particular, electroencephalography and magnetic resonance imaging. In the presence of small seizures, it is difficult to observe the dynamics of changes in brain activity.

It often happens that seizures do not respond to anti-epileptic drugs. The latter means that the previous diagnosis was made inaccurately, the child needs to be re-diagnosed.

Causes of neonatal seizures

There are many reasons for seizures in young children. Let's look at the common and typical ones.

Metabolic disorders of various etiologies. These primarily include hypoglycemia and hyponatremia. With hypoglycemia, there is a decrease in the amount of sugar in the blood. The condition often leads to seizures in the child. Remain attentive to the child’s condition; in some cases, hypoglycemia leads to irreversible consequences in the cerebral cortex. Reduced content calcium in the blood (hypocalcemia) also negatively affects the functioning of the brain and leads to seizures.
Encephalopathy. Brain damage manifests itself as acute or chronic failure oxygen in the blood.
Meningitis and encephalitis pose a huge danger to the newborn’s brain and are considered a serious cause of seizures.
Damage to the blood vessels of the brain, often found in premature infants. Threatens cerebral hemorrhages.
Insufficiency of magnesium or pyridoxine (vitamin B6) in the child’s body. Often pathologies develop simultaneously.
Birth injury.
Congenital brain defects in children.
When treated with psychoactive drugs, seizures occur as a withdrawal syndrome.

Psychoactive drugs

Symptoms of seizures in children of the first year of life

Conditions that cause seizures in newborns are often life-threatening. There are cases where children with seizures in the neonatal period subsequently developed without special complications. If seizures occurred due to low glucose levels in the baby’s blood, the child also did not develop complications in the future. If the spasms occurred as a result of meningitis, a high risk of developing all kinds of neurological complications is subsequently revealed.

According to clinical symptoms, seizures are classified as partial, localized, and generalized. In the first case, they spread to a specific muscle group. In the second case, a general convulsive seizure develops. A generalized type of seizures develops when both hemispheres of the brain are involved in the painful process.

If there is a recurrence of convulsive seizures, they speak of convulsive status. Breathing disturbances occur with symptoms of hypoxic cerebral edema. When edema spreads to the brain stem, a disorder of the respiratory, vasomotor center occurs, pathological breathing, vomiting, fever (even up to 39 degrees), bradycardia, collapse.

A generalized tonic-clonic seizure develops suddenly. Disturbing motor excitement, depression of consciousness up to loss. Characterized by tilting the head back, bending the arms in elbow joints, leg extension, facial tension. Possible apnea (stopping breathing), the face becomes pale and blue. Vomiting is observed. Holding your breath lasts no more than a minute. After the end of the seizure, the body is completely restored, and the same happens with consciousness. The child does not remember what is happening at all. The prognosis noticeably worsens if paresis or paralysis is observed along with convulsions.

Infant paralysis

Often, infants experience short-term generalized tonic-clonic seizures. They are typical in children under one year of age, but can occur in older children. It happens against the background of a rise in body temperature. The duration of convulsions is no more than three to five minutes. The prognosis is favorable, not accompanied by neurological disorders. Nervous and mental health does not suffer from children, does not lag behind, is completely age appropriate.

With a lack of calcium in the blood, tetanic convulsions and attacks of sudden respiratory arrest occur. Specific symptoms are noticeable:

Contraction of the orbicularis oculi muscle;
Contraction of the angularis oris muscle;
Abduction of the foot when tapping the forearm or shoulder;
Laryngospasm.
Vomit.

The child bends his arms at the elbow joints and is unable to straighten them. The brushes go down and acquire characteristic appearance"the hands of an obstetrician."

With a decrease in magnesium concentration, increased nervous excitability, muscle tremors, and convulsions are observed. With hypoglycemia, weakness, sweating, muscle tremors, a significant increase in heart rate with possible respiratory arrest are observed. The state of hypoglycemia threatens the child with the development of a coma.

Hypoglycemia in a child

The main principles of treating seizures in infants

Successful treatment of any seizure in a newborn becomes such once the cause is discovered. General rules for the treatment of convulsive conditions in children:

If hypocalcemia is the cause of a convulsive state, the child is given a solution of calcium gluconate in a glucose solution (slowly and intravenously).
For hypomagnesemia (magnesium deficiency), a solution of magnesium sulfate is injected intramuscularly.
In case of hypoglycemia, a dextrose solution is first administered, then a glucose solution is administered in a stream and intravenously. It is necessary to monitor temperature and vomiting.
In febrile convulsive conditions, the first step is to effectively control the fever.

Newborns diagnosed with seizures are admitted to the intensive care. The nurse's job is to carefully monitor the baby's condition. An electroencephalogram is also performed there to determine the state of the brain and the functioning of the organ. Based on electroencephalography indications, therapy adjustment is recommended.

If a baby under one year of age has convulsions that frequently recur and become persistent, the use of barbiturates—barbituric acid derivatives—is indicated. Barbiturates have a hypnotic and sedative effect, which is necessary for the development of seizures. The use of short, medium and long-term drugs is indicated depending on the case. Long-term action of barbiturates is required for the treatment of severe epileptic seizures.

In case of respiratory failure, loss of consciousness, fever and periodic vomiting, it is recommended to maintain artificial ventilation lungs, blood pressure. Pressure is maintained using special drugs. It is necessary to constantly stop convulsive paroxysm due to the considerable danger to the heart. Respiratory disorders and persistent impairment of consciousness – absolute readings for urgent etiotropic therapy combined with symptomatic anticonvulsant treatment.

Due to the fact that in the neonatal period of a child’s development (especially at the age of several months) it is difficult to detect the real reason development epileptic seizure, a third of children die. Death is associated with severe complications of seizures: ischemic encephalopathy, ischemic stroke. At meningococcal infection the prognosis is extremely poor. If convulsive syndromes caused by metabolic disorders, usually have a good prognosis.

The child must be under the supervision of a pediatrician from the first month of life for at least a year. It is necessary to conduct a complete and comprehensive examination of the functioning of the baby’s nervous system in order to prevent the development of serious neurological disorders.

Convulsions in newborns are recognized as an object close attention parents and doctors. It is extremely important to immediately determine the cause of seizures in order to begin effective treatment. And although certain types of seizures do not have a completely favorable prognosis, they can be effective treatment. Especially if the parents consulted a doctor for early stage development of the disease.

The birth of a baby is considered a joyful event. However, its appearance is often accompanied by new troubles and worries. One of the common problems that new parents have to deal with is seizures in newborns. The causes of this disorder may vary. Typically, pediatricians associate the disorder with the immaturity of the nervous system. There are other factors that cause seizures. They will be discussed in today's article. We will also tell you how to recognize the disorder in a timely manner and what parents should do in this situation.

Seizures in newborns: description of pathology

Cramps are involuntary intermittent muscle contractions that can vary in duration and intensity. Why do they arise? All processes in the body are regulated by the brain, including muscle relaxation and tension. In its cellular elements, which are called neurons, various biochemical reactions continuously occur. The result is excitement. The neurons then transmit signals to the muscles, “ordering” them to work and contract. However, not all so simple. Not every excitation in cellular elements is transmitted to the muscles. Sometimes the brain “decides” to pause the process. As a result, the excitation generated in the neurons does not reach the muscles.

When a certain irritating factor (inflammation or traumatic injury) affects brain cells, and the inhibitory mechanism does not work, seizures occur. In children, this disorder occurs several times more often than in adults. Doctors explain this trend by the characteristics of the brain. In babies, neurons are excited easily and quickly, and the processes of inhibition have not yet had time to be fully formed by this time. In rare cases, seizures in a newborn are caused by various diseases.

Main causes of violation

According to statistics, every fifth premature baby experiences seizures. In children born on time, the problem is diagnosed with a frequency of up to 10-14 cases per 1000 newborns. Among the main causes of the disorder, pediatricians name the following:

metabolic disorders due to hypoglycemia or calcium deficiency;
lack of oxygen flow to the brain;
infectious damage to the central nervous system with subsequent development of ischemic encephalopathy;
disruption of the adrenal glands due to their congenital pathology;
hemolytic jaundice, which is a consequence of high bilirubin in the blood.

Who is at risk?

This pathology is usually diagnosed in children in the first year of life. At this time, the nervous system is characterized by underdevelopment and rapid excitability. The stages of maturation of the brain and the entire central nervous system determine the characteristics of the age-related manifestations of seizures. Numerous studies of this problem have made it possible to identify the so-called risk group. Among the main factors predisposing to the occurrence of pathology, doctors identify:

underdevelopment of the central nervous system;
difficult childbirth;
maternal use of drugs or alcohol during pregnancy;
umbilical cord entanglement, asphyxia;
disruption of labor.

The presence of one or more items from this list increases the likelihood that parents will have to deal with the problem of seizures in their baby.

Main manifestations of pathology

Seizures in a newborn usually appear within a few days after the baby is born. Parents begin to worry about the health of the baby when the upper part of his body and legs begin to shake for no reason. Quite often, doctors diagnose tremor in newborns. This is a condition in which the chin and arms shake slightly. These symptoms indicate the neurological nature of the pathology and require immediate consultation with a specialized specialist.

Newborns may also experience seizures during sleep. They capture predominantly lower limbs. At the same time, the child suddenly begins to scream and jerk his legs. In rare cases, the attack is accompanied by holding your breath. At night, such convulsions indicate developing epilepsy. However, most often they indicate immaturity of the central nervous system and disappear after the first year of life.

What types of seizures are there?

Convulsions in a newborn baby and older children differ in their nature. The gradation of pathology depends on the development of brain functions. Therefore, doctors distinguish the following types of convulsive contractions.

Minor seizures are usually harbingers of serious brain pathologies. Among the main manifestations of the disorder are trembling and blinking of the eyes, some facial muscles, and limbs. Sometimes there is a bluish discoloration of the skin.
Tonic convulsions in newborns have the following symptoms: muscle tension throughout the body, short-term holding of breath. In this case, the baby takes an extensor position, and his head is thrown back. This state may last for several minutes. Such attacks are typical for premature babies.
Clonic seizures are characterized by rhythmic jerking of a specific part of the body. They are focal, multifocal and generalized. The latter are characterized by cyanosis and respiratory rhythm disturbances.
Myoclonic seizures in newborns are extremely rare. With this disorder, there is a sharp twitching of the entire body or individual limbs. In babies of the first year of life this pathology indicates serious brain damage, and of a congenital nature.

Possible consequences

Symptoms of pathology cannot be ignored. You should immediately seek help from a doctor. After full examination children's doctor will be able to determine what is causing seizures in a newborn. The causes of the disease, as a rule, determine the treatment tactics.

The lack of competent therapy often leads to irreversible consequences. First of all, seizures may be associated with brain damage or diabetes. A timely diagnosis increases the likelihood of a speedy recovery. Also, during an attack, the brain undergoes a colossal oxygen deficiency, which necessarily affects metabolic processes and incoming energy. If convulsions are frequent, the baby begins to lag behind physical development, his intellect suffers.

Diagnostic methods

Not every twitching or tremors in the limbs should be mistaken for newborn seizures. The causes of this disorder can only be determined by a specialist. To make a correct diagnosis, you need to contact a pediatrician and undergo an examination. This usually involves an electroencephalograph study. The device allows you to track changes in brain activity and determine the nature of convulsive contractions.

Sometimes, upon initial treatment, the doctor diagnoses epilepsy and prescribes appropriate treatment. If positive dynamics are not observed, and convulsions continue, it is necessary to undergo a more in-depth examination.

First aid

Seizures in newborns, the causes of which were described just above, require a qualified approach to treatment. This is not a condition where a child can be helped with a simple pill. If twitching occurs, you should immediately call a team of medical professionals. Before the doctors arrive, the baby needs to be placed in a safe place and the body freed from tight clothing. Try to turn the child on his side so that if he vomits, he does not choke. You can place a clean tissue between your gums. It is not recommended to disturb the newborn and give him medications.

After an attack, the baby needs to be calmed down, but be prepared for repeated attacks. It is important to pay attention to their duration, associated symptoms and intensity. This information will be useful to the healthcare team. If doctors suggest hospitalization, you should not refuse it. In a hospital setting, it is easier to determine the cause of the disorder, as well as choose the right treatment.

Features of therapy

To treat seizures in a newborn, the causes of the disorder must first be established. Typically, the fight against a disease comes down to following the following rules:

for hypocalcemia, a small patient is prescribed calcium gluconate in a glucose solution intravenously;
in case of hypoglycemia, treatment is first carried out with dextrose, and then intravenous administration of glucose solution is recommended;
In febrile convulsive conditions, the first step is to stop the fever.

If the pathology continues for a long time, the child is observed in the intensive care unit. In this case, medications made from barbituric acid (Phenobarbital, Phenytoin) are used as the basis for treatment. They help relax the central nervous system and reduce the intensity of muscle contraction. Gradually the patient's condition returns to normal.

It should be noted that therapy for this disorder should be comprehensive. Good results give the baby proper nutrition, gymnastic exercises, hardening through water procedures and relaxing massage. After the therapy, over the next few years the child should be observed by a neurologist and periodically undergo preventive examinations.

In the neonatal period, it is very difficult to determine what may be associated with seizures in newborns. The reasons are not easy to discover. Therefore, about a third of children die. Of course, we are talking about such serious defects as ischemia, meningitis, etc. If the seizure syndrome is caused by a metabolic disorder, the prognosis is favorable in most cases. Also, approximately one third of surviving patients have various disorders neurological nature.

Let's sum it up

The first manifestations of a pathology such as convulsions in newborns should not be ignored. The consequences that this disorder can lead to often darken the lives of children. It requires close attention from doctors and parents. It is extremely important to promptly determine the cause of seizures and begin therapy. Only in this case can we hope for a favorable outcome.

A small child is not only an object of joy, love and care, but also a constant cause for concern. And if he also begins to behave somehow unnaturally, then the young parents are seriously scared: what if the baby has seizures, and what if they are a symptom of some terrible disease? So, what are seizures, what do they look like and what are the causes of their occurrence in infants and older children?

A few words of reassurance

It is not always the case that what frightened parents mistake for seizures is actually one.

For example:

sudden throwing up of arms and legs during sleep - normal phenomenon for a newborn;
When falling asleep, babies slightly roll their eyes - no big deal;
when frozen, the child will tremble, his toenails may turn blue - just wrap him up warmer;
while crying, the chin may twitch resentfully, the hands may tremble - calm the baby and calm down yourself;
A newborn baby can hold his breath for a few seconds - and this is also not a reason to panic.

In addition, even true cramps, that is, involuntary, intermittent, rhythmic muscle contractions, in most cases are associated with immaturity of the central nervous system, or their cause can be relatively easily eliminated.

Causes

Often, the fears of young parents can be confirmed, and seizures can be a symptom of a serious illness. Knowledge about their causes and types will help you understand all this and in the future understand the nature of seizures in a newborn.

Metabolic disorders

A small organism is very susceptible to a lack (or excess) of any nutrients, vitamins, microelements.

So, the cause of febrile seizures can be:

hypocalcemia – calcium deficiency;
hypoglycemia – glucose deficiency;
hypomagnesemia – low magnesium content in the blood (rare, but it happens);
increased or decreased amount of sodium;
deficiency (excess) of tyrosine, proline and other amino acids;
vitamin B6 deficiency.

All these pathologies can be either a consequence of malnutrition of a nursing mother or serious symptoms indicating dysfunction of internal organs.

Convulsive attacks are of a generalized nature (that is, they cover the entire body): the limbs twitch, the head may fall back, the body becomes stiff or, conversely, is completely relaxed and limp.

Heat

In babies over the age of 6 months, when the temperature rises above 38 ° C, so-called febrile convulsions may occur, characterized by respiratory arrest, during which the baby’s face may turn blue; tilting the head; twitching of limbs.

Such cramps can also be caused by other reasons related to overheating and dehydration of the baby’s body. These are too warm clothes long stay in the sun or in a stuffy hot room, bathing in hot water.

It is important to know: febrile seizures, in which both limbs twitch simultaneously, are not terrible. It is much worse if they cover only half of the body: be sure to tell your doctor about this.

Overexcitable nervous system

In this case, against the background of severe fright or crying, affective-respiratory convulsions may appear when apnea is observed - holding the breath for more than 20 seconds (the child cannot exhale), the head is thrown back, the arms and legs are twitching. Possible loss of consciousness, bradycardia (one of the types of arrhythmia).

In some cases, it is possible to get the baby out of this state by spraying him cold water.

It should be remembered that such phenomena are typical for children in whom increased excitability of the central nervous system is combined with:

suffered birth injuries;
violations of the anatomy of the nose;
enlarged tonsils;
swelling of the nasopharynx due to allergies or inflammation.

A predisposition to affective-respiratory spasms is inherited, so if one of the parents experienced them in childhood, their child is at risk.

Congenital pathologies of the central nervous system

This is exactly what parents fear most. Most often these are so-called minor convulsions or spasms, during which there is trembling of the face and eyelids, frequent blinking, and jaw movements reminiscent of chewing. The eyes roll back, the pupils converge to the bridge of the nose or, conversely, to the outer corners of the eyes. If this happens in infants, this is a serious reason to visit a neurologist.

Premature babies are most susceptible to seizures associated with central nervous system pathologies - they are observed in 20% of cases. For normally full-term babies, the statistics are more favorable - only 10-15 cases per thousand newborns.

Minor seizures are a consequence of:

birth injuries;
high intracranial pressure;
oxygen starvation as a result of asphyxia (entanglement of the umbilical cord) in the fetus;
pathologies of brain development. Seizures can become a symptom of diseases such as hydro-, micro- or porencephaly, epilepsy.

Other reasons

There are a number of other factors that can cause certain types of seizures.

These include:

poisoning (overdose) with any medications;
otitis media, runny nose;
convulsions after vaccination;
infections affecting the brain: purulent meningitis, tetanus, encephalitis, toxoplasmosis;
high levels of bilirubin and the resulting hemolytic jaundice.
dysfunction of the adrenal glands;
pathologies of the cardiovascular system.

It is important to understand that the likelihood of seizures in a baby increases significantly if a woman had a difficult (premature) birth or she used drugs or alcohol during pregnancy or suffered from any infectious diseases. Transmission can occur through breast milk.

First aid

Regardless of the cause of the seizures, whether they are caused by physiology or vaccination, your actions should be aimed at easing the baby’s condition and preventing any injuries (bruises, vomit getting into the windpipe, etc.).

Try to calm down and remember everything that happens: later you will have to tell the doctor about what you saw to help him figure out the nature of the seizures.

Lay the child on his side, place a flat pillow under his head, top part free your torso from clothing, provide an influx of fresh air and carefully hold your head. When the attack passes (usually it lasts no more than a few minutes), call " Ambulance».

If the seizures do not recur, the baby feels well and you know their cause, you can postpone the visit to the doctor until the morning, but it is necessary to show the child to a specialist in any case.

Not for seizures:

shake the child and hold him tightly to you;
trying to hold twitching limbs;
give the baby artificial respiration;
leave him lying on his back;
try to give any medications, unclench your teeth, put foreign objects in your mouth.

If you know the reason, you can do the following:

For affective-respiratory convulsions: sprinkle cold water on the child’s face and let him smell ammonia.
For febrile convulsions: wipe the body with a damp, cold towel, and after the attack stops, give an antipyretic.
Drinking plenty of fluids is recommended.

Prevention

The following actions will help reduce the likelihood of seizures in a newborn:

One month before your planned pregnancy, take folic acid.
Throughout pregnancy, eliminate any harmful exposures and try to avoid infectious diseases, worm infections, etc.
Do not take any medications without first consulting a gynecologist.
After the birth of the child, perform a comprehensive examination, which will allow you to identify pathologies that can cause seizures in the early stages and successfully treat them.

That's all: all that remains is to say that the seizures themselves do not pose a danger: they are only a symptom of some disease, but what kind of disease it is and what the risk is for the child, you will only find out by contacting a specialist: do not delay the visit!

It often happens that a newborn baby experiences colic. They may be caused for various reasons, which are both external and internal (here we mean developmental pathologies). Often similar conditions appear in infants who, for some reason, were not born full-term, suffered a birth injury or infection. The peculiarity of the development of the brain of newborns distinguishes the seizures characteristic of it from a similar symptom in adults or older children. The immature nervous system, as well as its sensitivity to all external and internal factors fully explains the fact that newborn children often experience involuntary muscle movements. However, it can be difficult to recognize whether they are seizures. In the first months of life, young parents may observe their child's muscle tremors, tremor, and involuntary movements of the upper/lower limbs. In some cases, even an electroencephalogram cannot detect any changes in brain activity.

What are the types of seizures?

Cramps are involuntary muscle contractions. In newborns, such contractions may have different manifestations depending on the reasons for their occurrence. Medicine knows the following types of seizures in infants:

Small - represent small twitching of the limbs, trembling in the eyelids, facial muscles, frequent blinking. If this type of seizure continues for a long time, then this should lead parents to think about the presence of pathologies in the development of the nervous system.
Clonic - represent contractions of one group of muscles of a rhythmic nature.
Tonic neonatal - represent tension in all muscles, in which the baby’s body takes a shape resembling a bow (the head is thrown back). During such an attack, it is possible that breathing may stop for a short period of time.
Myoclonic - this type of seizures can most often be found in infants a little older.

Among other things, convulsions can differ according to the location of the contractions:

focal;
generalized (spread throughout the body);
multifocal.

Based on the high temperature, the seizures are called febrile. And if muscle contractions are observed in a baby when he is sleeping, then this is considered quite normal reaction on brain development.

If there are no other symptoms of pathology, then there is no reason to worry.

Causes of seizures in newborns

Based on the anatomical and physiological characteristics, the appearance of seizures in newborns can be triggered by various reasons. The main causes of seizures in newborns are the following:

The presence of pathologies in the development of the central nervous system:
- trauma received during childbirth (cerebral edema, intracranial hemorrhage);
- unstable intracranial pressure;
- malformations in the development of the brain (microcephaly, hydrocephalus, etc.);
- with asphyxia in the fetus, the appearance of oxygen starvation of the brain.
Metabolic disorders:
- lack of calcium in the blood;
- decreased blood glucose levels;
- lack of magic;
- the presence of water intoxication, which is accompanied by a decrease in sodium;
- increased levels of sodium in the blood;
- vitamin B6 deficiency;
- abnormalities in amino acid metabolism (proline, tyrosine, valine, glycine, etc.) of the congenital type.
Influence of external negative factors:
- encephalitis;
- rubella;
- purulent meningitis;
- tetanus;
- listeriosis;
- therapy with certain antibiotics/hormones on steroids;
- toxoplasmosis;
- heat;
- excessive swaddling, which causes overheating of the baby’s body.

Some babies experience sharp involuntary muscle contractions that vary in frequency and duration. Convulsions in newborns are not always a sign of severe pathology, but the symptom cannot be ignored.

The movements of newborns are quite uncoordinated and often resemble tremors, shaking and muscle spasms. Sometimes only a specialist can distinguish the norm from the manifestations of alarming symptoms. In any case, if you notice any alarming movements in your child, you should immediately contact your pediatrician.

There are several types of true seizures in infants:

Small, characterized by weak but prolonged muscle twitching of the face and limbs and often accompanied by a slight blue discoloration of the skin.
Tonic, manifested in the form of the newborn adopting a tense posture with the head thrown back and long delay breathing. Most often found in premature babies.
Clonic, observed only in full-term babies and accompanied by pronounced rhythmic contractions of certain parts of the body.
Myoclonic, characterized by pronounced sharp twitching of the entire body or limbs.

Causes of seizures in newborns

Metabolic disorders due to hypoglycemia (low blood sugar levels) and hypocalcemia (acute lack of calcium in the body), which is often found in premature babies. The condition is dangerous with irreversible consequences for the child’s central nervous system.
Ischemic encephalopathy, which is a direct consequence of oxygen deprivation of the baby's brain during difficult labor and complications during pregnancy (for example, in the case of preeclampsia and eclampsia).
Immaturity of the nervous system in premature infants, not accompanied by pathological changes cerebral vessels.
CNS infections. Often the cause of brain damage is encephalitis, meningitis, rubella, cytomegalovirus infection, acute toxoplasmosis.
Disruption of the adrenal glands, leading to excess production of norepinephrine, which is responsible for muscle spasms and uncontrollable twitching.
Damage to cerebral vessels resulting from hemorrhages in premature infants.
Violation of the thermal regime or increase in body temperature during the period of illness. Overheating of a child in the first days of life often leads to seizures. They do not pose a danger and disappear without a trace after the root cause is eliminated.
Intoxication due to hemolytic jaundice of newborns.

Convulsions in newborns do not always occur in all of the above situations. However, the following factors contribute to their occurrence:

prematurity;
severe illness of the mother during pregnancy;
woman drinking alcohol narcotic drugs and prohibited drugs;
protracted labor with various complications;
weak labor activity, long waterless period;
asphyxia as a result of entanglement with the umbilical cord and birth trauma;
placental insufficiency.

Parents' actions during an attack

It is impossible to ignore even minor manifestations of convulsive syndrome; this can not only lead to irreversible consequences for the central nervous system, but also have a serious threat to the child’s life. Parents should immediately consult a doctor to determine all the causes, seizures, muscle spasms and their timely elimination.

If the attack began suddenly and was accompanied by severe muscle spasms, breathing problems, rolling eyeballs and drooling, you need to call an ambulance. Before doctors arrive, you should:

place the child on a level surface hard surface, turning your head to the side;
place a clean handkerchief or rolled gauze between the baby’s teeth;
remove excess clothing (if the air temperature allows, undress the child down to the diaper);
open the window to provide fresh air;
if necessary, give the baby artificial respiration;
if the seizures are caused high temperature body, wipe the newborn's body with a damp sponge (vinegar, alcohol and other irritating liquids are prohibited).

The newborn is usually immediately placed in a hospital (intensive care unit or general ward of the neurological department, depending on the severity of the condition), where they are first excluded dangerous infections, epilepsy and irreversible organic brain damage. A thorough examination includes conducting the necessary laboratory tests and instrumental studies, studying the birth history and anamnesis of the mother and immediate family.

Depending on the results obtained, therapy includes the following actions:

treatment with antibiotics in case of acute infections;
elimination of fever and normalization of body temperature;
intravenous administration of glucose for hypoglycemia or calcium gluconate for hypocalcemia;
drug reduction of bilirubin levels in the blood;
hormonal treatment in case of endocrine disorders;
artificial ventilation in case of respiratory arrest and disturbances;
in most cases, the prescription of anti-seizure drugs.

Primary treatment of convulsive syndrome in a child usually includes the use of barbiturates, which have pronounced antispasmodic, anticonvulsant, sedative and hypnotic effects. As a rule, in the absence of serious illnesses, treatment lasts several days, and the manifestations of the pathology disappear without consequences. Persisting symptoms warrant the prescription of more serious drugs(pyridoxine, folinic acid, clonazepam, etc.), sometimes the question of advisability is raised surgical intervention. After discharge from the hospital, the child is registered with a neurologist at his place of residence.

Prevention of seizures

In order to prevent recurrent seizures, the following preventive actions must be taken:

Completely follow the recommendations of the neurologist and pediatrician, give prescribed medications, carry out prescribed manipulations;
Walk with your baby in the fresh air more often;
Give your child a relaxing massage and daily exercises;
Carry out hardening in the absence of contraindications;
Bathe your child daily in water with the addition of sea salt;
Maintain a strict daily routine;
Maintain a calm, favorable environment at home, avoid stress;
Observe the condition of the baby throughout the day.

Disease prognosis

Unfortunately, due to the inability to accurately, quickly and reliably diagnose pathology in newborns, about one third of cases result in death. Another third of children develop severe consequences from the central nervous system. The prognosis is especially unfavorable in the case of hemorrhages and organic brain damage due to infections and birth injuries.

In many children, convulsive syndrome passes easily and without a trace. This depends on the etiology of the disease, the degree of term of the baby and the time of initiation of competent treatment from the moment of the first attack. It is important for parents to remember: the health and life of the baby does not depend on their actions.

Video of baby seizures

In the first days of life, a baby (even a child under five years old) can often experience seizures. Sometimes spasms indicate the presence of serious pathologies in a child under one year old. Let's consider the most typical causes up to a year of life, signs and possible methods of treatment.

In children under one year of age, in older children (up to three and five years old), seizures show a different character. The latter is associated with the peculiarities of the functioning of the brain and nervous system (the nervous system of newborn children is at the stage of formation). Doctors divide seizures up to three years into a number of types.

Is it possible to independently determine the nature of seizures in a newborn and a child under three years of age?

The manifestations of seizures in children under one year of age are ambiguous and differ in a particular case. Parents will not be able to independently determine the nature of a seizure in a child without medical help, relying solely on their own experience or on information gleaned from medical sources. Not in every case, rhythmic muscle twitching is considered a seizure.

Seizures in a newborn and a child under three years of age are determined exclusively in a hospital setting. Doctors use the latest diagnostic methods, in particular electroencephalography and magnetic resonance imaging. In the presence of small seizures, it is difficult to observe the dynamics of changes in brain activity.

It often happens that seizures do not respond to anti-epileptic drugs. The latter means that the previous diagnosis was made inaccurately, the child needs to be re-diagnosed.

Causes of neonatal seizures

There are many reasons for seizures in young children. Let's look at the common and typical ones.

Metabolic disorders of various etiologies. These primarily include hypoglycemia and hyponatremia. With hypoglycemia, there is a decrease in the amount of sugar in the blood. The condition often leads to seizures in the child. Remain attentive to the child’s condition; in some cases, hypoglycemia leads to irreversible consequences in the cerebral cortex. Low calcium levels in the blood (hypocalcemia) also negatively affect the functioning of the brain and lead to seizures.
Encephalopathy. Brain damage is manifested by acute or chronic lack of oxygen in the blood.
Meningitis and encephalitis pose a huge danger to the newborn’s brain and are considered a serious cause of seizures.
Damage to the blood vessels of the brain, often found in premature infants. Threatens cerebral hemorrhages.
Insufficiency of magnesium or pyridoxine (vitamin B6) in the child’s body. Often pathologies develop simultaneously.
Birth injury.
Congenital brain defects in children.
When treated with psychoactive drugs, seizures occur as a withdrawal syndrome.

Symptoms of seizures in children of the first year of life

Conditions that cause seizures in newborns are often life-threatening. There are cases where children with convulsions in the neonatal period subsequently developed without any special complications. If seizures occurred due to low glucose levels in the baby’s blood, the child also did not develop complications in the future. If the spasms occurred as a result of meningitis, a high risk of developing all kinds of neurological complications is subsequently revealed.

If there is a recurrence of convulsive seizures, they speak of convulsive status. Breathing disturbances occur with symptoms of hypoxic cerebral edema. When edema spreads to the brain stem, a disorder of the respiratory, vasomotor center, pathological breathing, vomiting, increased temperature (even up to 39 degrees), bradycardia, and collapse occurs.

A generalized tonic-clonic seizure develops suddenly. Disturbing motor excitement, depression of consciousness up to loss. Characterized by tilting the head back, bending the arms at the elbow joints, straightening the legs, and tense the face. Possible apnea (stopping breathing), the face becomes pale and blue. Vomiting is observed. Holding your breath lasts no more than a minute. After the end of the seizure, the body is completely restored, and the same happens with consciousness. The child does not remember what is happening at all. The prognosis noticeably worsens if paresis or paralysis is observed along with convulsions.

Often, infants experience short-term generalized tonic-clonic seizures. They are typical in children under one year of age, but can occur in older children. It happens against the background of a rise in body temperature. The duration of convulsions is no more than three to five minutes. The prognosis is favorable, not accompanied by neurological disorders. The nervous and mental health of children does not suffer, does not lag behind, and is completely appropriate for their age.

With a lack of calcium in the blood, tetanic convulsions and attacks of sudden respiratory arrest occur. Specific symptoms are noticeable:

Contraction of the orbicularis oculi muscle;
Contraction of the angularis oris muscle;
Abduction of the foot when tapping the forearm or shoulder;
Laryngospasm.
Vomit.

The child bends his arms at the elbow joints and is unable to straighten them. The hands move down and take on the characteristic appearance of “obstetrician’s hands.”

The main principles of treating seizures in infants

Successful treatment of any seizure in a newborn becomes such once the cause is discovered. General rules for the treatment of convulsive conditions in children:

If hypocalcemia is the cause of a convulsive state, the child is given a solution of calcium gluconate in a glucose solution (slowly and intravenously).
For hypomagnesemia (magnesium deficiency), a solution of magnesium sulfate is injected intramuscularly.
In case of hypoglycemia, a dextrose solution is first administered, then a glucose solution is administered in a stream and intravenously. It is necessary to monitor temperature and vomiting.
The first step is to effectively relieve fever.

Newborns diagnosed with seizures are admitted to the intensive care unit. The nurse's job is to carefully monitor the baby's condition. An electroencephalogram is also performed there to determine the state of the brain and the functioning of the organ. Based on electroencephalography indications, therapy adjustment is recommended.

In case of respiratory failure, loss of consciousness, fever and periodic vomiting, it is recommended to maintain artificial ventilation of the lungs and blood pressure. Pressure is maintained using special medications. It is necessary to constantly stop convulsive paroxysm due to the considerable danger to the heart. Respiratory disorders and persistent impairment of consciousness are absolute indications for urgent etiotropic therapy combined with symptomatic anticonvulsant treatment.

Due to the fact that in the neonatal period of a child’s development (especially at the age of several months) it is difficult to detect the true cause of the development of an epileptic seizure, a third of children die. Death is associated with severe complications of seizures: ischemic encephalopathy, ischemic stroke. The prognosis for meningococcal infection is extremely poor. When caused by metabolic disorders, seizure syndromes usually have a good prognosis.

Convulsions in newborns are recognized as the object of close attention of parents and doctors. It is extremely important to immediately determine the cause of seizures in order to begin effective treatment. And although certain types of seizures do not have a very favorable prognosis, they can be treated effectively. Especially if the parents consulted a doctor at an early stage of the disease.

Frequency. Approximate incidence of clinically visible seizures:

0.7-2.7/1000 newborns.
57.2-132/1000 newborns with weight< 1500 г.
90% of these cases occur in the first 2 days of life.

Causes and risk factors for cerebral seizures in newborns

Ischemia, hypoxia, shock.

Intracranial hemorrhage.

Infections, meningitis, sepsis, congenital infections.

Brain infarction.

Metabolic disorders:

Rule out hypoglycemia, hypocalcemia, hypomagnesemia, hyper- or hyponatremia.
Amino acid metabolism disorders, peroxisomal disorders.
Acute neurological disorders (convulsions, impaired consciousness, vomiting, muscle hypotension and paresis).

Familial neonatal seizures.

Drug withdrawal syndrome.

Theophylline overdose.

Diabetes mellitus in the mother.

Attention: The etiology of more than 25% of seizures remains unclear. Approximately 30% of cases of seizures in full-term newborns and 50% of seizures in preterm infants are caused by perinatal complications.

Classification, symptoms and signs of cerebral seizures in newborns

Subtle seizures: the most common form of seizures in premature infants.

Persistent eye opening with a fixed position of the eyeballs (in premature infants) or tonic horizontal deviation of the eyeballs (in full-term infants), nystagmus, trembling or fluttering of the eyelids.
Sucking, smacking, drooling, grimacing, hiccups.
“Swimming”, “pedaling”, “rowing”.
Changes in skin color, blood pressure, heart rate and breathing rhythm, sudden deterioration in breathing, including during mechanical breathing.

Clinical seizures: slow (1-3 per second) rhythmic twitching of individual (focal) or multiple muscle groups that are not caused or suppressed by external stimuli.

Tonic spasms: prolonged contractions of muscle groups of the neck, trunk or limbs, focal or generalized

Myoclonic spasms: rapid short-term contractions of the flexors. There are focal, multifocal and generalized.

Attention: Any sudden change in clinical condition may be an attack of seizures, especially if they are repeated.

Differential diagnosis and diagnosis of cerebral seizures in newborns

Benign neonatal myoclonus; in a dream is not a seizure attack! Short myoclonus is characteristic, primarily during the phase of falling asleep, which can be interrupted.

Maternal history (eg, drugs, foods).

History of birth (asphyxia, trauma, intoxication due to the use of local anesthetics in the mother).

Thorough clinical examination.

Laboratory indicators:

Sodium, potassium, calcium, magnesium, chlorine, phosphate.
Glucose, blood gases, C-reactive protein.
Hematocrit, platelets, serum bilirubin.
Urea, creatinine, coagulogram, ammonium, liver enzymes.
General urine analysis.
Screening for TORCH (toxoplasma, rubella, CMV, herpes), better than PCR.
Amino acids in blood and urine, pyruvate, lactate, pyridoxal-5-phosphate, etc.
Vitamin B 12 in older infants and with an exclusively vegetarian diet for a nursing mother.
Blood cultures.
When the etiology of seizures is unclear and metabolic disorders are suspected.
Drug screening for maternal abuse.

Lumbar puncture (cytosis, protein, glucose, bacteriology and virology).

ECG: QT prolongation (hypocalcemia, less common with hypokalemia).

Cranial ultrasound.

Ophthalmological examination

EEG: if possible, baseline, treatment control, at discharge:

Standard EEG - to exclude epileptiform activity.
Amplitude-integrated EEG - for long-term monitoring in the intensive care unit. Focal low-amplitude and very short episodes of activity may go unrecognized.

Possible CT, MRI (subdural/epidural hemorrhage, malformation, venous sinus thrombosis).

Treatment of cerebral seizures in newborns

Ensuring adequate breathing, possibly respiratory support/ventilation, oxygen therapy.

ECG monitoring, blood pressure control.

Venous access.

Especially with repeated and prolonged convulsions, ensure sufficient glucose supply.

Antibacterial/antiviral therapy for suspected meningoencephalitis.

Tension hydrocephalus: relief by puncture or shunt.

If SNA ADH is suspected: Consider limiting fluid intake (70% of normal).

Beware dilution hyponatremia.

Beware decreased perfusion pressure due to hypovolemia.

For hypoglycemia:

0.5 g/kg glucose.
Then a long-term infusion of glucose 8(-16) mg/kg/min.

For hypocalcemia: 0.5 mmol/kg = 2.2 ml/kg 10% calcium gluconate over 10 minutes intravenously.

For hypomagnesemia: 0.3 mmol/kg = 1 ml/kg 10% magnesium aspartate (for example, 10% magnesiocard) intravenously slowly.

First of all, in mature newborns - pyridoxine 100 mg IV.

Anticonvulsants

The main question of “whether seizures lead to additional brain damage” has not yet been fully resolved.

Lombroso/Freeman: no additional damage, no changes in vital parameters.

Volpe/Gluckman: Repeated neonatal seizures cause brain damage. Therefore, treat all clinical seizures immediately.

Study of the effect of seizures on animals:

Increased susceptibility to seizures later in life.
Structural changes in the limbic system.
Limited ability to learn and recognize.

In children, during seizures, increased cerebral blood flow is observed after seizures, and the neurological outcome worsens.

Extremely variable individual pharmacokinetics.

Preferably frequent use due to less fluctuation in blood concentrations and lower risk of toxicity.

The goal of anticonvulsant therapy is to interrupt clinically manifested seizures, not every seizure activity.

Current Cochrane reviews indicate that the evidence base for the use of all anticonvulsants in newborns is small. The following approach is proposed:

Primary treatment for seizures:

Phenobarbital (Luminal):

The half-life depends on the duration of treatment: 2 weeks - 103 hours, 3 weeks - 65 hours, 4 weeks - 45 hours.
Side effects: hypotension, apnea.
50-70% of seizures are treatable with phenobarbital.

Phenytoin (fengidan):

The initial dose is 5-10 mg/kg over 10-15 minutes intravenously slowly or as a short infusion.
Repeat after 5-10 minutes.
The maintenance dose is 3-5 mg/kg per day intravenously or later orally in two divided doses.
The half-life varies (premature 75±65 hours, full-term 21±11 hours), so monitoring of blood concentrations is necessary.
Side effects: AV block, bradycardia, hypotension, ECG monitoring! Treatment is atropine 20 mcg/kg intravenously. Bleeding tendency (vitamin K), vitamin D deficiency, vomiting.

Attention: before and after administration of the drug, the catheter must be rinsed with 0.9% NaCl. For prolonged infusion, use a separate access! Maximum speed infusion 1 mg/kg/min.

Caution: Paravasal administration leads to severe tissue necrosis!

If cramps persist: elimination of pyridoxine deficiency, pyridoxal-5-phosphate or folin dependence.

Pyridoxine for vitamin B 6-dependent seizures:

The initial dose is 100 mg IV bolus; if there is no response, further IV administration is possible every 5-10 minutes. 100 mg each up to a maximum total dose of 500 mg.

Pyridoxine should be administered to newborns for all unclear or persistent seizures.

Lumbar puncture, if possible, before pyridoxine administration.

When responding to vitamin B 6, determination of glutamate, GABA and pyridoxal-5-phosphate in a previously collected portion of cerebrospinal fluid (follow the recruitment rules). Additionally, determine pyridoxal-5-phosphate in erythrocytes.

Maintenance dose: replacement of vitamin B 6 15-30 mg/kg per day orally until an effect is obtained or for several weeks until the absence of a therapeutic effect is verified.

If response to vitamin B6 occurs, discontinue other anticonvulsants.

If there is no effect:

Pyridoxal-5-phosphate (n-5-ph) with pyridoxal phosphate-dependent seizures. In this recently described condition, seizures are not relieved by administration of vitamin B6. The leading symptoms may be: lactic acidosis. signs of birth asphyxia, increased glycine and threonine. Initial dose: pyridoxal-5-phosphate 30 mg/kg per day for three administrations, the effect appears within 3-7 days. Dose for long-term therapy: 30-50 mg/kg per day in 3-5 divided doses. If there is no effect:

Folinic acid. Dose 3-5 mg/kg intravenously (single dose) for 3 days. Sometimes used in combination with n-5-ф. If effective, lifelong oral administration is required.

Carefully: apnea is possible after IV administration of pyridoxine!

If vitamin B6, its metabolites and folinic acid are ineffective Has the maximum therapeutic blood level of phenobarbital or phenytoin really been reached (check concentration)?

Phenobarbital and phenytoin are recognized as first- and second-line drugs. Supplementation with pyridoxine, n-5-P, and folinic acid may help, despite the rarity of seizures dependent on them. There is no consensus on which anticonvulsants and in what order to use next for persistent seizures. The following drugs can be used:

Clonazepam (rivotril).

Half-life: 20-43 hours.
Therapeutic level in blood serum: 20-40(-60) mcg/ml, however, the relationship between concentration and effect has not been reliably confirmed.
Side effects: increased salivation, injection solution contains alcohol.

Lorazepam (tavor):

The initial and maintenance dose is 0.05 mg/kg over 2-5 minutes IV, which can be repeated.
It acts longer than diazepam and does not accumulate; it depresses breathing less.
Side effects: myoclonus and stereotypic movement patterns (described in selected preterm infants).

Diazepam (Diazemuls).

Diazepam is used less and less because it has no advantages over phenobarbital: the anticonvulsant effect is short and the half-life is long.

Beware of respiratory depression!

External: Valium cannot be used because it contains sodium benzoate, which displaces bilirubin from its connection with albumin!

Midazolam (dormicum).

Initial dose of 0.1-0.15 mg/kg over 10 minutes intravenously, can be repeated.
- Maintenance dose 0.1(-0.4) mg/kg/day.

Carefully: By-effect: may cause seizures (more common in premature infants, especially with rapid administration). Therefore, it is administered slowly under close supervision.

Lidocaine:

Used only for seizures refractory to other treatment.

Although new anticonvulsants (levetiracetam or topiramate) have already been used in term and preterm infants, little experience with use does not yet allow general recommendations.

Duration of treatment

Individual, since there is no proven data on the required duration of treatment.

If possible, not for long; depending on the etiology, EEG findings and observation data.

In case of convulsions in premature infants in the first day of life and with an unclear etiology, medications can be stopped quickly, within several days after the convulsions.

Forecast

Depends on the etiology, to a lesser extent on the degree of immaturity of the child. Children who benefit from one drug usually have fewer problems and best forecast compared to children requiring multiple medications.

Even experienced doctors should not give a prognosis.

Attention: Prepare well for the conversation with parents, involve experienced colleagues! It is important to provide truthful information based on verified facts.