High-Risk Newborns

- Seizures

Neonatal seizures are serious neurological events caused by abnormal electrical activity in the brain. They appear as involuntary muscle contractions, which may affect one part of the body or the entire body. Sometimes, seizures may manifest as altered consciousness or autonomic dysfunction.

Types of Neonatal Seizures:

Type	Characteristics
Subtle Seizures	Mild, barely noticeable movements like eye deviation, chewing motions, or repetitive limb movements
Clonic Seizures	Rhythmic jerking movements of limbs or face
Tonic Seizures	Sustained muscle contractions, affecting either a single limb or the whole body
Myoclonic Seizures	Rapid, isolated jerks of the upper or lower limbs

Causes of Neonatal Seizures:

Common Causes:

• Birth asphyxia
• Intracranial hemorrhage due to birth trauma (forceps/vacuum extraction)
• Meningitis
• Neonatal sepsis
• Hypoglycemia, hypocalcemia, or hypomagnesemia

Less Common Causes:

• Congenital brain anomalies
• Severe jaundice (kernicterus)
• Electrolyte imbalances (sodium disturbances)
• Metabolic disorders
• Neonatal tetanus (due to umbilical cord contamination)
• Maternal drug use during pregnancy

Symptoms of Neonatal Seizures:

• Persistent limb jerking (not stopping with restraint)
• Repetitive limb movements (cycling/swimming motions)
• Eye deviation
• Chewing or sucking movements
• Brief apnea with tachycardia

Required Laboratory and Diagnostic Investigations

Initial Laboratory Tests:

• Blood glucose level

• Serum calcium, sodium, and magnesium levels

• Arterial blood gases

• Complete blood count (CBC)

• Blood culture and cerebrospinal fluid (CSF) culture

Additional Investigations:

• Electroencephalogram (EEG)

• Cranial ultrasound

• Brain CT scan and MRI

• Metabolic screening

• TORCH screening (infectious diseases during pregnancy)

Nursing Assessment of the Case

1. Medical History
The following information must be obtained:

1. Gestational age (intrauterine age).
2. Family history of neurological disorders or consanguineous marriage.
3. History of intellectual disability in siblings or neonatal death.
4. Maternal infections during pregnancy, diabetes, or abnormal fetal movements during gestation.
5. Abnormal neonatal findings at birth, such as reduced activity.
6. Mode of delivery and use of instruments (e.g., forceps).
7. Neonatal resuscitation status at birth, such as Apgar score at 1 and 5 minutes.

2. Physical Examination of the Infant

1. Presence of congenital malformations or anomalies.
2. Bulging of the anterior fontanelle.
3. Level of consciousness and activity.
4. Muscle tone, presence of hypotonia or hypertonia.
5. Observation of seizures: involuntary movements of part or all of the body.
6. Hepatomegaly or splenomegaly.
7. Abnormal skin pigmentation.

Nursing Care During Seizures
When seizures occur, immediate action is required:

1. Ensure the airway is clear of obstructions.
2. Suction the mouth and airway between seizures, not during the episode.
3. Provide oxygen therapy.
4. Check blood glucose level; if unavailable, administer 10% glucose IV over 1 minute at a dose of 2 ml/kg according to body weight.
5. Call the physician immediately.
6. Administer anticonvulsant medications such as phenobarbitone as prescribed.
7. Document seizure activity in the child’s medical record, including type, duration, heart rate, respiratory rate, medications administered, and nursing interventions performed.

Follow-up Care

8. Monitor vital signs (pulse, respiration, blood pressure, temperature).
9. Maintain normal body temperature.
10. Assess tissue perfusion by capillary refill time.
11. Monitor blood glucose levels.
12. Ensure IV cannula remains patent and functional.
13. Keep emergency equipment at bedside (oxygen source, Ambu-bag, laryngoscope, endotracheal tubes, suction machine, emergency drugs).