Neonatal seizure symptoms are often atypical, rarely presenting with generalized convulsions. They may sometimes appear mild and difficult to recognize, commonly seen in neonatal asphyxia, intracranial hemorrhage, meningitis, metabolic disorders (hypoglycemia, hypocalcemia, hyponatremia, vitamin B6 deficiency or dependency, amino acid metabolism abnormalities, etc.), and withdrawal syndrome.

bubble_chart Auxiliary Examination

In addition to routine examinations, focus on the following items based on the condition.

1. Hemoglobin and hematocrit: In polycythemia, hemoglobin >220g/L and hematocrit >65%.
2. Cerebrospinal fluid: Note the appearance for turbidity or blood. Cerebrospinal fluid cell count, protein, and glucose quantification are significant.
3. Blood generation and transformation: Measure blood glucose, calcium, phosphorus, magnesium, sodium, potassium, chloride, etc., and screen for congenital amino acid metabolism disorders.
4. Others: Fundus examination, cranial transillumination, electroencephalogram, skull X-ray, cranial ultrasound, and CT scan.

bubble_chart Diagnosis

(1) Medical History Inquire about childbirth history, maternal medication use, and family history. Pay attention to any history of asphyxia, birth trauma, premature rupture of membranes, and infections.

(2) Symptoms and Signs During a comprehensive physical examination, observe for signs such as bulging fontanels, abnormal pupils, facial nerve paralysis, and hemiplegia. Closely monitor general condition, crying, skin, and respiration. Seizures may manifest in the following types:

1. Subtle seizures: Facial muscle twitching, eye deviation, tremors, blinking, sucking and chewing movements, apnea, etc. These are the main manifestations of neonatal seizures. Symptoms may not correlate with disease severity.
2. Multifocal clonic seizures: May occur in several limbs, presenting as migratory episodes, starting in one limb and spreading to others.
3. Focal clonic seizures: May occur in any part of the body, presenting as clonic twitching.
4. Tonic seizures: May present as opisthotonos or localized episodes.
5. Episodic hypotonia: Accompanied by pale complexion and upward eye deviation.

(3) Disease Causes and Diagnosis

1. Age in days: - Onset within 4 days after birth is primarily due to birth trauma, hypoxia, intracranial hemorrhage, or hypoglycemia. - Onset between 5–8 days is often associated with metabolic disorders or hypocalcemia. - Onset after 8 days is usually caused by infections or toxic encephalopathy.
2. Seizure types: - In cases of organic brain injury, generalized tonic seizures, apnea, and spasms of head and facial muscles are common. - Hypoglycemia and hypocalcemia often present with localized limb spasms or clonic spasms.
3. Neurological symptoms: - Increased intracranial pressure, bloody or xanthochromic cerebrospinal fluid, leukocytosis, and positive meningeal irritation signs often indicate intracranial hemorrhage or central nervous system infections. - Hypotonia and medullary dysfunction (e.g., absent cough or sucking reflexes) suggest organic brain injury.

bubble_chart Treatment Measures

1. Control of convulsions: Phenobarbital and diazepam are commonly used anticonvulsants. Phenobarbital is administered at 10–15 mg/kg per dose via slow intravenous injection or intramuscular injection. The maintenance dose is 5–7 mg/kg orally per day. For persistent convulsions, diazepam at 0.1–0.3 mg/kg may be given intravenously, but its half-life is approximately 15 minutes, limiting its effectiveness. For prolonged convulsions, phenytoin sodium at 10–15 mg/kg may also be administered intravenously, with a daily maintenance dose of 3–8 mg/kg. Drug blood concentration monitoring is recommended.
2. Disease cause treatment: Address the underlying condition, such as immediate intravenous glucose infusion for hypoglycemia or calcium supplementation for hypocalcemia. Convulsions caused by metabolic disorders respond best to treatment. Prognosis for convulsions due to intracranial hemorrhage or infection varies depending on the severity, while brain malformations or inherited metabolic disorders have a poor prognosis and require long-term follow-up.
3. Symptomatic management: Ensure suctioning of secretions and maintain airway patency. Administer oxygen for cyanosis; for frequent apnea or spasms, continuous or intermittent positive pressure oxygen (CPAP or IP-PV) may be used. For severe cerebral hypoxia with brain edema, dexamethasone at 1 mg/kg per day may be given, with 20% mannitol for dehydration if necessary. To improve cerebral metabolism and promote brain cell recovery, administer coenzyme A, ATP, cytochrome C, γ-aminobutyric acid, and vitamins B and C.