CONVULSIONS OR FITS

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Causes

The commonest causes of neonatal convulsions include:

  • Hypoxic ischaemic encephalopathy (as a result of perinatal asphyxia)
  • Central nervous system infection
  • Hypoglycaemia
  • Hypocalcaemia

Non-pharmacological and pharmacological treatment

Management of the neonate or young infant who is having a fit:

  • Manage the airway and breathing
  • Ensure circulatory access
  • If hypoglycaemic, give glucose IV or nasogastrically (2 ml/kg of 10% glucose).
  • If blood glucose cannot be measured, give empirical treatment with glucose.
  • Treat convulsions with phenobarbital (loading dose 20 mg/kg IV).
  • If convulsions persist, give further doses of phenobarbital 10 mg/kg up to a maximum of 40 mg/kg.
  • Watch for apnoea. Always have a bag-mask available.
  • If needed, continue phenobarbital at a maintenance dose of 5 mg/kg per day.
  • If hypocalcaemia, symptoms may settle if the infant is given 2 ml/kg of 10% calcium gluconate as a slow IV infusion, and continue with oral supplementation.
  • Rule out central nervous system infection. Treat if present