Neonatal Seizures: All You Need To Know About Convulsions

Whenever any parent hears that their baby is having convulsions or seizures the parents' first reaction is isn't the baby too young can the baby get convulsions at this age? Is the baby going to survive? If they do are they going to be normal? Will they develop epilepsy? Dr Kishore Kumar, Neonatologist and Pediatrician, Cloudnine Group of Hospitals, Bengalurushares that all these are common questions a parent comes across in their minds some express it, and some suffer silently. Neonatal convulsions are abnormal movements or portions of the body - due to abnormal activity in the brain. They are relatively rare, affecting 1 in 1000 live birth babies. Neonatal Convulsions Or Seizures The fact of life is that neonatal convulsions or seizures are most often preventable. Here is the rule Prevention is better than cure. Newborn brain is developing too fast their brain size (measured by head circumference is 35 cm at birth, and by two years of age, it is usually around 50 cm.) Adult head size is generally about 54 to 55 cm. It means that >90% of brain growth happens in the first two years so a newborn's brain is susceptible to many insults which can and should be prevented. Convulsions In A Newborn The convulsions in a newborn baby can either be "obvious" or "subtle" which can easily be missed if the observant is not experienced enough. The convulsions need to be treated. The development of the baby needs to be monitored. Generally, treating the underlying cause is enough in most cases - like oxygen for hypoxia, calcium supplementation for hypocalcaemia, and sugar for hypoglycaemia - but sometimes, if the cause is unknown or if the baby is getting repeated convulsions - we do use anti-convulsant meds - as required for few months. Most convulsions on the first day of life are due to either lack of adequate oxygen to the brain called asphyxia or due to birth injuries causing significant swelling of the brain. Sometimes they could be due to malformations or deformations of the brain too. Second-day convulsions are usually due to imbalances of some electrical chemicals like low calcium, low magnesium, low sugar and other abnormalities that, if corrected, settle down. 3rd-day convulsions are usually thought to be sinister meaning metabolic due to problems in digesting the food, either carbohydrates or proteins or fats and the metabolites of these food items form toxic molecules causing the convulsions, usually due to brain swelling. Identification of this is crucial as the damage occurs by every hour and this is where Newborn Screening for metabolic disorders is critical. 4th day convulsions can generally be due to genetic predisposition or any of the above factors. 5th-day convulsions traditionally have been called "due to unknown factors," but lately, we have found a deficiency of Biotin could be a causative factor. Subtle convulsions are sometimes difficult to pinpoint or diagnose and could be easily missed by new staff who are inexperienced. They could manifest as unusual cries, movements or unusual behaviour, sometimes just cycling movements of arms or legs, or both. Tests To Detect Neonatal Convulsions Blood tests for electrolytes, Calcium, and Magnesium, metabolic screening, and sometimes brain wave activity test, EEG and scans like MRI Brain Prompt diagnosis of the cause of convulsions is essential for effective treatment to prevent lifelong damage. If no reason is found, we can screen for any genetic cause by doing genomic studies for disruptions. Overall, the prognosis for convulsions in the newborn is reasonable, provided their cause is identified and rectified immediately. The longer it takes to determine the reason, the greater the damage to the brain.