Neonatal convulsions

Specialties NICU

Published

I was caring for a 26 weeker babe who looked unwell this morning ,the night nurse told me he had frequent desat during night ,he was on nasal oxygen. even I increased the o2 he was not good. he developed severe skin mottling and I observed jerky movements involving both upper and lower limbs with tachycardia.when I alerted the doc she told it is not convulsion but jerks only.his electrolytes were normal blood sugar normal,now I am doubtful what a convulsion is ?How many seconds should it exceed? CRP was sent and it was negative also.finally baby was ventilated.

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Specializes in Pediatrics Only.

I'm no NICU nurse..

But a 26 weeker that was only on oxygen? What 26 weeker could breathe on their own? Shouldnt he have been immediately intubated or at least CPAP?

Wouldnt the desats and mottling indicate lack of oxygen and that the baby was in destress requiring immediate intubation?

As for the jerking, I think it would just be the immature nervous system, no?

Perhaps an experienced NICU nurse will come along and help us out..

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Specializes in Neonatal ICU (Cardiothoracic).

Some 26 weekers do just fine on NCO2....

It could have been seizures. What did his fontanelles feel like? Did they do a head ultrasound to r/o IVH? Did you see a sudden unexplained drop in his hgb/hct?

Most cases of seizures in micropreemies in my experience have been due to a new or expanding head bleed. You can assess whether they are true seizures or just neurological immaturity by gently restraining the baby's arms and legs in the fetal position. The jerking motions will usually stop if it's just neuro immaturity.

If they don't stop, we would probably start an EEG and load with phenobarbital (after a HUS, labs, physical exam) and if it didn't control them, ativan and Cerebyx. Neuro consult would be ordered in the am.

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Specializes in NICU.

Many of our 26-weekers aren't intubated, as they do fine on NCPAP or HFNC.

As far as seizure activity, we would have done like Steve explained .... gotten a HUS to r/o a bleed and then gone from there (EEG, started anticonvulsants, neuro consult, etc).

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