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Clinical analysis of 78 cases of neonatal convulsions_1466

By Christopher Thomas,2014-10-30 14:17
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Clinical analysis of 78 cases of neonatal convulsions_1466

Clinical analysis of 78 cases of neonatal convulsions

     Key Words convulsions

     Neonatal convulsions caused by a variety of diseases, nervous system symptoms, causes complex and a high fatality rate. Neonatal seizures affect brain development can

    produce neurological sequelae [1]. In order to clear the cause of early and effective

    ta analysis is as

    follows.

     A clinical data

     1.1 General Information

     220 cases hospitalized neonates, of which 78 cases of neonatal seizures accounted for 35.5%, male 45 cases, female 33 cases. 1 ~ 3 d after birth, seizures in 44 cases, 4 ~ 7 d 20

    Li, 8 ~ 14 d 9 Li, ? 15 d 5 Li. Childbirth: The 62 cases of full-term infants, premature

    infants in 12 cases, overdue child of 4 cases; Shun produced 58 cases, 3 cases of breech births, the fetal head to attract middle class in 13 cases, Caesarean section in 4 cases.

    Bruising of birth asphyxia in 15 cases, eight cases of suffocation pale.

     1.2 types of seizures

     Micro and small seizures in this group, 46 cases of tonic-type 15 cases, multiple foci

    clonic type in 9 cases, 5 cases of limited Agency clonic type, generalized myoclonic three cases; 5 cases occurred more than two kinds of attack types.

     Incidence of 1.3 causes convulsions

     Hypoxic-ischemic encephalopathy (HIE) 34 cases of intracranial hemorrhage in 20 cases, hypocalcemia 7 cases, 3 cases of hypoglycemia, hyponatremia in 2 cases, 1 case of hypernatremia, hypomagnesemia 1 cases , nuclear jaundice in 2 cases, 2 cases of purulent meningitis, sepsis in 3 cases, vitamin B6 deficiency in 1 case, congenital brain dysplasia in 1 case, for unknown reasons in 1 case.

     1.4 EEG Results

     Were performed 34 d after birth, such an examination abnormalities in 41 cases, accounting for 52.6%. The major manifestations of mild reduction and sharp wave EEG activity in 32 cases (78.0%), moderate reduction of brain electrical activity and multi-foci sharp waves, burst suppression waves in 6 cases (14.6%), severe illness, repeated myoclonic 3 cases (7.3%).

     1.5 head CT results

     Normal in 19 cases, 59 cases of abnormal, of which 34 patients had mild, moderate

    and severe changes in hypoxic-ischemic encephalopathy, 48 patients had cerebral

    edema, 14 cases of subarachnoid hemorrhage, two cases of subdural hemorrhage, 4 cases intraventricular hemorrhage.

     2 Treatment and prognosis

     2.1 General treatment

     To maintain airway patency, timely removal of throat secretions, head to one side to prevent inhalation of vomit asphyxiation, and to be oxygen, anti-convulsion. Reposted

    elsewhere in the paper for free download http://

     2.2 Now just scared

     Drug only shock: the preferred phenobarbital sodium, load 20 ~ 30 mg / kg, for the first time 10 ~ 15 mg / kg intravenously. 15 min does not control, such as convulsions, each 5 mg / kg repeat interval 5 ~ 10 min to maintain the seizure and control over the amount of change, such as the load capacity of 30 mg / kg has not only scared, plus with the stability and phenytoin. Stability for each 0.3 ~ 0.5 mg / kg, phenytoin loading dose 20 mg / kg, or chloral hydrate orally or by retention enema.

     2.3 Cooling

     Fever can physical cooling, the head can be cold-temperate cold-water bag or towel

    wet compress.

     2.4 reduce intracranial pressure

     Intravenous injection of 20% mannitol for each 0.25 ~ 0.5 g / kg, 2 ~ 4 times / d, total

daily fluid volume restricted to 60 ~ 80 mL / kg.

     2.5 Causes Treatment

     As soon as possible to find out the cause, giving the corresponding treatment. Pairs of HIE children are integrated therapeutic measures. Including the maintenance of

    water, electrolyte, acid-base balance and blood sugar to normal, prevention and control of cerebral edema, the application of brain cell metabolism activator and high-pressure

    oxygen therapy, there is intracranial hemorrhage (ICH) were even used to stop

    bleeding drugs; intravenously infected with the disease as early as possible effective antimicrobial drugs, active infection control; pairs of low calcium, low sodium, low magnesium, vitamin B6 absence seizures were to be calcium, magnesium, added

    sodium, intravenous vitamin B6, and application of adequate dose and course of treatment; of nuclear jaundice with light therapy, blood transfusions and albumin therapy.

     2.6 Vesting

     Cured 54 patients (69.2%), improved in 12 cases (15.4%), automatic discharge in 7

    cases (9.0%), 5 cases died (6.4%).

     3 Discussion

     The complex causes of neonatal seizures. From the onset and type of view, in order to micro and small hair as much as some cases showed only a blink of an eye, sucking,

    chewing movements repeated. For a history of abnormal birth newborns should be particularly vigilant against the occurrence of seizures. Full-term infants the incidence

    of neonatal convulsions 2% ~ 3%, premature infants from 10% ~ 13% [2]. The cause of

    neonatal convulsions caused by a lot, and sometimes simultaneous transformation of several factors, such as HIE, may be associated with low blood sugar, and (or) low blood calcium. In recent years, due to extensive use of head CT, markedly improved by

    perinatal asphyxia caused by HIE and the diagnostic rate of ICH. HIE are neonatal seizures in this group the cause of death, followed by ICH, it is emphasized that perinatal care, the establishment of high-risk neonatal intensive care is very important

    [3].

     The group of 78 cases in time to onset occurred within 3 d after birth up to 44 cases, significantly higher than other-day-old newborn, mainly by birth trauma, hypoxia,

    intracranial haemorrhage, with the literature [4] reported that in line. 4 ~ 7 d incidence

    among those from low-calcium, neonatal hyperbilirubinemia, neonatal metabolic

    disorders caused by chemical and biological. Biochemical metabolic disorders can occur in isolation, but also, but birth trauma and hypoxia consequences. Neonatal

    hypocalcemia alone generally have elevated serum phosphorus is due to a temporary lack of physiological hyperparathyroidism caused by renal excretion of phosphorus insufficiency caused, in addition to the stress response during childbirth so that an

    increase in sugar hormones, inhibit thyroid side gland secretion resulting from low blood calcium, so newborns with congenital rickets among concurrent things, its low blood calcium and vitamin D has no direct relationship [5]. Neonatal hypoglycemia in

    premature infants account for the first convulsion. Maternal hypertension during pregnancy, such as with diuretics, intrapartum use of oxytocin or hypotonic solution, their susceptibility to hyponatremia of neonatal health, and the other also in the neonatal period on the aldosterone response to renal tubular poor antidiuretic hormone

    after asphyxia increase in the secretion. Hypernatremia is common in hypertonic dehydration, acidosis infusion improper use or handling of sodium excess, can cause hypernatremia, often accompanied by intracranial hemorrhage, have been corrected by transfusion. More than 7 d after the onset of infectious diseases. Another case of neonatal febrile seizures who did not take into account the first simple febrile seizures, but to give more consideration as a serious infectious disease caused by neonatal convulsions.

     Neonatal seizures only scared the preferred drug phenobarbital, applications load quickly took control of seizures in order to alleviate seizures in cerebral oxygen

    consumption, thereby protecting brain cell function. If load is not only the seizures, 15 min after an additional dose, in order to prevent the accumulation of poisoning, a maximum of every 5 mg / kg, the total not to exceed 30 mg / kg, 12 or 24 h maintenance

    dose given after 4 ~ 5 mg / kg can be.

     References

     [1] Kim Han-Zhen, Huang Min, official shiggi. Practical neonatology [M]. 3 version. Beijing: People's Health Press, 2006:253.

     [2] Schmitt B, Wohlrab G, Sander T, et al. Neonatal seizures with tonic clonic sequences and poor developmental outcome. Epilepsy Res, 2005,20 (5): 156.

     [3] tube Mei-rong, GUO. Analysis of 66 cases of neonatal convulsions [J].

     [4] LI Xiu-fang, Liang Lanying, Lian, et al. Born in 88 cases of neonatal convulsions

Reposted elsewhere in the paper for free download http://

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