Evaluation of neonatal convulsions

Öz

Objective: Neonatal convulsions may be the first clinical sign of a neurological or metabolic disorder leading to neurological sequela or a reversible benign disorder. The determination of etiology and immediate management is mandatory. In this study we evaluated the neonates internated in our Neonatology department between January 2000-May 2003 due to neonatal convulsion. Material and Methods: Neonates with convulsion were included in this prospective study and were clinically, metabolically and radiologically evaluated. Results: The incidence of neonatal convulsions was found to be 0,87%( 87 among 9892 live births). 38(44,8%) had Hypoxic Ischemic Encephalopathy (HIE), 15(17,2%) intracranial hemorrhage (ICH), 11(12,6%) hypoglycemia, 8(9,2%) hypocalcemia, 6(6,8%) central nervous system infection, 2(2,3%) central nervous system malformation. In 7(8%) neonates an etiology could not be found. According to Sarnat classification 27(71,1%) neonates with HIE were in stage II and the rest in stage III. The convulsion was experienced in the first 24 hours in 26 (68,4%) neonates with HIE. Conclusion: Hypoxic Ischemic Encephalopaty was found to be the most frequent cause of neonatal convulsions. In order to protect newborns from the effects ofhypoxia the importance of antenatal care and appropriate ressuscitation measures in delivery room should be emphasized.

Anahtar Kelimeler

• Epilepsy, Benign Neonatal,Infant, Newborn,Hypoxia-Ischemia, Brain

Yenidoğan konvülsiyonlarının değerlendirilmesi

Öz

Amaç: Yenidoğan döneminde görülen konvülsiyonlar, sıklıkla hayatı tehdit eden ve kalıcı hasara neden olabilen ciddi nörolojik ya da metabolik hastalıkların ya da reverzibl bir bozukluğun ilk klinik bulgusu olabilir. Etyolojinin belirlenmesi ve uygun tedavinin başlatılması büyük önem taşımaktadır. Hipoksik iskemik ensefalopati ve metabolik nedenler neonatal konvülsiyonlarm en sık nedenleridir. Biz bu çalışmamızda , kliniğimizin yenidoğan ünitesinde konvülsiyon nedeniyle izlenen bebekleri değerlendirip, etyolojiyi aydınlatmaya çalıştık. Materyal ve Metod: 1 Ocak 2000 ve 31 Mayıs 2003 döneminde yenidoğan ünitemizde konvülsiyon nedeniyle izlenen, yaşları 0-28 gün arasında olan 87 bebek prospektif olarak değerlendirildi. Bulgular: Konvülsiyon insidansı % 0,87 ( 9892 canlı doğumda 87) olarak bulunmuştur. Seksen yedi olgunun 38'nde (%44,8) hipoksik iskemik ensefalopati (HIE), 15'nde (%17,2) intrakranial kanama! İKK), 11 'nde (%12,6) hipoglisemi, 8'nde (%9.2) hipokalsemi, 6'nda (%6,8) MSS enfeksiyonu, 2'nde (%2,3) konjeıütal serebral malformasyon saptanmıştır. Yedi (%8) olguda konvulsiyonun kesin nedeni aydınlatılamamıştır. HİE tanısı alan olguların 26'nda (%68,4) konvülsiyonlar hayatın ilk 24 saati içinde başlamıştır. 38 HİE olgusunun 27'si (%71.05) Sarnat sınıflamasına göre evre II, kalanlar evre III olarak saptan iniştir. Sonuç: Bu çalışmada neonatal konvülsiyonlarm en sık nedenini HİE olduğu saptanmış ve bebekleri asfiksiden korumak için antenatal bakım ve doğum odasındaki resüsitasyonun önemi vurgulanmıştır.

Anahtar Kelimeler

• Epilepsi, benign yenidoğan,Süt çocuğu, yenidoğan,Hipoksi-iskemi, beyin

Kaynakça

1. 1- Yoger JY, Vannucci RC. Seizures in neonates. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine. 7th edition. St. Louis :Mosby, 2002:887- 2- Johnston MV. Seizures in childhood and neonatal seizures. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed
2. Philadelphia:WB Saunders Company, 2004:2005-07
3. 3- Holden KR, Mellits ED, Freeman JM. Neonatal seizures I. Correlation of prenatal and perinatal events with outcomes. Pediatrics 1982; 70:165-76
4. 4- Scher MS, et al. Electrographic seizures in preterm andfullterm neonates: Clinical correlates, associated brain lesions and risk of neurologic sequelae. Pediatrics 1993; 91:128
5. 5- Mellits ED, Holden KR, Freeman JM. Neonatal seizures II. A multivariate analysis of factors associated with outcome. Pediatrics 1982; 70: 177-85
6. 6- Rose RL et al. Neonatal seizure status: A study of clinical, pathological and electroencephalographical features in 137 fullterm babies with a long-term follow- up. Pediatrics 1970; 45: 404-09
7. 7- Keen JH, Lee D. Sequelae of neonatal convulsions. Arch Dis Child 1973;48:542-46
8. 8- Karabulut O, Gökdemir M. Yenidoğan konvülsiyonlarmm değerlendirilmesi. Ulusal Çocuk Nörolojisi Kongresi 8-10 Mayıs 2002; İzmir

9. 9- Aicardi J, Arzimanoglu A, Guerrini R . Neonatal seizures. In: Arzimanoglu A, Guerrini R, Aicardi J eds. Aicardi's epilepsy in children . Philadelphia: Lippincott Williams and Wilkins, 2004: 188-209
10. 10- Finer NN, Robertson CM, Richards RT. Hypoxic-ischemic encephalopathy in term neonates : Perinatal factors and outcome. Journal of Pediatrics 1981;98:112-17
11. 11- Alcover B.E, Campistol J. Neonatal seizures, our experience. Rev Neurol 2004;38(9): 808-12
12. 12- Brown JK, Cockburn F, Forfar JO. Clinical and chemical correlates in convulsions of the newborn. Lancet 1972; 15:135-39
13. 13- Low JA, et al. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol 1994;170:1081-87
14. 14- Perlman JM,Risser R. Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers?. Pediatrics 1996; 97:456-61
15. 15- Perlman JM, Volpe JJ. Seizures in the preterm infant: Effects on cerebral blood flow velocity, intracranial pressure, and arterial blood pressure. J Pediatr 1983;102:288-93
16. 16- Zalnearitis EL, Young RS, Krishnamoorthy KS. Intracranial hemorrhage in utero as a complication of isoimmune thrombocytopenia. J Pediatr 1979;95;611-14
17. 17- Martin FIR, Dahlenburg GW, Russel J, Jeffery P. Neonatal hypoglycaemia in infants of insulin-dependent diabetic mothers. Arch Dis Child 1975:50:472-76
18. 18- Spellacy WN, Peterson PQ, Winegar A, Qilligan EJ. Neonatal seizures after cesarean delivery: Higher risk with labor. Am J Obstet Gynecol 1987;157;377-79
19. 19- Mulligan JC, Painter MJ. Neonatal asphyxia. II. Neonatal mortality and long-term sequelae. J Pediatr 1980;96;903-07