NEONATAL

SEIZURES
 GROUP 14

1. RIDANNA HARTATEANA (P1337424418010)

2. CINDY ETIKA BRILIAN (P1337424418034)
DEFINITION
Seizure is depolarization exaggerated cells neurons brai
n, which result in change which character paroxysmal fu
nction neurons (behavior, function motor and autonomo
us) with or without altered consciousness.

Seizures in newborns are seizures that occur in neonates

or within 28 days after birth.
Signs and Symptoms
1. Tremor
2. Hyperactive
3. convulsions
4. Suddenly cry squeaky
5. tone muscle is lost accompanied or no with lost awareness.
6. Movement which no determined (involuntary movements)
7. Nystagmus or eye wink proximal
8. Movement like chew and swallow
By because that Manifestation clinic which different and varied, often time se
izure on baby new born no recognized by which not yet experienced. In princ
iple, every movement which no normal on baby new born if
gradually over and over again and periodic, should thought possibility manife
station seizure ( Book reference training Service Obstetrics Neonatal Emerg
ency Basic, 2008).
Diagnosis
1. History
a) History complete about state Mother on moment pregnant.
 Drug which in drink by Mother moment pregnant
 Drug which given and which required when labor
 is there is child and family which previously suffer seizure and etc
 History labor: baby born premature, born with action, helper labor
 Asphyxia neonorum
 History immunization tetanus Mother, helper labor no power health
 History maintenance rope center with drug traditional.
 History seizure, drop awareness, there is movement abnormal on eyes,
mouth, tongue, extremity
 History spasm or rigidity on extremity, muscle mouth and stomach
 Seizure triggered by noise or procedure or treatment measures
2. Inspection physical
a) Seizure
 Movement normal on face, eye, mouth, tongue and extremity
 Extension or flexion tonic extremity, movement like pedal a bicycl
e, eye blink turn, squint
 Weeping squeaky with tone tall, hard stop
 Change status awareness, apnea, jaundice, crown big stand out,
temperature no normal
b) Spasm
 Baby permanent aware, cry pain
 Trismus, stiffness muscle mouth on extremity, stomach, contractio
n muscle, no under control triggered by noise, light or procedure
diagnostic
 Infection rope center
c) Inspection laboratory
 Checkup blood complete (Hb,L,Ht,Count type),blood delete.
 Inspection rate electrolyte blood
3. Inspection rate bilirubin (if there is jaundice)
4. Inspection lumbar puncture and fluid cerebrospinal
5. Inspection rate glucose blood (Hypoglycemia : rate glucose blood not
enough 45 mg/dl).
6. Inspection test sensitivity and culture blood (if suspect infection ).
7. Inspection periodically hemoglobin and hematocrit ( if there is history
lesion on head ).
8. Ultrasound for knowing existence bleeding periventricular-intra ventri
curricular.
9. CT scan head. For knowing existence bleeding subarachnoid or subd
ural, disabled default, infarction cerebral
Management
1. Principle base action overcome seizure on baby new Born as following :
a) Guard road breath permanent free with resuscitation ( Take note A B C res
uscitation ).
b) Overcome seizure with give drug anti seizure seizure/Drugs.
(For example: diazepam, phenobarbitalphenotine/definihydantoin).
c) Look for and treat factor reason seizure.
(Take note history pregnancy, childbirth and birth, abnormalities physical fou
nd, shape convulsions, and results laboratory).
2. Handling beginning seizure on neonate.
Step a until with step d called as step A B C resuscitation.
a) Baby placed in the place which warm make sure that baby not cold. Temp
erature maintained 36.5oC - 37oC.
b) Road breath baby cleaned with action sucker mucus around mouth, nose
until nasopharynx.
c) When baby apnea done help so that baby breathe againwith tool help ball
oon and hood, given oxygen with speed 2 liters/minute.
d) Done installation infusion intravenous in vessels blood peripheral hand, fo
ot, or head. When baby suspected born by sick mother diabetes miletus don
e installation infusion through the vein umbilicostis, with solution Dextrose 1
0% (2cc/kg IV).
Then action overcome seizure with giving anti-drug seizures/Drugs will be menti
oned according to 2 sources:
a) When infusion already installed in give drug anti seizure
 Diazepam 0.3-0.5mg/kgBB (maximum 20 mg) by IV injected slowly until s
eizure resolved or Diazepam rectal (suppository) 5mg for BB<10kg and 1
0mg for BB>10kg(Sari
 luminal ( Phenobarbital ) 5-10mg/kg bb and could is repeated maximum 2
0mg/kg bb by IV
b) Mark condition baby during 5 minute. Take note abnormality physical which th
ere is.
c) When still convulsion, give diazepam with dose and method which same.
d) Wait 5 minute with oxygenation which adequate.
e) When still seizure give Phenytoin/definilhydantoin dose 10-15 mg/kg body we
ight/time (maximum 200mg)
f) Wait 20 minute
f) When seizure already resolved, refer RS for dose maintenance (phenytoin 5-
8mg/kg BW or phenobarbital 4-5mg/kgBB)
g) When still seizure refer RS for maintenance PICU/NICU for get dose advanc
ed (Midazolam 0.2mg/kgBB or phenobarbital 5-10mg/kg BB)
h) Done history about state baby for look for factor reason seizure:
 is possibility baby born by Mother which diseased DM
 is possibility baby premature
 is possibility baby experience asphyxia
 is possibility Mother baby suffer from / use narcotics
i) When already resolved in take ingredients for inspection support laboratory,
CT Scans, Ultrasound for look for factor reason seizure, When still convulsio
n, give diazepam with dose and method which same.
Complications
1. Hypoxy ischemic encephalopathy
is syndrome clinical with disturbance function neurological on beginning life n
eonate which born on or more from 35 week gestation, with manifestation dr
op awareness or seizure, often accompanied disturbance for start and guard
respiration, and depression tone muscle and reflex. HIEalso is reason urgent
damage brain on baby new born with consequence period long which bad
2. Trauma Arrangement Nerve
Could occur on labor presentation butt, extraction pliers or extraction vacuu
m heavy
3. Bleeding Intracranial
Could caused by trauma born like asphyxia or hypoxia, deficiency vitamin K,
thrombocytopenia. Bleeding could occur sub Dural, sub arachnoid, intraventr
icular and intracerebral. Usually accompanied hypoglycemia, hypocalcemia.
Diagnosis which appropriate hard set, function lumbar and ophthalmoscopy
possible could help diagnosis
INFANT RESUSCITATION PRACTICES CONVULSIONS

1. Preparation Tool
a. The place resuscitation flat, flat, clean, dry and warm
b. Three sheet towel or cloth clean and dry
• For dry baby
• For envelop body and head baby
• For prop shoulder baby
c. Tool sucker lender
• Ball rubber clean and dry
• sucker sterile
d. Tool carrier air/ oxygen
e. light 60 watts bydistance from light to baby around 60 cm
f. Hour
g. Stethoscope
 SOP for resuscitation
Neonatal Seizures
No Rated aspect Implementation
Yes Not
Pre-Interaction Stage
1 Assess the need for a physical examination of the baby
2 Prepare tools
3 Washing hands
Orientation stage
4 Inform the family of the possibility of newborn asphyxia.
use language which easy to understand

5 Explain the purpose and procedure of action

Working stage
6 use apron, face mask, Closing head and shoe boot (if need)
7 Remove all jewelry that is worn, wash both hands up to the elbows with soap and
clean water flow and dry hands with disposable towels

8 Use gloves
9 Perform an initial assessment as soon as the baby is born:
a. The presence of thick meconium on the baby's body / meconium fluid (if there is
suction of mucus after the head) baby born)
b. Are BBL not crying or not breathing spontaneous
c. Immediately determine whether the baby requires resuscitation, by looking at the is
baby : Not breathe - gasp - Frequency breathing below 30 times /minute
 THE FIRST STEP (completed in < 30 seconds)

10 Keep baby permanent warm by maintaining blanket which cover baby's body

11 Adjust the position of the baby's head and neck to a little look up (half extension) for
mopen airway by propping the baby's shoulder with fold cloth

12 Suck mucus starting from the mouth + 5 cm then the nose + 3 cm

13 Dry and perform tactile stimulation by:

 dry advance, head and bodyh baby with a little pressure
 Gently pat / flick the soles of the feet baby
 back rub, stomach and baby chest with palm hand
 Change cloth and wrap the baby, let the baby's chest show

14 Reposition the baby's head and wrap the baby

15 Mark return breathing baby : normal, no breathe or gasp-gasp.
a. When baby breathe normal : put it baby on chest Mother and blanket baby
togethera her mother and suggest mother to breastfeed immediately the baby
b. If the baby is not breathing, is gasping for air, or is crying weakly, immediately take
steps to ventilate the baby
 VENTILATION
16 Make sure position head already correct then put on the hood so that cover nose,
mouth and chin

17 Perform experimental ventilation (2x) by blowing the base tube or push balloon with
pressure 30 em water while observing the baby's chest movement
 If chest expands continue ventilation
 If the chest does not expand, correct the attachment of the mask/position of the
baby, see if there is mucus, if any suck mucus.
18 Perform positive pressure ventilation eVTP) 20 X in 30 seconds with pressure 20 em
water sarnbil pay attention to the development of the baby's chest
 When baby start breathing normally : stop ventilation by gradually and watch
mendition baby sevent carefully
 Bila the baby is not breathing: do ventilation again

19 Stop ventilation gradually if the baby:

 Start breathing normally/no why - why and or cry strong then do care post
resuscitation
 If the baby is gasping for air or is not breathing, continue ventilation
 POSITIVE PRESSURE VENTILATION AND COMPRESSION
CHEST (if frequency heart < 60x/minute after done VTP effective)
20 Prepare officers 2 person for To do VTP and compression chest Arrange position 1 officer
is at on position in head and 1 officer is at Beside near baby's head
21 Do evaluation on chest and put hand dengan correct (officer yang To do chest
compressions)
22 place hood face by effective and monitor chest movement
23 Pull line imaginary between 2 putting milk, put it finger middle and sweet in adjacent
finger index finger, move third finger the to middle sternum, position finger upright,
raise your finger index finger, keep it up finger middle and finger sweet, To do
compression chest with depth+1/3 diameter antero-posterior chest, long emphasis more
short from long maximum cardiac output:
 Perform positive pressure ventilation and chest compressions: 1 cycle: 3 compressions
and 1 ventilation in 2 seconds (3:1)
 Frequency: 90 compressions + 30 ventilations in 1 minute (means 120 activities per
minute)
 Done in 30 seconds 15 cycles
POST-RESUSCITATION MEASURES
RESUSCITATION SUCCESSFUL
24 Perform post-resuscitation care if the baby has started to breathe normally by monitoring
by carefully in the baby after resuscitation for 2 hours Is the baby cyanotic?
25 Keep baby permanent warm and dry
26 Give baby to Mother if breath baby and color skin nnormal
Infants need to be referred if:
 Frequency respiration not enough from 30 time perminutes or more than 60 times per
minute
  Existence intercostal retractions
 Baby moan (noisy expiratory breath) or gasp-gasp (noisy breath inspiration)
 Baby's body is pale or bluish
 limp baby
NO SUCCESSFUL/FAILED RESUSCITATION
27 Stop resuscitation if the baby is not breathing after 20 minutes, there is no heart rate,
the pupil is medriasis, since the start of the resuscitation the action is declared failed
and the baby
declared dead
28 Make up and cleanright tools and returned to the place beginning

29 Take off the gloves

30 Washing hands
Termination stage
31 End and conclude the activity
32 Evaluation of mother and father's feelings, baby's condition
33 Contract for next activity
34 Contract for next activity
35 Clean up tools
36 Washing hands
37 Document the baby's actions and conditions
THANK
YOU