The commonest causes of neonatal convulsions include:
- hypoxic ischaemic encephalopathy (as a result of perinatal asphyxia)
- central nervous system infection
Management of the neonate or youn infant who is having a fit:
- Manage the airway and breathing
- Ensure circulatory access
- If hypoglycaemic, give glucose IV or nasogatrically (2 ml/kg of 10% glucose). If blood glucose cannot be measured, give empirical treatment with glucose.
- Treat convulsions with phenobarbital (loading dose 20 mg/kg IV). If convulsions persist, give further doses of phenobarbital 10 mg/kg up to a maximum of 40 mg/kg. Watch for apnoea. Always have a bag-mask available. If needed, continue phenobarbital at a maintenance dose of 5 mg/kg per day.
- If hypocalcaemic, symptoms may settle if the infant is given 2 ml/kg of 10% calcium gluconate as a slow IV infusion, and continue with oral supplementation.
- Rule out central nervous system infection. Treat if present.