Chapter 3.7 Convulsions or fits

The commonest causes of neonatal convulsions include:

  • hypoxic ischaemic encephalopathy (as a result of perinatal asphyxia)
  • central nervous system infection
  • hypoglycaemia
  • hypocalcaemia

Treatment

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.