Neonatal seizures or convulsions: All you need to know, tests to detect them | Health

Whenever any parent hears that their baby is having convulsions or seizures – the first reaction of the parents is, “Isn’t the baby too young?”, “Can the baby get convulsions at this age?”, “Is the baby going to survive?”, “If they do – are they going to be normal?”, “Will they become epileptic?” All these are common questions which come across a parent’s minds – some express it and some suffer silently.

In an interview with HT Lifestyle, Dr Kishore Kumar, Neonatologist and Pediatrician at Cloudnine Group of Hospitals in Bengaluru, explained, “Neonatal convulsions are abnormal movements of the body or portions of the body due to abnormal activity in the brain. They are relatively rare, affecting 1 in 1000 live birth babies. The fact of life is that neonatal convulsions or seizures most often are preventable. Newborn babies’ brains develop too fast – their brain size (measured by head circumference is 35 cms at birth and by 2 years of age it is usually around 50 cms.) Adult head size is generally around 54 to 55 cms. It means that >90% of the brain growth happens in the first 2 years – so the brain of a newborn is susceptible to lot of insults – which can and should be prevented.”

He elaborated, “The convulsions in a newborn baby can either be “obvious” or “subtle” – which can easily be missed if the observant is not experienced enough. The convulsions need to be treated. Development of the baby need to be monitored. Generally treating the underlying cause is enough is most cases – like oxygen for hypoxia, calcium supplementation for hypocalcaemia, sugar for hypoglycaemia – but sometimes if the cause is unknown or if the baby is getting repeated convulsions – we do use anti- convulsant meds – as required for few months. Obvious convulsions generally – depends on the number of days of life and the causes are usually expected from that.”

Obviously, these are general rules but Dr Kishore Kumar revealed that there are exceptions sometimes for every rule.

1. Most convulsions on first day of life are due to either lack of adequate oxygen to the brain – called asphyxia or due to birth injuries causing significant swelling of the brain. Sometimes they could be due to malformations or deformations of the brain too.
2. Second day convulsions are usually due to imbalances of some electrical chemicals like low calcium, low magnesium, low sugar and other abnormalities which if corrected settles down.
3. Third day convulsions are usually thought to be sinister – meaning metabolic in nature – due to problems in digesting the food either carbohydrates or proteins or fats – and the metabolites of these food items forms toxic molecules causing the convulsions usually due to swelling of the brain, as a result. Identification of this is crucial as damage occurs by every hour – and this is where Newborn Screening for metabolic disorders is crucial and in Cloudnine all babies are tested for these as a rule as per the international good practices.
4. Fourth day convulsions generally can be either due to genetic predisposition or any of the above factors.
5. Fifth day convulsions – in the past traditionally have been called “due to unknown factors” but lately we have found deficiency of Biotin could be a causative factor.

Highlighting that subtle convulsions are sometimes difficult to pin point or diagnose and could be easily missed by new staff who are inexperienced, Dr Kishore Kumar said, “They could manifest in the form of unusual cry, or unusual movements or unusual behaviour or sometimes just cycling movements of arms or legs or both.”

Tests to detect neonatal convulsions

According to Dr Kishore Kumar, tests to detect neonatal convulsions include blood tests for electrolyes, calcium, magnesium, metabolic screening and sometimes brain wave activity test EEG and scans like MRI Brain. He said, “Prompt diagnosis of the cause of convulsions is important for effective treatment so that lifelong damage is prevented. These days, if no cause is found, then we can screen for any genetic cause by doing genomic studies for convulsions.”

He concluded, “Overall, generally the prognosis for convulsions in newborn are fairly good provided their cause is identified and rectified as soon as possible. The longer it takes to identify the cause the greater the damage to the brain. Parents, staff, and relatives are all anxious when a baby is convulsing. Convulsions are usually stopped by giving anti- convulsant medication/s. Ultrasound head or MRI brain and EEG are sometimes required to identify the cause of the convulsions.”