Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal seizures and encephalopathy — branching viva
Branching viva from the recognition of a neonatal seizure through the seizure-versus-jitteriness distinction, the cooling decision in the encephalopathic term infant, and the refractory-seizure search for a metabolic cause.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar on the postnatal ward. The midwife asks you to review three newborns with abnormal movements of differing cause and severity. The examiner releases information in stages about an encephalopathic term infant, a well-looking term infant with tremulous movements, and a preterm infant with apnoea and desaturation.
Station opening
Examiner: "Define a neonatal seizure and explain why the great majority are described as provoked rather than epilepsy." [5]
Strong candidate (must-hit)
- Defines a neonatal seizure as the clinical or electrographic expression of abnormal, excessive neuronal discharge in the immature brain, almost always provoked by a treatable brain insult (HIE commonest, then stroke, haemorrhage, infection, metabolic derangement, malformation); explains that provoked (acute symptomatic) seizures reflect an acute insult, whereas epilepsy is a chronic tendency to unprovoked seizures. [5]
Weak candidate
- "A seizure is when the baby shakes." [5]
References6ShowHide
- [1]Azzopardi DV; Strohm B; Edwards AD; et al Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009.PMID 19797281
- [4]Painter MJ; Scher MS; Stein AD; et al Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med, 1999.PMID 10441604
- [5]Pressler RM; Abend NS; Auvin S; et al Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures. Epilepsia, 2023.PMID 37655702
- [7]Sharpe C; Reiner GE; Davis SL; et al Levetiracetam Versus Phenobarbital for Neonatal Seizures: A Randomized Controlled Trial. Pediatrics, 2020.PMID 32385134
- [8]Shellhaas RA; Chang T; Tsuchida T; et al The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol, 2011.PMID 22146359
- [9]Nyman J; Mikkonen K; Metsäranta M; et al Poor aEEG background recovery after perinatal hypoxic ischemic encephalopathy predicts postneonatal epilepsy by age 4 years. Clin Neurophysiol, 2022.PMID 36183624