Standard Treatment Protocol in Newborn care-Management of Newborn with Seizures
Differentiate a seizure from jitteriness
Secure airway
Face mask oxygen
Optimise breathing, circulation and temperature
Check BM – RBS
IV cannula – FBC, BC, CRP, Ca+, SE
Blood glucose <45mg/dl
Give 2ml/kg 10% Dextrose
Start dextrose infusion
Blood sugar – normal and Seizure-continuing
Phenobarbitone 20mg/kg IV slowly over 20 minutes
Repeat Phenobarbitone 10mg/kg IV slowly every 30 minutes until a total of 40mg/kg is reached
Seizures continuing
IV Phenytoin 20mg/kg slowly over 20 minutes
IV clonazepam 100mcg/kg loading dose and then 10-40mcg/kg/hour
Signs or suspicious of meningitis
Consider Lumbar puncture and IV cefotaxime 80mg/kg
Low serum Calcium & Give IV Calcium
Causes
Hypoglycaemia
Meningitis
Intraventricular haemorrhage
Asphyxia
Seizures controlled with initial management
Start maintenance Phenobarbitone 5mg/kg PO
Once daily 12 hours after the last seizures
Consider neuro imaging for refractory seizures
No clinical seizures in the next 72 hours
If controlled by Phenobarbitone alone, stop without tapering of the dose
If controlled by more than one drug, stop the drugs one by one. Phenobarbitone should be stopped the last.