Jittery- Normal Eye Movement, Hands Stop Moving If They Are Grasped

Jittery Baby

Jittery vs. seizure?

Jittery- normal eye movement, hands stop moving if they are grasped

Seizures- eye movements can be abnormal (i.e. staring, blinking, nystagmoid jerks, or tonic horizontal eye deviation; hands continue to move if grasped

Benign Myotonic activity- usually jerking of one extremity during sleep, benign

EEG positive with seizures and jitteriness they are negative

Important History information:

1)  History of birth asphyxia or risk factors of sepsis

2)  Blood glucose level

3)  How old is the baby?

-At birth:

- maternal anesthetics

-  day #1 metabolic abnormalities: hypoglycemia, hypocalcaemia, hypoxic-ischemic encephalopathy (presents at 6-18 hours of life and worsens at 24-48)

-  day #2-3 drug withdrawal and meningitis

-  day #5 or greater- hypocalcemia , TORCH infections (toxo, other, rubella, cytomegalovirus, and HSV)

-  more than 1-2 weeks- methadone withdrawal

Differential DX

-  hypoxic-ischemic injury

-  intracranial hemorrhage

-  neonatal cerebral infarction

-  metabolic abnormalities

-  infection

-  neonatal withdrawal

-  inborn errors of metabolism

-  maternal anesthetic agents

-  drug toxicity

-  developmental abnormalities – cerebral malformations

-  CNS trauma

-  Hydrocephalus

-  Polycythemia

Work-up-

History-when, how long, when in relation to feeding and sleeping

PE- neuro exam, moros, rooting and looking for cns abnormalities, tuft of hair or skin findings above the spinal cord or AF

Labs- glucose, sodium, calcium and magnesium, utox

Infection work up- cbc with diff, blood, urine and csf (+/-) cxs

Radiologic studies- ultrasound of head- looks for bleeds and may see cysts ( dandy-walker malformation)

CT of head- better for subgaleal bleeds and congenital malformations

EEG- recommended after the seizure activity has been documented several times.

Immediate Treatment for seizures-

1)  rule out hypoxia

2)  check glucose level

3)  obtain stat calcium, sodium and magnesium

4)  anticonvulsant therapy- so, if everything else has been corrected and still seizing,

- phenobarbital 20mg/kg for loading , can give up to 40mg/kg if have not stopped

-  phenytoin if still seizing 20 mg/kg

-  benzos- maybe used but may cause respiratory failure but, may already be intubated.

Treatment of cause of the Seizures