How would moving an infant’s legs in a bicycling-type motion help with assessment?

Overview

A seizure is caused by sudden, abnormal and excessive electrical activity in the brain. By definition, neonatal seizures occur during the neonatal period — for a full-term infant, the first 28 days of life. Most occur in the first one to two days to the first week of a baby's life. Premature or low birth weight babies are more likely to suffer neonatal seizures.

Inhaltsverzeichnis Show

Signs & symptoms
Symptoms of Subtle Seizures
Symptoms of Clonic Seizures
Symptoms of Tonic Seizures
Symptoms of Myoclonic Seizures
Where to get care (1)
Recommended reading
Our research initiatives
Awards & recognition
We have interpreters for Cantonese, Mandarin, Spanish, Russian, American Sign Language and more.
Which assessment finding would the nurse recognize as common in infants with Down syndrome?
Which assessment would the nurse perform while caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis?
Which type of play involves a child's pleasure with swinging?
Which clinical finding suggests developmental dysplasia of the hip in an infant?

Many of the visible signs of neonatal seizures — such as chewing motions and "bicycling" movements — also occur in healthy newborns. Therefore, testing is usually required to confirm the diagnosis.

The outcomes for babies who have neonatal seizures depend on the type of seizure and the underlying cause. Some neonatal seizures are mild and short-lived and therefore do not cause any lasting health problems. However, prolonged and untreated seizures can cause permanent damage due to decreased oxygen flow to the brain and excessive brain cell activity. Neonatal seizures are often symptoms of a more serious underlying condition, particularly brain injury. For this reason, babies experiencing neonatal seizures should receive rapid, specialized care.

About half of all babies who have neonatal seizures will develop epilepsy later in life. Those with seizures related to brain injuries or developmental abnormalities may have further complications, such as cerebral palsy, mental retardation and other neurological disorders. These conditions result from the underlying brain damage, not the seizure itself.

Causes

Neonatal seizures have a variety of causes. These include:

Lack of oxygen before or during birth due to placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labor, or compression of the umbilical cord
Infection acquired before or after birth, such as bacterial meningitis, viral encephalitis, toxoplasmosis, syphilis or rubella
Stroke before or after birth
Blood clot in the brain
Bleeding in the brain
Brain birth defects
Blood sugar or electrolyte imbalances
Metabolic disorders such as maple syrup urine disease, pyridoxine dependency or phenylketonuria (PKU)
Drug withdrawal, which may affect babies born to mothers addicted to barbiturates, alcohol, heroin, cocaine or methadone

In rare cases, neonatal seizures are caused by a condition called benign familial neonatal seizures, also known as fifth-day convulsions or fifth-day fits. This condition is inherited, and the baby's mother or father will also have had the disorder. Many babies with benign familial neonatal seizures develop normally, although some may have developmental delays that are seen in early childhood.

Signs & symptoms

Neonatal seizures can be difficult to diagnose because the seizure may be short and subtle. In addition, symptoms of neonatal seizures may mimic normal movements and behaviors seen in healthy babies.

Symptoms depend on the type of seizure — subtle, clonic, tonic or myoclonic.

Symptoms of Subtle Seizures

Subtle seizures are more common among full-term babies. Symptoms of subtle seizures include:

Random or roving eye movements, eyelid blinking or fluttering, eyes rolling up, eye opening, staring
Sucking, smacking, chewing and protruding tongue
Unusual bicycling or pedalling movements of the legs
Thrashing or struggling movements
Long pauses in breathing (apnea)

Symptoms of Clonic Seizures

Rhythmic jerking movements that may involve the muscles of the face, tongue, arms, legs or other regions of the body

Symptoms of Tonic Seizures

Stiffening or tightening of the muscles
Turning the head or eyes to one side, or bending or stretching one or more arms or legs

Symptoms of Myoclonic Seizures

Quick, single jerking motions, involving one arm or leg or the whole body

Diagnosis

A test called an electroencephalogram (EEG) is essential for diagnosing and managing neonatal seizures. EEG records the electrical activity of the brain, and abnormalities on an EEG test (measured between seizures) can indicate a risk for seizures. However, babies with benign familial neonatal seizures usually have normal EEG readings.

Imaging tests of the brain, including magnetic resonance imaging (MRI) and computed tomography (CT) scan, are also used to determine the cause of seizures.

Treatment

Prompt diagnosis and treatment of neonatal seizures is essential. Your baby's health care team will also work to identify and treat any underlying cause of the seizures.

To control the seizures, anticonvulsant medications may be prescribed, including phenobarbital, lorazepam and phenytoin. Your baby will be closely monitored at all times while receiving these medications.

Babies suffering from hypoxic ischemic encephalopathy (not enough oxygen to the brain) may receive hypothermia treatment, which may reduce brain damage caused by the lack of oxygen. Hypothermic treatment involves cooling the baby's brain and body by a few degrees immediately after birth for several hours or days. Babies are closely monitored during treatment, and then slowly re-warmed to normal body temperature.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

Where to get care (1)

Our research initiatives

UCSF Newborn Brain Research Institute
The Newborn Brain Research Institute promotes brain development and recovery by leveraging clinical excellence, a cutting-edge data hub and innovative basic and clinical research.

Awards & recognition

One of the nation's best in neurology & neurosurgery
Ranked among the nation's best in 10 specialties

Translation, please

We have interpreters for Cantonese, Mandarin, Spanish, Russian, American Sign Language and more.

Request an interpreter

Which assessment finding would the nurse recognize as common in infants with Down syndrome?

On physical examination, patients with trisomy 21 have characteristic craniofacial findings, such as the following: Physical characteristics: a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, and a single crease of the palm. Flat occiput and a flattened facial appearance.

Which assessment would the nurse perform while caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis?

Assessment in a child with pyloric stenosis include: Assess the child's history of vomiting. Ask when the vomiting started and determine the character of the vomiting. Assess for the child's elimination.

Which type of play involves a child's pleasure with swinging?

Which content type of play allows a child to experience pleasure by swinging? Sense-pleasure play is a nonsocial stimulating experience in which the pleasurable experiences are derived from the environment, handling of raw materials, and body motion such as swinging, bouncing, and rocking.

Which clinical finding suggests developmental dysplasia of the hip in an infant?

Early clinical manifestations of developmental dysplasia of the hip (DDH) are identified during examination of the newborn. The classic examination finding is revealed with the Ortolani maneuver, in which a palpable "clunk" is present when the hip is directed in and out of the acetabulum and over the neolimbus.