obsolete fits in newborn

Obsolete Terms for Neonatal Seizures

In the past, neonatal seizures were referred to as "fits" or "convulsions." These terms are now considered outdated and have been replaced with more accurate and descriptive language.

• Fits: This term was commonly used in the 1970s and earlier to describe sudden, brief episodes of muscle contractions or convulsions in newborns. However, it is no longer a preferred term due to its imprecision and potential for misinterpretation.
• Convulsions: Similar to "fits," this term was also used to describe neonatal seizures but has largely been replaced by more specific terminology.

Current Understanding

Today, neonatal seizures are recognized as a serious medical condition that requires prompt diagnosis and treatment. The terms "grand mal seizures" or "major motor seizures" are still used in some contexts to describe tonic-clonic seizures, which involve both muscle contractions and relaxation.

However, the preferred term for describing neonatal seizures is now neonatal seizure or seizure disorder, which acknowledges the complex nature of these events and their potential impact on a newborn's brain development.

References

• [9] Seizures in newborn; Neonatal seizure; obsolete fits in newborn.
• [10] Fifth-Day Fits in the Newborn Maria P. Guerra, MD, Goigia A. Wilson †, Geraldine B. Boylan, MSc†, and Janet M. Rennie, MD
• [11] A new syndrome of neonatal convulsions is described.

Note: The references provided are based on the search results and may not be an exhaustive list of relevant sources.

Common Signs and Symptoms of Neonatal Seizures

Neonatal seizures can be challenging to diagnose due to their subtle nature, often mimicking normal movements and behaviors seen in healthy newborns. The symptoms depend on the type of seizure the baby is experiencing: subtle, clonic, tonic, or myoclonic.

• Subtle Seizures: These are the most common type of convulsion in newborns. They can manifest as:
  • Tremors in the eyelids
  • Fixed gaze in the eyes or staring vacantly [6]
  • Unusual mouth movements, like chewing or smacking lips [14]
• Clonic Seizures: These seizures are characterized by rapid, rhythmic contractions of muscles. Symptoms may include:
  • Clenching of fingers, arms, or legs
  • Spasms or rigidity in one muscle group
  • Sweating and vomiting [13]
• Tonic Seizures: These seizures cause sustained muscle contractions, leading to:
  • Stiffening of the body or limbs
  • Increased muscle tone
• Myoclonic Seizures: These are sudden, brief contractions of muscles. Symptoms may include:
  • Jerking or twitching movements

Other Signs and Symptoms

In addition to these specific seizure types, neonatal seizures can also manifest as:

• Autonomic signs: increased heart rate, blood pressure, and respiratory rate
• Increased motor activity: restlessness, agitation, or excessive crying
• Disturbed or disrupted sleep patterns
• Dyspnea (discomfort while breathing)

Important Considerations

It's essential to note that neonatal seizures can be difficult to distinguish from normal newborn movements, especially in the first few days of life. If you suspect a seizure, it's crucial to consult with a healthcare professional for proper evaluation and treatment.

References:

[1] DB Acar (2019) - Subtle (unspecified) seizure is the most common type of convulsion. [3] Oct 17, 2018 - Benign neonatal convulsions are defined as seizures with onset after birth through day 28 in an otherwise healthy child. [5] G Ramantani (2022) - Neonatal seizures are often the first and most common neurological sign in neonates. [6] H Australia (2023) - Symptoms of an absence seizure include stopping what you're doing and losing consciousness. [8] World Health Organization (2011) - Seizures are a common manifestation of metabolic abnormality in newborn period. [10] Symptoms of neonatal seizures. Neonatal seizures can be difficult to diagnose because the seizure may be short and subtle. [12] Seizures in babies occur when an unusual burst of electrical activity occurs between neurons, or brain cells, in the brain. [14] Learn more about the symptoms and causes of newborn seizures here.

Diagnostic Tests for Obsolete Fits in Newborns

Obsolescence refers to something being outdated or no longer used. In the context of newborn seizures, "obsolete fits" likely refer to a type of seizure that is no longer commonly diagnosed or treated.

According to search result [11], seemingly unexplained seizures in healthy newborns were first described in Australia in the late 1970s and were referred to as "fifth-day fits." However, it's essential to note that these seizures are not specifically mentioned as being obsolete.

For diagnosing seizures in newborns, continuous conventional video EEG (cEEG) is considered the preferred method and gold standard [3]. This involves monitoring infants with continuous video EEG if possible. Other diagnostic modalities include:

• Routine Laboratory Studies
• CT Scanning and/or MRI of the Brain
• Electroencephalography

These tests can help determine the cause of seizures in newborns, which is crucial for providing appropriate treatment.

Key Points:

• Continuous conventional video EEG (cEEG) is the preferred method for diagnosing neonatal seizures.
• Other diagnostic modalities include routine laboratory studies, CT scanning and/or MRI of the brain, and electroencephalography.
• Determining the cause of seizures in newborns is essential for providing appropriate treatment.

References:

[3] Jul 1, 2024 — Continuous conventional video EEG (cEEG) is the preferred method and gold standard for neonatal seizure diagnosis, although it is resource-intensive.

Treatment Options for Neonatal Abstinence Syndrome (NAS)

Neonatal abstinence syndrome, also known as drug withdrawal or NAS, occurs when a newborn is exposed to substances such as opioids during pregnancy. The treatment approach for NAS depends on various factors, including the type and amount of substance exposure, the newborn's overall health, and whether they were born full-term.

Medications Used in Treatment

• Pharmacological therapy: Medications like phenobarbital, levetiracetam, and benzodiazepines (such as lorazepam or midazolam) may be used to manage symptoms of NAS. However, the effectiveness of these medications can vary depending on individual circumstances.
• Monitoring with Finnegan Score: A standard assessment instrument like the Finnegan Score is often used to monitor newborns with documented in-utero opioid exposure or a high pre-test probability of exposure.

Duration and Goals of Treatment

Treatment for NAS typically lasts between five days to six months, depending on the severity of symptoms. The primary goal of treatment is to help the newborn feel well and have no drugs in their body. In some cases, long-term treatment may be necessary to address ongoing symptoms, which could include cognitive behavioral therapy and medication to treat conditions that appear as a side effect.

References

• [4] Phenobarbital is strongly recommended by the World Health Organization for the first-line treatment of neonatal seizures and is the standard of care at most hospitals.
• [6] The most commonly used medication for neonatal seizures is phenobarbital, which slows down brain activity but causes sedation.
• [9] Phenobarbital, which slows down brain activity is the most commonly used medication for neonatal seizures, according to the report.

The differential diagnosis of seizures or "fits" in newborns, also referred to as "obsolete fits," involves a broad range of possible causes. Here are some key points to consider:

• Hypoxic-ischemic encephalopathy: This is a condition that occurs when the brain does not receive enough oxygen and blood flow, leading to seizures or other neurological symptoms [1].
• Metabolic disturbances: Abnormal levels of glucose, calcium, or magnesium can cause seizures in newborns [3].
• Genetic causes: Certain genetic conditions, such as epilepsy syndromes, can increase the risk of seizures in newborns [2].
• Benign neonatal convulsions: These are seizures that occur in otherwise healthy newborns with no other known medical or neurological issues [4].
• Structural-metabolic and genetic causes: The differential diagnosis for neonatal seizures is broad and includes these categories, which can be further broken down into specific conditions [5].

It's also worth noting that certain non-epileptic movements, such as abnormal muscle tone or spasms, can mimic the symptoms of seizures in newborns [9]. In addition, persistent pulmonary hypertension of the newborn (PPHN) and other respiratory disorders can present with similar symptoms to seizures [10].

When evaluating a newborn for seizures or "obsolete fits," it's essential to consider these potential causes and perform a thorough physical examination, including checking for signs of trauma or other underlying conditions.

References:

[1] Jan 1, 2022 — Differential Diagnosis [3] by MD Thornton · 2013 · Cited by 13 — [2] by HC Glass · 2014 · Cited by 153 — [5] by HC Glass · 2014 · Cited by 153 — [9] common abnormal movements must be considered in the differential diagnosis of neonatal seizures (Table 2).4. [10] Persistent pulmonary hypertension of the newborn (PPHN).