10. NERVOUS SYSTEM DISORDERS IN NEONATAL INFANT: NEONATAL SEIZURES, HYPOXIA-ISCHEMIC ENCEPHALOPATHY, INTRACRANIAL HAEMORRHAGE, PERIVENTRICULAR LEUKOMALACIA

Question 1

Main treatment of seizures in infants:

Answer 1

Phenobarbital is a drug of choice. It is given intravenously at initial loading dose of 20 mg/kg body weight and the dose could be fractionally increased to 40 mg/kg.

After 12 or 24 hours the treatment continues at maintenance dose of 5 mg/kg.

Question 2

Pathogenesis of periventricular leukomalacia:

Answer 2

According to ischemic theory, cerebral ischemia during development (23-32 week of gestation) leads to ischemic necrosis mainly in periventricular white matter. According to oligodendroglial theory milder and short ischemic episodes during 23-32 weeks of gestation lead to arrest in development of oligodendroglia.

Question 3

Pathogenesis of hypoxemic ischaemic encephalopathy:

Answer 3

Primary phase is presented with perinatal asphyxia, decreased heart rate, arterial hypotension, cerebral ischemia, early energy failure, early cell death.
Secondary phase develops 6-15 hours after the ischemic event and manifests with delayed cell death and excitotoxicity.
Tertiary phase presents months after ischemic event with late neuronal death, remodelling, and astrogliosis.

Question 4

Treatment of hypoxemic ischemic encephalopathy:

Answer 4

→ Neuroprotection in term infants with perinatal asphyxia through therapeutic hypothermia in first 56 hours after birth has already been established.
→ In clinical practice : cooling of whole body to rectal temperature 33.5-34° C for 72 hours with gradual warming thereafter.
→ Conventional treatment includes measures for stabilization of haemodynamic and ventilation, appropriate hydration, and anticonvulsive medication.