چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
|---|---|
| شهرام صادق وند | اول |
| عنوان | متن |
|---|---|
| کلمات کلیدی | Treatment , neonatal , seizures |
| خلاصه مقاله | Neonatal seizures are a medical emergency with potentially serious neurological complications that require prompt and systematic diagnosis and management. The neonatal seizure management algorithm is a step-by-step roadmap designed to stabilize the patient, terminate the seizures, identify and treat the underlying cause, and ultimately prevent long-term complications. The algorithm is based on a hierarchical approach that progresses treatment from initial and primary interventions to specialized and supportive care. Step 1: Initial stabilization and assessment (ABC) Before any medical intervention, stabilization of the infant’s vital status is paramount. This is achieved by following the basic principles of resuscitation (Airway, Breathing, Circulation). Ensuring a patent airway, administering oxygen if needed, and supporting circulation are fundamental steps. At the same time, immediate diagnostic evaluations are initiated, including measuring blood sugar, electrolytes (such as calcium and magnesium), blood levels of potential drugs, and investigation of infection (blood and urine cultures). Brain imaging with ultrasound or MRI, and especially electroencephalography (EEG) or EEGamp;amp;videomonitoring, is essential to confirm the diagnosis, determine the seizure pattern, and monitor response to treatment. Step 2: Treat modifiable causes While the patient is stabilized, modifiable causes of seizures should be sought and treated promptly. This critical step is often initiated in conjunction with the initiation of drug therapy. Key examples include: * Administer glucose for hypoglycemia. * Administer pyridoxine (vitamin B6) on a trial basis in cases of suspected pyridoxine dependence. * Correct electrolyte imbalances (e.g., calcium gluconate infusion for hypocalcemia). * Initiate broad-spectrum antibiotics if meningitis or sepsis is suspected. Step 3: Initial anticonvulsant therapy If seizures persist after correction of the above causes or are initially modifiable without an obvious cause, anticonvulsant drug therapy is initiated. Benzodiazepines are the first-line drugs at this stage: Lorazepam: Often preferred due to its relatively short half-life and reduced risk of accumulation. Midazolam: Especially useful as a continuous intravenous infusion for the control of persistent seizures. Diazepam can also be used if not available. Step 4: Second-line anticonvulsant therapy If seizures do not respond to benzodiazepines, second-line anticonvulsants enter the protocol: Phenytoin (or its derivative fosphenytoin, which is associated with fewer side effects): A classic and effective drug. Phenobarbital: Although traditionally used, it may be placed after phenytoin in some algorithms due to side effects on consciousness and the nervous system. Step 5: Management of refractory seizures (Status Epilepticus) If seizures persist despite the above treatments, the infant is in a state of 'refractory seizures' or 'status epilepticus'. At this stage, more advanced options include: Continuous infusion of anticonvulsant drugs: such as midazolam or phenobarbital. Pyridoxine: if not previously prescribed, should be tried at this stage. Newer-generation anticonvulsant drugs: such as levetiracetam, which is increasingly being used due to its better safety profile and lack of drug interactions. Phenytoin or fosphenytoin: if previous drugs fail to respond. In very resistant cases, anesthetic drugs such as pentobarbital may be used under close monitoring in the neonatal intensive care unit (NICU). Conclusion: The neonatal seizure treatment algorithm is a dynamic, evidence-based framework that prioritizes first stabilizing the patient, then identifying and treating the underlying cause, and finally using anticonvulsant drugs in a hierarchical manner. Continuous EEG monitoring is essential to assess response to treatment, as many neonatal seizures are not clinically apparent. The ultimate goal is not only to stop seizures, but also to minimize brain damage and optimize developmental and neurological outcomes for the baby. |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
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| Tazehha.pdf | 1404/07/06 | 2255666 | دانلود |
| unnamed1.jpg | 1404/07/06 | 57340 | دانلود |
