Differentiating Neonatal Seizures (Fits) from Jitteriness
Dr. M. Tauseef Omer
Seizures (True Fits)
Pathologic: Always abnormal and require urgent evaluation.
Urgency: Immediate management is essential to prevent neurological injury.
Clinical Features:
May involve upward eye deviation, facial twitching, lip smacking, central cyanosis, bradycardia, tachycardia, apnea, rowing or pedaling limb movements, and altered consciousness.
Not suppressible by gentle passive restraint.
Movements are typically slower (lower frequency) and have greater amplitude than jitteriness.
Common Etiologies:
Hypoxic-ischemic encephalopathy (HIE)
Intracranial hemorrhage
Metabolic disturbances: hypoglycemia, hypocalcemia, hypomagnesemia
Central nervous system infections: e.g., meningitis
Investigations:
Blood glucose, calcium, magnesium
Sepsis screen
EEG
Lumbar puncture (if meningitis is suspected)
Cranial ultrasound scan (especially in preterm infants or suspected hemorrhage)
Neuroimaging (MRI/CT if indicated)
Management:
Correct underlying causes: e.g., treat hypoglycemia, infections, or metabolic derangements.
Supportive care: oxygen supplementation, airway management during seizures.
Antiepileptic therapy may be considered based on etiology and severity, but specific drug choice should follow updated neonatal neurology guidelines.
Jitteriness
Nature: Often benign and self-limited, especially in preterm or neurologically immature neonates.
Clinical Features:
May involve one or all four limbs.
Infant remains alert and conscious during episodes.
No associated signs such as eye deviation, cyanosis, apnea, or abnormal facial movements.
Movements are suppressible with gentle limb restraint.
Characterized by faster (higher frequency), lower amplitude, tremor-like movements.
Duration may vary: episodes can last several minutes and recur multiple times per hour or day.
Common Etiologies:
Immature central nervous system
Metabolic causes: hypoglycemia, hypocalcemia
Drug withdrawal (e.g., maternal substance use)
Investigations:
EEG is normal
Basic metabolic screening to rule out reversible causes
Management:
Observation is often sufficient.
Correct reversible factors (e.g., treat hypoglycemia or hypocalcemia).
No role for anticonvulsants
Parental reassurance is key.
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