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Neonatal Reflexes, HIE, and Neonatal Seizures Explained in Detail
Frequently Asked Questions
What are neonatal reflexes?
Neonatal reflexes are primitive automatic responses present at birth that indicate normal neurological function and brainstem integrity. They gradually disappear as cortical control develops.
Why are neonatal reflexes clinically important?
They help assess CNS maturity, detect neurological injury such as hypoxic ischemic encephalopathy, and identify peripheral nerve injuries like brachial plexus palsy.
What is the Moro reflex and when does it disappear?
The Moro reflex is a startle response where the infant abducts and then adducts the arms after sudden head movement. It disappears by 4–6 months of age.
What does an absent Moro reflex indicate?
Absent Moro reflex may indicate severe CNS depression, hypoxic ischemic encephalopathy, prematurity, or significant neurological injury.
What does an asymmetric Moro reflex suggest?
An asymmetric Moro reflex suggests peripheral injury such as brachial plexus injury (Erb palsy) or clavicle fracture.
What is the rooting reflex and its significance?
Rooting reflex is turning of the head toward cheek stimulation. It is important for feeding and disappears by 3–4 months. Absence suggests CNS depression.
What is hypoxic ischemic encephalopathy (HIE)?
HIE is neonatal brain injury caused by reduced oxygen supply and impaired cerebral blood flow around the time of birth, leading to neuronal damage.
What are the common causes of HIE?
Common causes include placental abruption, cord prolapse, uterine rupture, prolonged labor, severe maternal hypotension, and neonatal shock or respiratory failure.
What are the main clinical features of HIE?
Features include low Apgar scores, poor tone, weak reflexes, lethargy or coma, poor feeding, respiratory depression, and seizures.
What is the Sarnat staging system in HIE?
Sarnat staging classifies HIE into Stage I (mild), Stage II (moderate with seizures), and Stage III (severe coma with absent reflexes and poor prognosis).
When do seizures typically occur in HIE?
Seizures in HIE most commonly occur within the first 24 hours, often during the secondary energy failure phase.
What is therapeutic hypothermia and when is it used?
Therapeutic hypothermia is controlled cooling to 33–34°C for 72 hours. It is used in moderate to severe HIE if started within 6 hours of birth.
What is the most common type of neonatal seizure?
Subtle seizures are the most common, presenting as eye deviation, lip smacking, apnea, or bicycling movements.
What are the most common causes of neonatal seizures?
The most common causes include hypoxic ischemic encephalopathy, hypoglycemia, hypocalcemia, intracranial hemorrhage, infections, and neonatal stroke.
How can jitteriness be differentiated from seizures in newborns?
Jitteriness is stimulus-sensitive and stops with gentle restraint, while seizures are not suppressible and may have abnormal EEG activity.
What is the first step in evaluating a neonate with seizures?
The first step is to check blood glucose immediately, as hypoglycemia is a reversible and common cause.
What is the first-line anticonvulsant for neonatal seizures?
Phenobarbital is the first-line anticonvulsant, given as a 20 mg/kg IV loading dose followed by maintenance therapy.
Which drug is commonly used as second-line therapy for neonatal seizures?
Levetiracetam is increasingly used as second-line therapy due to its safety profile and minimal respiratory depression.
What investigation is the gold standard for confirming neonatal seizures?
EEG is the gold standard for seizure confirmation, especially because many neonatal seizures are clinically subtle.
What factors determine prognosis in neonatal seizures?
Prognosis depends mainly on the underlying cause. Metabolic seizures have excellent outcomes, while seizures due to severe HIE or structural brain injury have poorer prognosis.
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