Patient's question:
My nephew is 10 days old. He now has 5 to 6 bowel movements a day, and they are quite loose. He often has twitching and convulsions while sleeping, and he burps very intensely. His umbilical cord has not fallen off yet, and he also has a lot of skin peeling (especially around the joints). Is this normal? Please reply, thank you.Doctor's answer:
Hello, neonatal convulsions refer to a symptom of transient dysfunction of the central nervous system caused by various factors (such as birth injuries, hypoxia, metabolic disorders, infections, and congenital malformations). It is a condition where partial neurons in the brain suddenly exhibit abnormal discharges of varying degrees, leading to involuntary contractions of the whole body or local muscles. It is a common emergency during the neonatal period, and it can be either benign or indicate a dangerous condition. It has a certain impact on brain development, so once it occurs, it should be treated urgently and the cause of the convulsions should be identified.Causes
(1) Intracranial diseases
① Hypoxic-ischemic encephalopathy: Accounts for 60% to 70% of convulsion causes, and convulsions are most common within 24 hours after birth.
② Hypoxic and traumatic intracranial hemorrhage: Convulsions are most common 2 to 3 days after birth.
③ Cerebral infarction: Most often involves the middle cerebral artery, and convulsions are most common 1 to 4 days after birth.
(2) Infections
Seen in meningitis, encephalitis, brain abscesses, sepsis, tetanus, etc., with purulent meningitis and sepsis being most common. Infections acquired in utero result in convulsions within 3 days after birth, while postnatal infections are more common 1 week after birth. Neonatal high fever convulsions are rare.
(3) Metabolic disorders
① Hypoglycemia: Most common within 3 days after birth.
② Hypocalcemia: Includes early-onset convulsions occurring 1 to 3 days after birth and late-onset convulsions occurring 1 to 2 weeks after birth.
③ Hypomagnesemia: Often coexists with late-onset hypocalcemia.
④ Hypercalcemia or hyponatremia.
⑤ Pyridoxine (Vitamin B6) deficiency: Convulsions occur within hours to 2 weeks after birth and are ineffective with sedatives.
⑥ Bilirubin encephalopathy.
⑦ Amino acid metabolic disorders: Maple syrup urine disease, phenylketonuria, hyperglycinemia, etc.
(4) Drugs
① Drug overdose or toxicity: Such as stimulants, theophylline, organophosphates, etc.
② Withdrawal syndrome: If the mother used anesthetics or barbiturate drugs, these can cross the placenta into the fetus. After delivery, the drug supply is suddenly interrupted, and convulsions often occur within 6 hours after birth, returning to normal within 24 to 48 hours.
(5) Congenital central nervous system malformations
Hydrocephalus, brain underdevelopment, microcephaly, etc.
(6) Familial benign convulsions
This is a self-limiting condition, with convulsions occurring within 3 days after birth. The attacks are frequent but the general condition is good. 87% of cases resolve within weeks to months, while 13% develop into epilepsy.
(7) Others
Including polycythemia, galactosemia, hypertensive encephalopathy, etc., or cases with an unknown cause.