Definition

Neonatus is the term used in babies in the first 28 days of its life. This first four weeks are periods of very rapid changes in babies. The shock in neonatus is a sudden, abnormal condition, and there is a change in brain activity resulting in seizures. The shock in neonatus has different characteristics and images from seizures in infants and children at the next age, and can show serious nerve disorders.

At this age, the baby's brain tissue is still in development, so there are still some brain areas that have not developed perfectly. Cases of seizures in babies are quite common and are one of the reasons parents are in the emergency department. It is important for you to prevent and recognize the symptoms of seizures in the baby. 

Cause

Some of the causes of seizures in neonatus can be treated and can stop seizures. Causes of seizures in neonatus usually require checking and handling emergencies, divided into several categories as follows:

1. The metabolic imbalance of the baby's body, such as low blood sugar levels, calcium, magnesium, and if the sodium levels in the blood are also lower or higher than normal.
2. Hypoxia (lack of oxygen levels in the blood) before or during the delivery process, such as placesntas that are depressed or sudden release, as well as the old delivery process, can reduce oxygen delivery to brain tissue.
3. Bleeding in the baby's head cavity.
4. Infections in brain membranes or brain tissues that can be caused by bacteria or viruses, and infections that occur during pregnancy.
5. Congenital disorders that cause babies to lack vitamins and enzymes that are important in the body's metabolic process.
6. There is a blood clot that clogs blood vessels in the baby's brain tissue.
7. epilepsy syndrome or repeated seizures in babies without a clear cause.
8. An abnormal brain tissue form since birth.

Risk Factors

Some of the risk factors that can make a baby experience seizures in the first 28 days of their life are:

1. Pregnancy birthed babies (under 37 weeks of gestation) or over 40 weeks of pregnancy
2. The baby's weight at birth is less than 2.5 kg or more than 4 kg
3. Male gender
4. Mothers have a history of diseases such as diabetes, preeclampsia, or obesity in pregnancy.
5. Mother is a heavy smoker
6. There are complications during pregnancy, and babies are given special medical treatment at birth due to poor health conditions
7. The history of dengue descent in the family.

The risk of seizures in neon status also increases with the increase in the age of mothers while pregnant. It is important to know the risk factors in infants who experience seizures in enforcing a diagnosis. 

Symptoms

The shape of seizures in neonatus varies, there are rhythmic and repeated seizures that occur in the areas of the face, chest, hands and feet and can move to other parts of the body. There are also seizures that look like stiffness in the body, or the baby's posture becomes non-symmetric, and the eye looks to the side. Seizures in the baby can also appear like muscle contractions that do not repeat and occur quickly, usually occur in the upper arm, chest, or face.

In addition to the repeated or rigid shape of the body's movement, its tongue can also look prominent and its lips are like chewing or grandchildren. Sometimes the leg also looks like he is pedaling a bicycle. Changes in vital signs that suddenly hit the baby with a previous history of seizures could be signs that the baby is having a seizure. Babies can look tired and sick in the period between seizures, or there is a long pause in their breathing. 

Diagnosed

The doctor will interview the baby's family to find out about the history of maternal pregnancy, especially history of illness and history of family disease descent. When a seizure occurs, it may indicate the cause, if it occurs within the first 12-24 hours after the baby is born, it can be caused by disorders in the brain tissue due to lack of oxygen levels. Mother's pregnancy history is like a history of miscarriage (indicating the possibility of genetic heredity), diabetes or preeclampsia in pregnancy, infection while pregnant, and the use of drugs can cause seizures in neonatus. 

Monitoring and assessment at the time of the seizure can indicate the cause of the seizure, if the seizure occurs in certain parts of the body. Additional examinations of babies that may be carried out by doctors in helping to enforce diagnosis include:

1. Examination of blood sugar levels and electrolytes
2. Complete blood tests, blood culture, substances that show inflammation
3. Examination of kidney function
4. Analysis of cerebrospinal liquid (liquid in the brain and spinal cord) to see organisms that cause infection, concentration of amino acids, and glucose levels
5. Examination of TORCH infections (Toxoplasma, Rubella, CMV and Herpes)
6. CT scan, MRI, or recording of electrical activity in the brain (EEG)

Implementation

An important initial therapy in babies who are having seizures is to maintain airways and steady blood circulation. Then the baby will be attached with access to its blood vessels to become a drug entry route. After that, a follow-up examination will usually be carried out to find out the cause of seizures, then the appropriate therapy for seizure-causing diseases. There is a special anti-sex drug given to neonatus as the first therapy to stop the seizure, namely phenobarbital. Usually doctors will carry out strict monitoring and aggressive therapy to prevent further complications.

In cases of seizures caused by electrolyte imbalance, improvement of the child's condition must be carried out as soon as possible under strict supervision. In infants with metabolic disorders, breastfeeding or other intake must be temporarily suspended and replaced with intravenous fluids. Head bleeding requires immediate surgery. The buildup of fluids in the head cavity can be seen with a rapid increase in the head circumference.

Complications

Complications in babies that experience seizures can come from these seizures and from the treatment of seizures. When giving drugs to stop seizures, the complications that can occur are kLack of oxygen in the blood or buildup of carbon dioxide in the blood. If this continues, it can cause cardiac arrest in the baby.

Therefore, the administration of anti-pection drugs also requires strict supervision from doctors. In addition, kAnother omplication that can occur due to seizures in neonatus is:

1. Cerebral palsy (CP)/density in the body: CP is an abnormality where children have difficulty moving and maintaining balance and body posture. 
2. Brain tissue that shrinks (atrophy) or builds up brain fluids.
3. Epilepsy, occurred in half cases of babies having seizures.
4. Difficulty in eating food
5. Mental retardation or disorders in the development of babies.

The complications of seizures can be permanent due to damage to brain tissue from low oxygen flow and too high brain activity. 

Prevention

Genetically derivational disorder cannot be prevented. However, there are several things that can be done to prevent seizures in neonatus:

1. Carry out regular pregnancy control through antennatal examination and laboratory examination, take the supplements recommended by doctors during pregnancy, and treat complaints that arise during pregnancy
2. Run antenna checks during pregnancy regularly
3. Carrying out the delivery process under the supervision of trained health workers
4. Giving therapy to seizures as early as possible

When do you have to go to a doctor?

Kejang is a state of emergency because it can cause disturbances in the heart and airways. Do not insert any object or fluid into the mouth of the baby who is having a seizure. Go to the nearest hospital for immediate treatment and examination. Note if the seizure is accompanied by the following signs:

1. The shock lasts more than 5 minutes, or if the seizure occurs more than once in a few minutes
2. There is stiffness in the baby's neck
3. Declining consciousness, babies can be seen as prone to sleep and inactive.
4. The prominent small crowns.
5. The baby looks difficult to breathe, or there is a long pause between his breathing