Pediatric Annals

Case Challenges 

A 10-day-old Infant with Seizures

Robert Listernick, MD

  • Pediatric Annals. 2007;36(2)
  • Posted February 1, 2007

Abstract

This 10-day-old infant was transferred for evaluation of seizures. He was the 7-pound product of a 38-week gestation to a 37-year-old gravida 4 para 4 woman. His mother had normal prenatal laboratory testing and tested negative for group B streptococcus (GBS). The pregnancy was uncomplicated, except for a maternal cough and sore throat 10 days prior to delivery, which was treated with azithromycin. There was no history of maternal fever. Membranes were ruptured at delivery. The baby stayed for one day in the hospital without problems.

Key Learning Points

  1. Specific manifestations of neonatal seizures include a sudden arrest of ongoing behavior, automatisms such as lip-smacking or “bicycling” movements of the lower extremities, or even mild cyanosis and tachycardia. Tonic or clonic seizures are unusual in a neonate.
  2. The differential diagnosis of neonatal seizures includes infection (bacterial meningitis, viral encephalitis), metabolic disease such as hypoglycemia, hypocalcemia, or inborn errors of metabolism, structural disorders of the brain (cerebral dysgenesis), and hypoxic-ischemic insults.
  3. Both enteroviruses and herpes simplex virus (HSV) can cause the syndrome of neonatal liver failure and encephalitis.
  4. In babies who have HSV encephalitis, a polymerase chain reaction test performed on cerebrospinal fluid for HSV DNA has a sensitivity and specificity of approximately 90%. This test is much more sensitive and specific outside of the neonatal period.

ABOUT THE AUTHOR

Robert Listernick, MD, is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

Abstract

This 10-day-old infant was transferred for evaluation of seizures. He was the 7-pound product of a 38-week gestation to a 37-year-old gravida 4 para 4 woman. His mother had normal prenatal laboratory testing and tested negative for group B streptococcus (GBS). The pregnancy was uncomplicated, except for a maternal cough and sore throat 10 days prior to delivery, which was treated with azithromycin. There was no history of maternal fever. Membranes were ruptured at delivery. The baby stayed for one day in the hospital without problems.

Key Learning Points

  1. Specific manifestations of neonatal seizures include a sudden arrest of ongoing behavior, automatisms such as lip-smacking or “bicycling” movements of the lower extremities, or even mild cyanosis and tachycardia. Tonic or clonic seizures are unusual in a neonate.
  2. The differential diagnosis of neonatal seizures includes infection (bacterial meningitis, viral encephalitis), metabolic disease such as hypoglycemia, hypocalcemia, or inborn errors of metabolism, structural disorders of the brain (cerebral dysgenesis), and hypoxic-ischemic insults.
  3. Both enteroviruses and herpes simplex virus (HSV) can cause the syndrome of neonatal liver failure and encephalitis.
  4. In babies who have HSV encephalitis, a polymerase chain reaction test performed on cerebrospinal fluid for HSV DNA has a sensitivity and specificity of approximately 90%. This test is much more sensitive and specific outside of the neonatal period.

ABOUT THE AUTHOR

Robert Listernick, MD, is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

This 10-day-old infant was transferred for evaluation of seizures. He was the 7-pound product of a 38-week gestation to a 37-year-old gravida 4 para 4 woman. His mother had normal prenatal laboratory testing and tested negative for group B streptococcus (GBS). The pregnancy was uncomplicated, except for a maternal cough and sore throat 10 days prior to delivery, which was treated with azithromycin. There was no history of maternal fever. Membranes were ruptured at delivery. The baby stayed for one day in the hospital without problems.

Key Learning Points

  1. Specific manifestations of neonatal seizures include a sudden arrest of ongoing behavior, automatisms such as lip-smacking or “bicycling” movements of the lower extremities, or even mild cyanosis and tachycardia. Tonic or clonic seizures are unusual in a neonate.
  2. The differential diagnosis of neonatal seizures includes infection (bacterial meningitis, viral encephalitis), metabolic disease such as hypoglycemia, hypocalcemia, or inborn errors of metabolism, structural disorders of the brain (cerebral dysgenesis), and hypoxic-ischemic insults.
  3. Both enteroviruses and herpes simplex virus (HSV) can cause the syndrome of neonatal liver failure and encephalitis.
  4. In babies who have HSV encephalitis, a polymerase chain reaction test performed on cerebrospinal fluid for HSV DNA has a sensitivity and specificity of approximately 90%. This test is much more sensitive and specific outside of the neonatal period.

ABOUT THE AUTHOR

Robert Listernick, MD, is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

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