Common causes of acute provoked seizure in neonates.

Treatment algorithm of neonatal seizures

Treatment algorithm of neonatal seizure unresponsive to anti-convulsants

باختصار، رگعه بفيتامين B6, نفسه pyridoxine.

وإذا ما فاد، رگعه بالمركب الفعال من B6, نفسه PLP.

وإذا ما فاد رگعه بـ folic acid analogue, اللي هو Leucovorin.

وإذا ما فاد رگعه بـ B7, نفسه الـ Biotin.

ليش هالموضوع مهم كلش؟
لأن مرات يجيك طفل مولود قبل ساعتين كلشي ما بيه بس فجأة يدخل بنوبة صرع ما تستجيب لأي دوة تنطيه. بس بمجرد ما تنطيه شي تافه مثل فيتامين B6 تلكاها توقفت والطفل رجع طبيعي، لأن عنده وحدة من عشرات الأمراض النادرة اللي نسميها inborn errors of metabolism

يكلك هواي أطفال مُصابين بأمراض الأيض الوراثية (inborn errors of metabolism) اللي هواي منها نكدر نعالجها بشي بسيط مثل حبوب فيتامين ونظام غذائي خاص، يتم تشخيصهم خطأً على أنهم يعانون من cerebral palsy وأمراض ثانية خطيرة مالها أي علاج... ببساطة لأن أمراض الأيض الوراثية نادرة وعادةً ما تخطر على بال الطبيب.

بهالمناسبة، على حد قول دكتور الأعصاب مالتنا، يكول إذا شفت عائلة بيها ثنين أطفال عدهم CP معناها التشخيص خطأ، لأن الـ CP مو وراثي ولما تشوف حالتين بنفس العائلة عدهم نفس المرض، فغالبًا هذا مرض وراثي مثل أمراض الأيض الوراثية وغيرها.

Asphyxia is defined as the marked impairment of gas exchange leading, if prolonged, to progressive hypoxemia, hypercapnia, and significant metabolic acidosis. 

Cyanocobalamin cannot cross the blood-brain barrier, while mythelcobalamin can. This is why you should use the latter (not the former) for neuropathy caused by B12-deficiency.

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ITP, TTP, HUS, & DIC as they present in investigations

The clinical presentation of neonatal meningitis is indistinguishable from that of neonatal sepsis without meningitis. The most commonly reported clinical signs are temperature instability, irritability or lethargy, and poor feeding or vomiting. Bulging fontanelle and nuchal rigidity are not common findings at the time of initial presentation but are found in approximately 25 and 15 percent of affected neonates, respectively.

Therefore, all neonates with clinical signs concerning for sepsis should undergo LP to evaluate for meningitis. Ideally, the LP should be performed before or soon after starting antibiotic therapy. However, in some cases, the neonate may be too unstable to safely undergo LP at the time of the initial diagnostic evaluation. In these instances, antimicrobials should be provided in doses sufficient for the treatment of meningitis, until the neonate is stable enough to tolerate the procedure. 

It's a paraneoplastic syndrome, caused by different mechanisms:

1- Tumor secretion of parathyroid-related peptide (PTHrP). This is also known as humoral hypercalcemia of malignancy, or pseudo-hyper-parathyroidism. It's usually seen in squamous cell carcinomas, renal, bladder, and breast cancer.

• Overproduction of active vitamin D by tumor cells. This is often seen with lymphomas (although only a minority of them cause hypercalcemia). Tumor cells express 1a-hydroxylase enzyme which converts vitamin D to its active form.

• Osteolytic lesions that release calcium from the bones. Seen in any tumor that metastasizes to the bones, but more frequently with breast cancer and multiple myeloma.

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