A nurse observes a convulsions and twitching of extremities in a new born infant. What could be the probable… - HPSSSB Staff Nurse - 2016

HPSSSB Staff Nurse - 2016

Child Health Nursing (Pediatrics)

Easy

Appeared in: HPSSSB Staff Nurse - 2016

Explanation

Hypoxic-Ischemic Encephalopathy (HIE) resulting from perinatal asphyxia is the single most common cause of seizures in the neonatal period.
Medical literature indicates that HIE accounts for a significant majority of cases, estimated at 50-60%.
The typical onset for seizures caused by asphyxia is within the first 24 hours of life, fitting the scenario of a 'new born infant'.
Compared to other causes like infection or metabolic disturbances, asphyxia is statistically the most probable initial cause.

Option B: Meningitis is a serious infection of the membranes surrounding the brain and can cause seizures, but it accounts for a smaller percentage (5-10%) of neonatal seizures compared to asphyxia. It often presents with other signs like fever and lethargy.
Option C: Group B Streptococcus (GBS) is a specific bacterium that is a leading cause of neonatal sepsis and meningitis. While it can lead to seizures, it falls under the broader, less frequent category of 'Infection' and is not the single most probable cause overall.
Option D: Infection is a significant cause of neonatal seizures but is less common than HIE from asphyxia. The category of intracranial infections accounts for about 5-10% of cases, whereas HIE accounts for over 50%.

Clinical Relevance

Nursing practice connection: Use the key finding related to Etiology of Neonatal Seizures to guide bedside assessment, documentation, and the next nursing action.
Prompt recognition and management of neonatal seizures are critical nursing responsibilities to prevent secondary brain injury.
A thorough assessment of the perinatal history (e.g., Apgar scores, fetal distress, mode of delivery) is crucial for identifying infants at high risk for seizures due to asphyxia.
The primary nursing goals during a seizure are to maintain a patent airway, ensure safety, and accurately observe and document the event to aid in diagnosis.

How to Approach the Question

First, identify the core clinical presentation: a newborn infant is having convulsions (seizures).
Next, analyze the question's requirement: it asks for the 'probable cause'. This directs you to think about the most common or statistically most likely reason for the presentation.
Recall the main etiologies of neonatal seizures: Hypoxic-Ischemic Encephalopathy (HIE) from asphyxia, infections (meningitis, sepsis), metabolic disturbances (hypoglycemia, hypocalcemia), and intracranial hemorrhage.
Compare the likelihood of the given options. Asphyxia is the leading cause, especially in the first few days of life.
Meningitis, GBS, and Infection are all related and are possible causes, but they are statistically less common than HIE as the initial cause.
Therefore, select Asphyxia as the most probable cause based on its high incidence rate.

Concept Tested & Keywords

Concept Tested: Etiology of Neonatal Seizures
Stem keywords: new born infant, convulsions, twitching of extremities
Lead-in keywords: probable cause
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1425-1427, 1423-1425