In the first day of life of a newborn, the possible causes of seizures are all except

Appeared in: NHM UP Staff Nurse-2021 Shift-2nd

Explanation

Tetanus is the correct answer as it is an exception; it does not cause seizures on the first day of life.
Neonatal tetanus is caused by Clostridium tetani spores infecting the umbilical stump.
The incubation period for neonatal tetanus is 3 to 14 days, with symptoms typically appearing after the third day of life.
Because of this incubation period, it is impossible for tetanus to manifest with seizures on day one.

Option A: Hypoglycemia (low blood sugar) is a very common metabolic cause of seizures in the immediate neonatal period, often presenting within the first few hours to 24 hours.
Option C: Asphyxia at birth can lead to Hypoxic-Ischemic Encephalopathy (HIE), which is the single most common cause of neonatal seizures, with an onset typically within the first 24 hours.
Option D: Intraventricular bleeding (hemorrhage) is a significant cause of seizures, particularly in preterm infants, and can occur within the first 24 hours after birth.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology and timing of neonatal seizures as background academic context rather than a clinical decision trigger.
A key nursing responsibility is the early recognition of neonatal seizures, which can be subtle (e.g., eye deviation, repetitive sucking, bicycling movements).
The timing of seizure onset is a critical clue for the differential diagnosis. Seizures on day 1 point to perinatal insults like asphyxia, hypoglycemia, or hemorrhage.
Nurses must monitor at-risk infants (e.g., preterm, low birth weight, history of birth asphyxia) closely for signs of seizures and hypoglycemia.

How to Approach the Question

First, identify the core elements of the question: it's about causes of 'seizures' in a 'newborn' on the 'first day of life'.
Note the crucial keyword 'except'. This means you are looking for the option that is NOT a cause on day one.
Evaluate each option based on your knowledge of neonatal conditions and their typical onset.
Recall or deduce the onset time for Hypoglycemia (early), Asphyxia (early), and Intraventricular bleeding (early).
Recall or deduce the onset time for Tetanus. Remember that it's an infection with an incubation period, meaning it takes several days for symptoms to appear.
The condition with the delayed onset (Tetanus) is the one that does not fit the 'first day of life' criteria, making it the correct answer to the 'except' question.

Concept Tested & Keywords

Concept Tested: Etiology and timing of neonatal seizures
Stem keywords: first day of life, newborn, seizures, causes
Lead-in keywords: except
Negative lead-in flag: The question asks for the exception among the given options.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1426-1428

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 21-29

Practise the full NHM UP Staff Nurse-2021 Shift-2nd

Attempt every question from this paper in a timed mock, then review the full solution for each one.