From the Guidelines
Management of jitteriness in neonatal encephalopathy should prioritize therapeutic hypothermia, in addition to supportive care, for term or near-term newborns with evolving moderate-to-severe hypoxic-ischemic encephalopathy, as recommended by the most recent guidelines 1. The approach to managing jitteriness in neonatal encephalopathy involves a multifaceted strategy that includes:
- Maintaining normal glucose levels, above 45 mg/dL, to prevent hypoglycemia
- Ensuring adequate calcium levels and treating hypocalcemia with calcium gluconate 100-200 mg/kg IV slowly
- Correcting any electrolyte imbalances to prevent further neurological injury
- Using phenobarbital as the preferred medication for seizure control, starting with a loading dose of 20 mg/kg IV, followed by maintenance doses of 3-5 mg/kg/day divided every 12 hours
- Considering additional medications like levetiracetam or phenytoin for persistent seizures
- Implementing environmental modifications, such as reducing stimulation by dimming lights, minimizing noise, and gentle handling, to reduce jitteriness
- Using swaddling to provide comfort and reduce jitteriness
- Continuous monitoring of vital signs, neurological status, and electrolytes is essential to guide treatment and prevent complications. Therapeutic hypothermia, as recommended by the 2024 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1, should be initiated within 6 hours after birth, with strict temperature control to a specified range (typically 33 °C–34 °C) and most commonly for a duration of 72 hours with rewarming over at least 4 hours. This treatment should only be considered, initiated, and conducted under clearly defined protocols with treatment in neonatal care facilities with the capabilities for multidisciplinary care and availability of adequate resources.
From the Research
Management of Jitteriness Caused by Neonatal Encephalopathy
- Neonatal encephalopathy is a heterogeneous disorder characterized by alterations in mental status, hypotonia, seizures, and abnormalities in feeding and respiration 2.
- The most common cause of neonatal encephalopathy is hypoxic-ischemic encephalopathy, for which treatment with 72 hours of therapeutic hypothermia is associated with reduced death or disability 2, 3.
- Therapeutic hypothermia is the standard of care for the treatment of neonatal encephalopathy presumed to be caused by hypoxia-ischemia, with a number needed to treat of approximately 6 to 7 to prevent one child from either death or disability at age 18 to 22 months 2.
- EEG monitoring and MRI are important tools in determining the etiology of encephalopathy and prognosis of the infant 2, 4.
- Other etiologies of neonatal encephalopathy include ischemic stroke, intracranial hemorrhage, infection, developmental anomalies, and inborn errors of metabolism 2, 5.
- Management of neonatal encephalopathy depends on the specific cause and stage of evolution of injury, and may involve tailored treatments according to gender, genetic risk, injury severity, and inflammatory status 3, 4.
- Novel therapeutics and adjunct therapies are being developed to enhance neuroprotective effects and improve outcomes for infants with neonatal encephalopathy 3, 6.