严重的新生儿低钠血症代表了严重的电解质失衡,具有潜在的严重的神经系统结局,一种在社区中很少记录的疾病,足月新生儿。这份报告强调了一个23天大的独特案例,以前很健康,足月男性新生儿出现严重低钠血症,导致癫痫发作,强调迅速承认和干预的紧迫性。新生儿出现呕吐等症状,呻吟,发冷,固定的凝视,和四肢震颤。入院时的关键发现包括体温过低,低血压,心动过速,并伴有明显的体重减轻。临床表现以脱水为标志,嗜睡,虚弱的哭泣,一个固定的目光,不规则呼吸,和粗糙的肺音,然而腹部扩张,高渗肢体运动,并观察到反复发作。立即干预包括建立IV准入,复温,机械通气,癫痫发作管理,体积膨胀,多巴胺用于循环支持,并开始使用经验性抗生素。诊断评估显示钠离子浓度为105.9mmol/L,而振幅整合脑电图(aEEG)检测到明显的癫痫发作活动,其特征是缺乏睡眠-觉醒节律,在较低和较高的振幅边缘明显升高,以及下降到5μV以下的下限电压的持续下降,呈现尖锐或锯齿状波形。管理策略需要使用高渗盐水和碳酸氢钠快速电解质正常化,抗惊厥治疗,和全面的支持性护理,持续的aEEG监测,直到癫痫发作停止。值得注意的是,第三天,新生儿的病情已经稳定,入院后10天健康出院。在16个月的随访中,患儿未出现神经系统不良结局,且生长发育良好.我们对病因进行了广泛的审查,临床表现,aEEG监测,重度新生儿低钠血症诱发癫痫的特点,治疗方法,严重低钠血症引发的癫痫发作的预后旨在加深对这种复杂疾病的认识并加强临床处理。它强调了早期检测的重要性,准确诊断,和定制治疗方案,以改善受影响新生儿的预后。此外,这篇综述强调了aEEG监测在管理癫痫发作风险升高的新生儿中不可或缺的作用.然而,快速使用高渗盐水纠正重度低钠血症诱发的癫痫发作的安全性和有效性,需要通过医学研究进行进一步研究.
Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate\'s condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.