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The
glucose level in neonates with hypoxic-ischemic encephalopathy should
be kept at 75 to 100 mg/dL. Blood pressure should be kept within the normal
limits for age. The urinary output should be maintained at 65 mL/kg per
day. The head of the bed should be elevated 30 to 45 degrees. Mannitol
0.25 g/kg every 6 hours, furosemide 2 mg/kg every 8 hours, and corticosteroids
during the first 24 hours after the insult have been suggested but are
not routinely used. Neonatal convulsions should be controlled with antiepileptic
drugs. 
The treatment of hypoxic-ischemic
encephalopathy consists of correcting metabolic derangements, maintaining
vital functions with careful consideration to the cardiac and renal status,
managing cerebral edema, and controlling seizures. Hypothermia looks promising
in preliminary reports. Hypoglycemia and hypocalcemia are frequent in
asphyxiated neonates and should be considered as a
possible cause of seizures in all neonates with hypoxic-ischemic encephalopathy.
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Benign
Familial Neonatal Convulsions
The
diagnosis of benign familial neonatal convulsions should be reserved for
patients with convulsions during the first week of life who also have:
(1) normal physical and neurological examinations; (2) no detectable cause
for the convulsions; (3) normal EEG; (4) normal development; and (5) a
positive family history of one or more relatives with neonatal convulsions
who have subsequently developed normally. The seizures may manifest as
tonic or tonic-clonic convulsions with or without apnea. There is not
a specific clinical electroencephalographic pattern that is diagnostic
of benign familial neonatal convulsions.
Benign familial neonatal convulsions are linked to chromosomes 20 and
8. The likelihood of these patients having seizures as adults is 14%.
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