дрожание у младенцев-на взгляд невролога

[Nachmed]

Ув коллеги, часто к нам обращаются родители с жалобами на тремор, вздрагивания, пугливость у детей грудного возраста. Хочу поделиться с вами информацией:
Neonatal Neurology. Gerald M. Fenichel.
Churcill livigstone
Elsevier 2007

Arousal
…An excessive response to arousal, jitteriness (also known as tremulousness),
is seen in normal children but is more common in children with encephalopathy
and those born to drug dependent mothers (Parker et al., 1990). Low frequency,
high-amplitude shaking of the limbs and jaw characterizes the response. A low
threshold for the Moro reflex is commonly associated. However, the move-
ments also occur in the absence of any apparent external manipulation and then
mistaken for seizures. Distinguish jitteriness from seizures by electroencepha-
lographic (EEG) monitoring and the following clinical criteria: provocation by
stimulation, absence of eye movements, and lack of change in respiratory pat-
tern. It commonly accompanies arousal in lethargic or obtunded newborns and
can be the only evidence of arousal from the stuporous state.
A hyperalert state characterized by full wakefulness and jitteriness for peri-
ods up to 18 hours may occur in asphyxiated newborns. The eyes are widely
open but lack visual tracking and the Moro reflex is easy to elicit ...
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Jitteriness
● Clinical features. Jitteriness or tremulousness is an excessive response to
stimulation. Touch, noise, or motion provokes a low frequency, high-ampli-
tude shaking of the limbs and jaw. Jitteriness is commonly associated with
a low threshold for the Moro reflex, but it can occur in the absence of any
apparent stimulation and be confused with myoclonic seizures.
● Diagnosis. Jitteriness usually occurs in newborns with perinatal asphyxia
that may have seizures as well. EEG monitoring, the absence of eye move-
ments or alteration in respiratory pattern, and the presence of stimulus
activation distinguishes jitteriness from seizures. Newborns of addicted
mothers and newborns with metabolic disorders are also jittery.
● Management. Reduced stimulation decreases jitteriness. However, new-
borns of addicted mothers require sedation to facilitate feeding and to
decrease energy expenditure.