Beruflich Dokumente
Kultur Dokumente
The Jittery
D e b ra C . A r m e n t r o u t , R N - C , M S N , N N P,
a n d Ju dy C a p l e , R N - C , M S N , N N P Newborn
ments observed in infants, especially of a sudden contraction of a single mus-
BACKGROUND
myoclonus and seizure activity. Trem- cle, muscle group, or limb in a rhyth-
Definitions ors are stimulus sensitive, diminish mic or nonrhythmic sequence, often
Jittery is a term to describe a series of with passive flexion of the extremity, migrating from one body area to
recurrent tremors in infants. and are not associated with abnormali- another; it can be initiated by stimuli.
Tremors are involuntary, rhythmic, Seizure activity is often noted in the ex-
oscillatory movements of equal ampli- tremities and consists of jerky, rhy-
T
tude. Tremors are described as fine or thmic, or nonrhythmic movements
coarse. A fine tremor is of high fre- unequal in amplitudes; the activity
quency (>6 cycles per second [cps]) wo thirds of healthy does not cease with passive flexion
and low amplitude (<3 cm). Coarse of the extremity. Seizures are often
tremors are of low frequency (>6 cps) newborns exhibit fine associated with altered gaze and con-
and high amplitude (>3 cm) (Painter, sciousness (Korones & Bada, 1993;
1995; Rosman, Donnelly, & Braun, tremors during the first Painter, 1995; Rosman et al., 1984;
1984). Volpe, 1995).
mL/kg of a 50% solution of magne- PROGNOSIS Korones & H. S. Bada (Eds.), Neonatal decision
sium sulfate followed by daily oral making (pp. 194-199). St Louis: Mosby.
The outlook for infants who have ex-
Linder, N., Moser, A. M., Asli, I., Gale, R. Livoff,
doses of 0.25 mL/kg (Korones & Bada, perienced jitteriness largely depends A., & Tamir, I. (1989). Suckling stimulation test
1993; Tsang et al., 1998). on the underlying cause and the degree for neonatal tremor. Archives of Disease in
to which it can be corrected. Parker et Childhood, 64, 44-52.
Drug Withdrawal al. (1990) reported that jittery babies Painter, M. (1995). Neonatal seizure disorders. In
Initial treatment of drug withdrawal is M. I. Leven & R. J. Lilford (Eds.), Fetal and
are more visually inattentive and diffi- neonatal neurology and neurosurgery (pp. 547-
supportive (swaddling, decreasing stim- cult to console compared with nonjit- 561). New York: Churchill Livingstone.
ulation, small frequent feedings). In- tery infants. Parents of jittery infants Parker, S., Zuckerman, B., Baucher, H., Frank, D.,
travenous fluids and electrolytes may may benefit from learning consoling Vinci, R., & Cabral, H. (1990). Jitteriness in full-
be indicated if the infant becomes clin- term neonates: Prevalence and correlates.
interventions and techniques to elicit
Pediatrics, 85, 17-23.
ically unstable. The decision to use visual attention. Anticipatory guidance Rosman, N. P., Donnelly, J. H., & Braun, M. A.
drug therapy depends on the severity concerning infant behavioral and tem- (1984). The jittery newborn and infant: A
of withdrawal symptoms. Infants with perament issues should also be ad- review. Developmental and Behavioral Pediatrics,
confirmed drug exposure without with- dressed. 5, 263-273.
drawal do not require therapy. Infants Shuper, A., Zalzberg, J., Weitz, R., & Mimouni, M.
(1991). Jitteriness beyond the neonatal period:
demonstrating seizures, poor feeding, A benign pattern of movement in infancy.
diarrhea, vomiting resulting in exces- REFERENCES Journal of Child Neurology, 6, 243-245.
sive weight loss and dehydration, in- American Academy of Pediatrics: Committee on Tsang, R. C., Demarini, S., & Rath. L. (1998).
ability to sleep, and fever unrelated to Drugs. (1998). Neonatal drug withdrawal. Fluids, electrolytes, vitamins and trace min-
Pediatrics, 101, 1079-1088. erals: Basis of ingestion, digestion, elimina-
infection are more likely to require
Blackburn, S. T. (1998). Assessment and manage- tion, and metabolism. In C. Kenner, J. W.
drug therapy (American Academy of ment of neurologic dysfunction. In C. Kenner, Lott, & A. A. Flandermeyer (Eds.), Compre-
Pediatrics, 1998). J. W. Lott, & A. A. Flandermeyer (Eds.), Com- hensive neonatal nursing: A physiologic per-
prehensive neonatal nursing: A physiologic perspec- spective (pp. 336-353). Philadelphia: W. B.
Hypoxic Ischemic Encephalopathy tive (pp. 564-607). Philadelphia: W. B. Saunders. Saunders.
Treatment of hypoxic ischemic encepha- Brann, A. W., & Schwartz, J. F. (1992). In A. A. Volpe, J. (1995). The neurological examination:
Fanaroff & R. J. Martin (Eds.), Neonatal-perinatal Normal and abnormal (chapter 3); neonatal
lopathy is supportive and based on the medicine: Diseases of the fetus and infant (pp. 704- seizures (chapter 5). In J. Volpe (ed.), Neurology
severity of the symptoms (Brann & 715, 729-734). St Louis: Mosby. of the newborn (pp. 118, 181-182, 211-259).
Schwartz, 1992). Korones, S. B., & Bada, H. S. (1993). In S. B. Philadelphia: W. B. Saunders.
Pediatric
Pearl
Watch your back!
Bending over an examining table and looking into the eyes of an infant is one
of the more enjoyable responsibilities of being a pediatric nurse practitioner.
However, bending too far over a period of time can lead to serious back
problems. Because my height is 5 ft 7 in, the “ergonomically correct” height
for an examining table for me is 40 inches from the floor. However, my prac-
tice had examining tables of 29 inches and 32 inches from the floor. After 15
years of working with examining tables that were too low to the ground, I
needed back surgery. All practitioners should have an ergonomic assessment
to determine the correct height for an examining table and practice good
body mechanics in assessing infants. Adjustable examining tables are avail-
able, but if these prove to be too expensive, pediatric nurse practitioners need
to be creative in conducting infant examinations to avoid placing too much
strain on their backs.
Janet D. Edwards, CPNP
Blaine, Minnesota