ANTICONVULSANT TREATMENT IN NEWBORNS
Abstract:
Neonatal seizures are medical emergencies. Untreated seizures are increasing the risk of
secondary brain injury, mortality, epilepsy, abnormal cognitive development and cerebral palsy. Infants
with neonatal seizures should be treated in tertiary-level neonatal units, which have continuously
available personnel and equipment to provide life support for as long as needed. Seizures lasting longer
than 3 minutes, with a greater than 3 per hour, or associating cardio-circulatory and respiratory
compromise, require specific anticonvulsant therapy. The first-line anticonvulsant agents are
phenobarbital and phenytoin which, in associated are controlling 70% of neonatal seizures. The second
and third-line anticonvulsants used if neonatal seizures are refractory to first-line anticonvulsants are:
Midazolam, Diazepam, Lorazepam, Lidocaine, Carbamazepine, Primidone, Sodium valproate. Other
anticonvulsants are insufficiently tested to be used in the treatment of refractory neonatal seizures. The
optimal treatment strategy for neonatal seizures remains controversial.
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