Efficacy of Phenobarbital in Neonatal Seizures

ABSTRACT:A retrospective study of neonatal seizures in a tertiary care neonatal intensive care unit determined a 3.2% incidence, and confirmed the relatively poor efficacy of the traditional anticonvulsants phenobarbital and phenytoin. Only 33% responded to an initial adequate loading dose of phenobarbital, while 56% responded to either or both anticonvulsants. Although multifocal clonic seizures were most common (42%), tonic seizures were next in freqency (30%). Tonic seizures which did not respond to phenobarbital responded quite poorly to the addition of phenytoin compared to other seizure types. Tonic seizures may be the result of brainstem release phenomena and require a different strategy for management. Among nonresponders in this study, there was a 56% mortality rate but only 33% of responders died. There is a critical need for studies to find more efficacious agents than phenobarbital and phenytoin to treat seizures in the newborn.

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Clinical and biochemical profile of neonatal seizures admitted in neonatal intensive care unit of a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20212313 ◽

2021 ◽

Author(s):

Mohanram V. ◽

Arulraj Russelian ◽

Palpandi V.

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Biochemical Profile ◽

Neonatal Seizures ◽

The Common

Background: Several factors contribute to seizures among neonates. To avoid complications from under recognition of clinical seizures and the adverse effects of medications administered, the diagnosis and management of neonatal seizures necessitate an interprofessional approach. Present study was done to study the clinical and biochemical profile of neonates with seizures admitted to a tertiary care hospital, Chennai.Methods: A cross sectional study was conducted where all the neonates from birth to 28 days of life who got admitted in the neonatal intensive care unit (NICU) of a tertiary care hospital-Shri Sathya Sai medical college and research institute were included in the study. Baseline characteristics of all the babies were noted on the prescribed proforma. Thorough physical examination was done and seizures were diagnosed by clinical observation. Clinical details of each seizure episode were recorded like age at onset of seizures, duration of seizure, number and type of seizure.Results: In the present study, 50 neonates satisfying the inclusion and exclusion criteria were included in the study. The main mode of delivery was normal vaginal delivery (50%) followed by LSCS (40%) and assisted delivery (10%). 54% were male and 46% were female and majority of babies were delivered at term i.e., 72% and 28% were pre term babies. The mean day of onset of seizures in the present study was 3.18±2.09. Based on day of onset of seizures, with in 24 hrs (28%), 24 hrs to 72 hrs (46%), 4th day to 1 week (22%), more than 1 week (4%). Based on type of seizure 64% had subtle type, 26% had tonic type and 10% had clonic type of seizures. In this study, 24% had hypoglycemia, and 10 (20%) had hypocalcemia, 14% in the present study had hyponatremia, and 2 (4%) had hypomagnesemia, 2 (4%) had hypernatremia, 6% had combination of hypocalcemia and hypoglycemia.Conclusions: Hypocalcemia, hypoglycemia, hyponatremia were the common biochemical abnormalities observed in our study. Subtle seizures were the common type of seizures observed among both pre term and term infants.

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