Phenobarbitone for the Management of Neonatal Seizures - A Single Center Study
Keywords:
Phenobarbitone, Neonatal Seizure, Cumulative Dose, Seizure Control
Abstract
Introduction: Phenobarbitone is currently the drug of choice for neonatal seizures. In this study we analyzed the effect of Phenobarbitone in the management of neonatal seizures.
Objectives: To review the cumulative dosage, efficacy of phenobarbitone and need for second and third anti-seizure medication in the treatment of neonatal seizures.
Methods: This is a cross sectional retrospective observational study from January-2011 to December-2014. Based on clinical observation, anticonvulsant efficacy was assessed. Need for second Ant seizure drug and Cumulative loading dose were studied. All babies admitted with clinical seizures and those developing seizures during hospitalization who were treated with Phenobarbitone as the first drug were studied.
Interventions: Management of neonatal seizures as per standard unit protocol. Study was approved by the Institutiona::l Ethical Committee.
Statistical Analysis: All the data were collected in validated preformatted proforma sheet and analysed using appropriate statistical methods.
Results: 117 babies received phenobarbitone during the study period. Majority (49.57%) of seizures occurred during day 1 of life. HIE was the commonest cause noted in 42.73%. Seizure control with 20 mg/kg loading dose of phenobarbitone was noted in 40.17% of pateints & Seizure control with 30 mg/kg loading dose of phenobarbitone was in 19.65%. Seizure control with phenobarbitone as monotherapy was 59.82% and as combinant therapy with Levetiracetam was 32.47%.
Conclusion: Phenobarbitone had significant seizure control both as monotherapy and along with levetiracetam as combinant therapy.
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References
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34. Painter Mj, Scher Ms, Stein Ad et al. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. New England Journal of Medicine 1999; (341): 485-489. [PubMed]
35. Painter MJ, Pippenenger C, Wasterlain C, Barmada M, Pitlick W, Carter G, Abern S. Phenobarbital and phenytoin in neonatal seizures: Metabolism and tissue distribution. Neurology 1981; (31): 1107-1112.
36. Ouvrier RA, Goldsmith R. Phenobarbitone dosage in neonatal convulsions. Archives of Diseases in Childhood 1982; (57): 653-7. [PubMed]
37. Jalling B. Plasma concentrations of phenobarbital in the treatment of seizures in newborns. Acta Paediatrics 1975;(64): 514-524.
38. Raines A, Henderson TR, Swinyard EA, Dretechen KL. Comparison of midazolam and diazepam by the intramuscular route for control of seizures in a mouse model of status epilepticus. Epilepsia 1990; (31): 313-317.
39. Gal P, Toback DJ, Boer HR, Erkan NV, Wells TJ. Efficacy of phenobarbital monotherapy in treatment of neonatal seizures- relationship to blood levels. Neurology 1982; (32):1401. [PubMed]
40. Foster M, Lewis, Peter A. The Treatment of Neonatal Seizures: A Critical Review of the Evidence. Neonatal, Paediatric and Child Health Nursing 2007; 10(2).
2. Sood A, Grover N, Sharma R.Biochemical abnormalities in neonatal seizures. Journal of Pediatrics 2003;(70):221-4. Sood A, Grover N, Sharma R. Biochemical abnormalities in neonatal seizures. Indian J Pediatr. 2003 Mar;70(3):2. [PubMed]
3. Mizrah EM. Neonatal seizures and neonatal epileptic syndrome. Neurology Clinics. 2001;(19):427–463. [PubMed]
4. Bartha AI, Shen J, Katz KH, et al. Neonatal seizures: multicenter variability in current treatment practices. Pediatric Neurology 2007;(37):85e90. [PubMed]
5. Carmo KB, Barr P. Drug treatment of neonatal seizures by neonatologists and paediatric neurologists. Journal of Pediatrics & Child Health 2005;(41):313e6. [PubMed]
6. Clancy RR. Summary proceedings from the neurology group on neonatal seizures.Pediatrics 2006;(117):S23e7.
7. Painter MJ, Gaus LM. Neonatal seizures: diagnosis and treatment. Journal of Child Neurology. 1991 Apr;6(2):101-8. [PubMed]
8. Van Rooij LG, van den Broek MP, Rademaker CM, de Vries LS. Clinical management of seizures in newborns : diagnosis and treatment. Paediatric Drugs. 2013 Feb;15(1):9-18
9. Wickstrom R, Hallberg B, Bartocci M. Differing attitudes toward phenobarbital use in the neonatal period among neonatologists and child neurologists in Sweden. European Journal of Paediatric Neurology. 2013 Jan;17(1):55-63. [PubMed]
10. Vento M, De Vries Ls, Alberola A et al. Approach to seizures in the neonatal period: a European perspective. Acta Paediatrics. 2010; 99(4): 497-501. [PubMed]
11. Gilman JT, Gal P, Duchowny MS, Weaver RL, Weaver RL, Ransom JL. Rapid sequential phenobarbitone treatment of neonatal seizures. Pediatrics. 1989; (83):674-8.
12. Bialer M, Smith PE. Introduction. Epilepsia 2012;53(s8):1-2.
13. Volpe JJ. Neonatal Seizures: Neurology of the Newborn. Philadelphia: WB Saunders; 1999. P.172-225.
14. Sanjeev kumar digra, Ashok gupta,JK SCIENCE-28;Vol.9,No.1,January-March 2007.
15. Mahjoob N.AL-Naddawi. Clinical types and possible etiologies of neonatal seizures- a hospital based study, Journal of Faculty of Medicine, Baghdad 2,Vol.53, No.1,2011.
16. Taksande AM, Vilhekar K, Jain M,Lakra M.Clinico-Biochemical Profile Of Neonatal Seizures. Pediatric Oncall 2005;October 1;2.
17. Plouin P, Kaminska A. Neonatal seizures. Handbook of Clinical Neurology. 2013; 111:467-76. [PubMed]
18. Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population based study. Journal of Pediatrics 1999;(134):71e5.
19. Yidiz EP, Tatli B, Ekici B, Eraslan E, Aydinli N, Calişkan M, Ozmen M. Evaluation of etiologic and prognostic factors in neonatal convulsions. Pediatric Neurology. 2012 Sep;47(3):186-92.
20. Cowan F, Rutherford M, Groenendaal F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361: 736-742.
21. Iype M, Prasad M, Nair PM, Geetha S, Kailas L. The newborn with seizures - a follow-up study. Indian Pediatrics 2008;(45):749-52. [PubMed]
22. Kumar A, Gupta A, Talukdar B. Clinico-etiological and EEG profile of neonatal seizures. Indian Journal of Pediatrics 2007;(74):33-7. [PubMed]
23. Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Seminars in Fetal Neonatal Medicine. 2013 Aug;18(4):185-91. [PubMed]
24. Tekgul H, Gauvreau K, Soul J, et al. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics. 2006;117:1270-1280. [PubMed]
25. Pathak, et al. Phenobarbitone Vs Phenytoin For Neonatal Seizures.Indian Pediatrics 756 Volume 50 ,August 15, 2013.
26. Boylan GB, Rennie JM, Pressler RM, Wilson G, Morton M, Binnie CD. Phenobarbitone, neonatal seizures, and video-EEG. Archives of Disease in Childhood - Fetal & Neonatal Edition. 2002;(86):165-7.
27. Roop Gursahani .Phenobarbitone in Modern India, Supplement to the journal of the association of physicians of India- August 2013- Vol .61.
28. Gilman JT, Gal P, Duchowny MS, Weaver RL, Ransom JL. Rapid sequential phenobarbital treatment of neonatal seizures. Pediatrics 1989;(83):674e8. [PubMed]
29. Painter MJ, Pippenger C, MacDonald H, Pitlick W. Phenobarbital and diphenylhydantoin levels in neonates with seizures. Journal of Pediatrics 1978;(92):315e9.
30. Van Orman CB, Darwish HZ. Efficacy of phenobarbital in neonatal seizures. Canadian Journal of Neurological Sciences 1985;(12):95e9.
31. Castro Jr C, Hernandez Borges AA, Domenech ME, Gonzalez CC, Perera SR. Midazolam in neonatal seizures with no response to phenobarbital. Neurology 2005;(64):876e9. [PubMed]
32. Painter MJ, Scher MS, Stein MD, Armatti S, Gardner JC. Phenobarbitone compared with Phenytoin for neonatal seizures. New England Journal of Medicine.1999;(341):485-9. [PubMed]
33. Michael J.Painter, Mark S .Scher, Aryeh D.Stein. Phenobarbital compared with Phenytoin for the treatment of Neonatal Seizures. New England Journal of Medicine .Vol 341,No 7.
34. Painter Mj, Scher Ms, Stein Ad et al. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. New England Journal of Medicine 1999; (341): 485-489. [PubMed]
35. Painter MJ, Pippenenger C, Wasterlain C, Barmada M, Pitlick W, Carter G, Abern S. Phenobarbital and phenytoin in neonatal seizures: Metabolism and tissue distribution. Neurology 1981; (31): 1107-1112.
36. Ouvrier RA, Goldsmith R. Phenobarbitone dosage in neonatal convulsions. Archives of Diseases in Childhood 1982; (57): 653-7. [PubMed]
37. Jalling B. Plasma concentrations of phenobarbital in the treatment of seizures in newborns. Acta Paediatrics 1975;(64): 514-524.
38. Raines A, Henderson TR, Swinyard EA, Dretechen KL. Comparison of midazolam and diazepam by the intramuscular route for control of seizures in a mouse model of status epilepticus. Epilepsia 1990; (31): 313-317.
39. Gal P, Toback DJ, Boer HR, Erkan NV, Wells TJ. Efficacy of phenobarbital monotherapy in treatment of neonatal seizures- relationship to blood levels. Neurology 1982; (32):1401. [PubMed]
40. Foster M, Lewis, Peter A. The Treatment of Neonatal Seizures: A Critical Review of the Evidence. Neonatal, Paediatric and Child Health Nursing 2007; 10(2).
CITATION
DOI: 10.17511/ijmrr.2015.i1.11
Published: 2015-02-28
How to Cite
1.
Rabindran R, Parakh H, J K R, Reddy P. Phenobarbitone for the Management of Neonatal Seizures - A Single Center Study. Int J Med Res Rev [Internet]. 2015Feb.28 [cited 2024Nov.23];3(1):63-1. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/187
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Original Article
OAI - Open Archives Initiative
