Drug treatment of neonatal seizures by neonatologists and paediatric neurologists.
OBJECTIVE
To survey anti-epileptic drug (AED) treatment of early-onset neonatal seizures by neonatologists and paediatric neurologists.


METHODS
A self-administered questionnaire was posted to Australian and New Zealand neonatologists and paediatric neurologists. Participants were given the hypothetical case of a full-term infant with early-onset seizures following perinatal asphyxia and asked to nominate their preferred AED for treatment of three seizure episodes during the first 24 h.


RESULTS
One hundred and seven (57%) of 187 individuals answered the questionnaire: neonatologists responded more often than neurologists (chi(2) (1,187) = 7.18, P = 0.007). Phenobarbitone was used by 95% of the respondents to treat the first episode of seizures and 75% of them used an appropriate loading dose (20 mg/kg). Phenobarbitone was used by 84 and 40% of the respondents to treat the second- and third-seizure episodes, respectively. Neonatologists used phenobarbitone, phenytoin and a benzodiazepine with equal frequency to treat a third episode of seizures, whereas neurologists rarely used a benzodiazepine. Neonatologists used significantly larger total doses of phenobarbitone than neurologists. Very few respondents used pyridoxine to treat recurrent seizures that were historically linked to perinatal asphyxia and hypoxic-ischaemic encephalopathy. Neonatologists were more likely than neurologists to discontinue AED within a few days of seizure cessation (chi(2) (1,106) = 11.60, P = 0.0006).


CONCLUSIONS
Australian and New Zealand neonatologists and paediatric neurologists generally use phenobarbitone to treat neonatal seizures presumed to be owing to hypoxic-ischaemic encephalopathy, though they do not always use appropriate doses. Neonatologists use phenobarbitone, phenytoin or a benzodiazepine for second and third episodes of seizures, whereas neurologists tend not to use benzodiazepines. Neonatologists use larger total doses of phenobarbitone than neurologists in pursuit of seizure control. Neonatologists discontinue AED earlier than neurologists.
Carmo
Kathryn Browning
KB
Department of Neonatology, Royal Alexandra Hospital for Children, Sydney, New South Wales, Australia.
Barr
Peter
P
D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D009462:Neurology; D009517:New South Wales; D009520:New Zealand; D010634:Phenobarbital / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012640:Seizures / Q000150:complications / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D000078329:Workforce
D000927:Anticonvulsants; D001569:Benzodiazepines; D010672:Phenytoin; D010634:Phenobarbital