Adverse neurodevelopmental outcomes after exposure to phenobarbital and levetiracetam for the treatment of neonatal seizures.
OBJECTIVE
Compare neurodevelopment after levetiracetam (LEV) and phenobarbital (PB) for neonatal seizures.


METHODS
Retrospective study of infants who received antiepileptic drugs (AEDs) for neonatal seizures. Effect of cumulative exposure to LEV and PB on outcomes of death, cerebral palsy (CP) and Bayley Scales of Infant Development (BSID) scores were evaluated at 24 months corrected age. Analyses were adjusted for number of electrographic seizures and gestational age.


RESULTS
In 280 infants with comparable seizure etiology and cranial imaging results, increased exposure to PB was associated with worse BSID cognitive and motor scores (8.1- and 9-point decrease per 100 mg kg(-1); P=0.01). The effect was less with LEV (2.2- and 2.6-point decrease per 300 mg kg(-1) LEV (P=0.01)). CP probability increased by 2.3-fold per 100 mg kg(-1) PB and was not associated with increasing LEV.


CONCLUSIONS
Increased exposure to PB is associated with worse neurodevelopmental outcomes than LEV. Prospective studies of outcomes of neonatal exposure to AEDs are essential.
Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
N L
NL
Maitre
C
C
Smolinsky
J C
JC
Slaughter
A R
AR
Stark
D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D015331:Cohort Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D000077287:Levetiracetam; D010634:Phenobarbital / Q000008:administration & dosage / Q000009:adverse effects*; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*
D000927:Anticonvulsants; D000077287:Levetiracetam; D010634:Phenobarbital; D010889:Piracetam