title: Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors.
abstract: BACKGROUND
  Lidocaine is an effective therapy for neonatal seizures; however, it is not widely used, presumably due to the risk of cardiac events.
  
  
  OBJECTIVE
  To investigate the incidence of cardiac events in full-term and preterm infants receiving lidocaine for seizures.
  
  
  METHODS
  Full-term (n = 368) and preterm (n = 153) infants, admitted to a level 3 neonatal intensive care unit from 1992 to 2012, who received lidocaine for seizures were retrospectively studied. The causal relation between reported cardiac events and lidocaine administration was evaluated based on expected plasma concentrations, symptoms and relevant interactions during cardiac events.
  
  
  RESULTS
  Cardiac events were reported in 11/521 infants (2.1%; 9 full-term, 2 preterm). In 7/11 infants the causal relation was considered plausible, in 3/11 questionable and in 1/11 implausible. The incidence was calculated to be 1.3-1.9% (n = 7-10/521), but was only 0.4% (n = 1/246, p = 0.02) when using reduced-dose regimens. Important risk factors for cardiac events were unstable potassium, (congenital) cardiac dysfunction and concurrent phenytoin use.
  
  
  CONCLUSIONS
  Lidocaine-associated cardiac events were rare in our cohort, especially since the introduction of new reduced-dose regimens. This indicates that lidocaine is safe to use as an antiepileptic drug in full-term and preterm infants.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Weeke
authors.forename: Stein
authors.initials: S
authors.lastname: Schalkwijk
authors.forename: Mona C
authors.initials: MC
authors.lastname: Toet
authors.forename: Linda G M
authors.initials: LG
authors.lastname: van Rooij
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
authors.forename: Marcel P H
authors.initials: MP
authors.lastname: van den Broek
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001724:Birth Weight; D001919:Bradycardia / Q000139:chemically induced*; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007035:Hypothermia / Q000139:chemically induced*; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008012:Lidocaine / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy*; D047929:Term Birth
chemical_list: D000927:Anticonvulsants; D008012:Lidocaine