title: Short-Term Effects of Phenobarbitone on Electrographic Seizures in Neonates.
abstract: Phenobarbitone is the most common first-line anti-seizure drug and is effective in approximately 50% of all neonatal seizures.
  
  
  
  To describe the response of electrographic seizures to the administration of intravenous phenobarbitone in neonates using seizure burden analysis techniques.
  
  
  
  Multi-channel conventional EEG, reviewed by experts, was used to determine the electrographic seizure burden in hourly epochs. The maximum seizure burden evaluated 1 h before each phenobarbitone dose (T-1) was compared to seizure burden in periods of increasing duration after each phenobarbitone dose had been administered (T+1, T+2 to seizure offset). Differences were analysed using linear mixed models and summarized as means and 95% CI.
  
  
  
  Nineteen neonates had electrographic seizures and met the inclusion criteria for the study. Thirty-one doses were studied. The maximum seizure burden was significantly reduced 1 h after the administration of phenobarbitone (T+1) [-14.0 min/h (95% CI: -19.6, -8.5); p < 0.001]. The percentage reduction was 74% (IQR: 36-100). This reduction was temporary and not significant within 4 h of administrating phenobarbitone. Subgroup analysis showed that only phenobarbitone doses at 20 mg/kg resulted in a significant reduction in the maximum seizure burden from T-1 to T+1 (p = 0.002).
  
  
  
  Phenobarbitone significantly reduced seizures within 1 h of administration as assessed with continuous multi-channel EEG monitoring in neonates. The reduction was not permanent and seizures were likely to return within 4 h of treatment.
authors.affiliation: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Evonne
authors.initials: E
authors.lastname: Low
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Stevenson
authors.forename: Sean R
authors.initials: SR
authors.lastname: Mathieson
authors.forename: Vicki
authors.initials: V
authors.lastname: Livingstone
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Ryan
authors.forename: Janet M
authors.initials: JM
authors.lastname: Rennie
authors.forename: Geraldine B
authors.initials: GB
authors.lastname: Boylan
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D004569:Electroencephalography; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D008991:Monitoring, Physiologic; D010634:Phenobarbital / Q000008:administration & dosage*; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital