DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20220449
Published: 2022-02-23

Comparative trial of seizure recurrence in phenobarbitone maintenance for 72 hrs versus till discharge in moderate to severe perinatal asphyxia in term infants

Hemangi Koul, G. S. Saini

Abstract


Background: This study was done to look for seizure recurrence in moderate to severe perinatal asphyxia when phenobarbitone was stopped at seizure free interval of 72 hours versus those in whom phenobarbitone was continued upto discharge.

Methods: It was a open label randomized trial conducted in neonatal intensive care unit of department of Pediatrics, SMGS from November 2014 to October 2015. This study was conducted on term babies (>37 weeks) with birth asphyxia with moderate to severe encephalopathy according to Levene classification with seizures within 24 hours admitted in NICU.

Results: Recurrence of seizures was 6 (10%) in whom phenobarbitone was continued upto discharge and 8 (13.3%) in whom phenobarbitone was stopped after 72 hours of seizure free interval. These results were statistically comparable.

Conclusions: There is no beneficial effect of giving phenobarbitone for more than 72 hour in neonates having moderate to severe perinatal asphyxia who are neurologically normal.


Keywords


Asphyxia, Antiepileptic drugs, Development, EEG, Mortality, Seizures, Phenobarbitone

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References


Clancy RR. Summary proceedings from the neurology group on Neonatal seizures. Europe PMC. 2006;117(3pt2):S23-7.

Evans DJ, Levene M, Tsakmakis M. Anticonvulsants for preventing mortality and morbidity in full term newborns with perinatal asphyxia. Cochrane Database of Systematic Reviews. 2007;3:CD001240.

Bhutta ZA. Paediatrics in the Tropics. Manson's Tropical Infectious Diseases. 2014;1197-1214.e2.

Sankar JM, Agarwal R, Deorari A, Paul VK. Management of neonatal seizures. Indian journal of paediatrics. 2010;77:1129-35.

Clancy RR. Summary proceedings from the neurology group on Neonatal seizures. Europe PMC. 2006;117(3pt2) S23-7.

Bartha AI, Shen J, Katz KH, Rebecca E. Mischel, Katherine R. Yap, JudithA.Ivacko, Ena M.Andrews, Donna M, Ferriero, Laura R, Ment, Faye S. Silverstein Neonatal seizures: multicenter variability in current practices. Pediatric Neurology. 2007;37 85-90.

Marsh ED, Brooks-Kayal AR, Porter BE. Seizures and antiepileptic drugs; does exposure alter normal brain development. Epilepsia. 2006;47(12):1999-2010.

WHO Guidelines 2011: Guidelines on neonatal seizures. 2011.

Gilman JT, Gal P, Duchowny MS, Weaver RL, Lawrence J. Ransom Rapid sequential Phenobarbital treatment of neonatal seizures AAP gateway. 1989;83:674-78.

Garima Pathak, Amit Upadhyay,Umesh Pathak,Deepak Chawla and Sneh P Goel. Phenobarbitone and phenytoin for treatment of neonatal seizures: open label randomized control trial, Indian Pediatrics, 2013;50(8):753-7.

Guillet R, Kwon J. Seizure recurrence and developmental disabilities after neonatal seizures: outcome are unrelated to use of phenobarbitone prophylaxis. Journal of child neurology. 2007;22:389-95.

Gherpelli JL, Pas JA, Leone CR, Ramoz JLA. Diament Seizure recurrence in infants with neonatal convulsions. rq neuro-psiquiat. 1992;50(1):31-6.

Hellstrom-Westas G, Blennow M, Lindroth I, Rosen NW. Low risk of seizure recurrence after early withdrawal of antiepileptic treatment in the neonatal period: Archives of Disease in Childhood. Fetal and Neonatal Edition. 2007;72(2):F97-101.

Painter MJ, Scher MS, Stein AD. Phenobarbitone compared with phenytoin for treatment of neonatal seizures. N eng J Med. 1999;341:485-9.

Hall RT, Hall FK, Donna K. Daily High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: A randomized, prospective study with three-year follow-up:Journal of Pediaatrics. 1998;132(2):345-8.

Lai YH, Ho CS, Chiu NC, Tseng CF, Huang YL. Prognostic Factors of Developmental Outcome in Neonatal Seizures in Term Infants. Paediatrics and Neonatology. 2013;54(3):166-72.

Velaphi S, Mokhachane M, Mphahlele R, Beckh-Arnol E. Effect of prophylactic phenobarbital on seizures, encephalopathy and mortality in neonates with perinatal asphyxia. South African Journal of Child Health. 2013;7:1.

Conde JR, Borges AAH, Martínez EDC, Campo G, Soler RP. Midazolam in neonatal seizures with no response to phenobarbital. Neurology. 2005;64(5):876-9.

Donn SM, Grasela TH, Gary W. Goldstein Safety of a higher loading dose of phenobarbital in the term newborn. Pediatrics. 1985;75:1061-64.

Singh D, Singh A. A randomized controlled trial of phenobarbital in neonates with hypoxic ischemic encephalopathy. The Journal of Maternal-Fetal & Neonatal Medicine. 2005;18:6:391-5.

Scarpa P, Chierici R, Tamisari L, Fortini C, Volpato S. Criteria for discontinuing neonatal seizure therapy: A long-term appraisal. Brain and Development. 198;5(6):541-8.

Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology. 1987;37(12):1837-44.

Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 2008;93(3):F187-91.