A preterm infant with poor respiration at bih stas throwing seizures at 10 hours after bih. Anti- epileptic of choice shall be:
Ans. c. Phenobarbitone Phenobarbital: Drug of first choice in neonatal seizures Loading dose: 20 mg/Kg If this dose is not effective, then additional doses of 5-10 mg/kg can be given until a dose of 40 mg/kg is reached. After 24 hours of loading dose, maintenance dosing can be staed at 3-6 mg/Kg/day, usually administered in two separate doses Treatment of Neonatal Seizures A mainstay in the therapy of neonatal seizures is the diagnosis and treatment of underlying etiologyQ. Etiologies: Hypoglycemia0, hypocalcemiaQ, meningitisQ, drug withdrawal and trauma0 Drugs used in Neonatal Seizures Phenobarbital Drug of first choice in neonatal seizuresQ Loading dose: 20 mg/Kg If this dose is not effective, then additional doses of 5-10 mg/kg can be given until a dose of 40 mg/kg is reached. After 24 hours of loading dose, maintenance dosing can be staed at 3-6 mg/Kg/day, usually administered in two separate doses. Metabolized by liver, excreted by kidney Drugs used in Neonatal Seizures Phenytoin/Fosphenytoin If a total loading dose of 40 mg/kg of Phenobarbital was not effective, then a loading dose of 15-20 mg/Kg of Phenytoin or Fosphenytoin can be administered IV. Rate should not exceed 0.5-1 mg/Kg/min in order to prevent cardiac problem. Fosphenytoin, which is phosphate ester prodrug is preferred. It is highly soluble in water and can be administered very safely IV or IM, without causing injury to tissues Lorazepam The initial drug used to control acute seizure is usually Lorazepam Can be use either as the initial drug or as a 2"d line treatment in a newborn who does not respond to the treatment with Phenobarbital and Phenytoin. Lorazepam is distributed to brain very quickly and exes its anticonvulsants action in minutes. Diazepam and Midazolam Highly lipophilic, so it distributes very rapidly into the brain and then is cleared very quickly out, carrying the risk of recurrence of seizures Carries the risk of apnea and hypotension However, the IV preparation contains sodium benzoate and benzoic acid, it is currently not recommended as a first line agent. Leveteracetam Dose: 10-30 mg/Kg/day Drug of 2"d or 3rd choice
Leveteracetam
Phenytoin
Phenobarbitone
Lorazepam