The Use of Anti-Seizure Medications in Neonatal Intensive Care Unit

Neonatal seizures are the most common emergency neurological condition. Neonatal seizures require emergency treatment to prevent further brain injury. The most effective is causal treatment, such as treatment of transient metabolic disturbances, systemic and intracranial infections. However, anti-seizure medications are important for the treatment of seizures in high-risk neonates in whom seizures are not expected to resolve spontaneously. The International League Against Epilepsy developed evidence-based recommendations about anti-seizure medication and treatment of neonatal seizures. Phenobarbital remains the first-line treatment for neonatal seizures in term and preterm neonates. If neonatal seizures do not stop to phenobarbital, levetiracetam or phenytoin may be used as a second-line anti-seizure medication, as well as midazolam or lidocaine. Midazolam is a short-acting benzodiazepine using for treatment of refractory neonatal seizures. In neonates with cardiac disorders, levetiracetam may be the preferred second-line anti-seizure medication than phenytoin. Pyridoxine is recommended in neonates with seizure unresponsive to seconde-line therapy. Carbamazepine and phenytoin, as sodium blockers channels, are preferred for neonates with characteristics suggesting a channelopathy.