Approach to treatment of neonatal seizures

This algorithm represents our suggested approach to the treatment of neonatal seizures. Refer to UpToDate topics on neonatal seizures for full details regarding the use of antiseizure medications, including initiating therapy, selecting appropriate agents, and stopping or continuing therapy.

EEG: electroencephalography; IV: intravenous; PE: phenytoin equivalents.

* For neonates with confirmed acute provoked seizures, we generally discontinue antiseizure medications without a taper after 72 hours of seizure freedom prior to hospital discharge.

¶ There are limited data on comparative efficacy and best dosing strategies for second-line therapies.

Δ Low body weight (<2.5 kg) and newborns undergoing hypothermia treatment are at risk for accumulation of lidocaine. Adjust dose for low body weight or if using concurrent therapeutic hypothermia^[1]. Refer to accompanying UpToDate text and separate table of lidocaine dosing for neonatal seizures.

◊ Levetiracetam may not be effective as a second-line antiseizure medication.

Reference:

van den Broek MP, Rademaker CM, van Straaten HL, et al. Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: efficacy, safety and dosing. Arch Dis Child Fetal Neonatal Ed 2013; 98:F341.

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