41 Drug treatment of neonatal seizures by neonatologists and paediatric neurologists: a survey of practice in Australia and New Zealand

Background Guidelines recommend that recurrent or prolonged seizures in neonates be treated with phenobarbitone being the preferred drug for initial treatment. A 2005 survey of neonatologists and paediatric neurologists in Australia and New Zealand (ANZ) reported that 95% of respondents chose phenobarbitone (PB) as initial therapy?. Newer anti-epileptic drugs have become available which may have better safety profiles, although efficacy is less well-established. This current study aimed to reassess the practice of ANZ neonatologists and paediatric neurologists with regards to choice of drugs for initial and escalation treatment of neonatal seizures and to assess whether seizure management by each specialty has changed since 2005. Methodology Neonatologists and paediatric neurologists in ANZ were invited to complete an online survey. A scenario suggestive of acute symptomatic seizures in a 12-hour-old, term infant was presented. Participants were asked multiple choice questions about drug treatment choices. Survey questions were modelled on the questions of the 2005 survey with additional questions to detect practice change. Results Neonatologists (n=70) and paediatric neurologists (n=16) completed the survey. When presented with a scenario of an infant in a referring hospital who had several brief clinical seizures, 22% (18) of respondents chose no drug treatment while awaiting a retrieval team. Of those that did choose treatment, 93% chose PB and 7% levetiracetam (LEV). Neurologists were more likely to use LEV than neonatologists (p<0.05). To treat a second episode of seizures 69% of respondents chose another dose of PB compared with 84% of respondents in2005 (p<0.05). Others chose LEV (24%), phenytoin (3%), or topiramate (1%). For a third episode of seizures, of the 83% who would treat, 24% chose PB and 51%, LEV, while the remainder chose phenytoin or a benzodiazepine. Half of participants (52%) would not continue treatment after cessation of seizures. Conclusion PB remains preferred for initial treatment of neonatal seizures among ANZ neonatologists and paediatric neurologists. Phenytoin or benzodiazepines choices decreased but LEV is increasingly chosen for seizures refractory to PB. Considerable practice variability persists in management of neonatal seizures and reduction in this may improve outcomes. Reference Carmo KB, Barr P. Drug treatment of neonatal seizures by neonatologists and paediatric neurologists. J Paediatr Child Health 2005;41(7):31.