Initial management and anticonvulsant duration in neonatal seizures
THE CONTEXT
Neonatal seizures are a medical emergency requiring prompt recognition, stabilization, and appropriate medication.
Immediate management
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First identify and characterize the seizure, then ensure normal temperature, an open airway, breathing, and circulation.
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After hypoglycemia has been ruled out, phenobarbitone is the initial medication.
Long-term anticonvulsant therapy
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Most drugs used in anticonvulsant therapy have the potential to damage long-term brain development, particularly during the first two years of age.
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World Health Organization guidelines suggest discontinuing anticonvulsant therapy as soon as possible.
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In the practice described, maintenance phenobarbitone is discontinued when the neonate is breastfeeding well and has a normal neurological examination at discharge.