Early Discontinuation of Phenobarbital After Acute Symptomatic Neonatal Seizures in the Term Newborn

Abstract

Acute symptomatic seizures in the term newborn are often seen after perinatal brain injury. Common etiologies include hypoxic-ischemic encephalopathy, ischemic stroke, intracranial hemorrhage, metabolic derangements, and intracranial infections. Neonatal seizures are often treated with phenobarbital, which may cause sedation and may have significant long-term effects on brain development. Recent literature has suggested that phenobarbital may be safely discontinued in some patients before discharge from the neonatal intensive care unit. Optimizing a strategy for selective early phenobarbital discontinuation would be of great value. In this study, we present a unified framework for phenobarbital discontinuation after resolution of acute symptomatic seizures in the setting of brain injury of the newborn.

Figure. Framework for Phenobarbital Discontinuation After Acute Symptomatic Seizures

While most patients with resolved acute symptomatic neonatal seizures will benefit from discontinuing all antiseizure medications during NICU discharge, there are some patients who would instead benefit from a stratified approach to discontinuing phenobarbital use, based on predictors of long-term epilepsy. Predictors of long-term epilepsy include but are not limited to severe perinatal brain injury, elevated seizure burden, and the presence of neonatal status epilepticus. NICU, neonatal intensive care unit.