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Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants
Wilhelmina Childrens Hosp, Univ Med Ctr Utrecht, Dept Neonatol, Utrecht, Netherlands..
Wilhelmina Childrens Hosp, Univ Med Ctr Utrecht, Dept Neonatol, Utrecht, Netherlands..
Wilhelmina Childrens Hosp, Univ Med Ctr Utrecht, Dept Neonatol, Utrecht, Netherlands..
Wilhelmina Childrens Hosp, Univ Med Ctr Utrecht, Dept Neonatol, Utrecht, Netherlands..
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2016 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 57, no 2, 233-242 p.Article in journal (Refereed) Published
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Abstract [en]

ObjectiveTo investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug (AED) for neonatal seizures. MethodsFull-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed <2 h). ResultsLidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p < 0.001). In full-term infants the response to lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p < 0.001). Factors associated with a good response to lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second- or third-line AED and seizure etiology. SignificanceSeizure response to lidocaine was seen in similar to 70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs.

Place, publisher, year, edition, pages
2016. Vol. 57, no 2, 233-242 p.
Keyword [en]
Lidocaine, Midazolam, Response rate, Antiepileptic drugs, Neonatal seizures
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-281839DOI: 10.1111/epi.13286ISI: 000370048100009PubMedID: 26719344OAI: oai:DiVA.org:uu-281839DiVA: diva2:917320
Funder
EU, FP7, Seventh Framework Programme, 241479 HEALTH-F5-4.2-1
Available from: 2016-04-06 Created: 2016-03-30 Last updated: 2017-11-30Bibliographically approved

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Hellström-Westas, Lena

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