Phenobarbital for neonatal seizures

response rate and predictors of refractoriness

Carlotta Spagnoli, Stefano Seri, Elena Pavlidis, Silvia Mazzotta, Annalisa Pelosi, Francesco Pisani

Research output: Contribution to journalArticle

Abstract

Background : Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45%. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited.
Objective : To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy.
Methods : We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness.
Results : Out of 91 newborns receiving phenobarbital, 57 (62.6%) responded completely, 15 (16.5%) partially, and 19 (20.9%) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p ≤ 0.005) correlated with response to phenobarbital. However, EEG (p ≤ 0.02) and seizure type (p ≤ 0.001) were the only independent predictors.
Conclusion : Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns.
Original languageEnglish
Pages (from-to)318-326
Number of pages9
JournalNeuropediatrics
Volume47
Issue number5
Early online date26 Jul 2016
DOIs
Publication statusPublished - Oct 2016

Fingerprint

Phenobarbital
Seizures
Electroencephalography
Status Epilepticus
Neonatal Intensive Care Units
Neurologic Examination
Anticonvulsants
Italy
Multivariate Analysis

Keywords

  • neonatal seizures
  • newborns
  • outcome
  • phenobarbital
  • predictors of refractoriness
  • therapy

Cite this

Spagnoli, C., Seri, S., Pavlidis, E., Mazzotta, S., Pelosi, A., & Pisani, F. (2016). Phenobarbital for neonatal seizures: response rate and predictors of refractoriness. Neuropediatrics, 47(5), 318-326. https://doi.org/10.1055/s-0036-1586214
Spagnoli, Carlotta ; Seri, Stefano ; Pavlidis, Elena ; Mazzotta, Silvia ; Pelosi, Annalisa ; Pisani, Francesco. / Phenobarbital for neonatal seizures : response rate and predictors of refractoriness. In: Neuropediatrics. 2016 ; Vol. 47, No. 5. pp. 318-326.
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abstract = "Background : Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45{\%}. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited. Objective : To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy. Methods : We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness. Results : Out of 91 newborns receiving phenobarbital, 57 (62.6{\%}) responded completely, 15 (16.5{\%}) partially, and 19 (20.9{\%}) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p ≤ 0.005) correlated with response to phenobarbital. However, EEG (p ≤ 0.02) and seizure type (p ≤ 0.001) were the only independent predictors. Conclusion : Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns.",
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Spagnoli, C, Seri, S, Pavlidis, E, Mazzotta, S, Pelosi, A & Pisani, F 2016, 'Phenobarbital for neonatal seizures: response rate and predictors of refractoriness', Neuropediatrics, vol. 47, no. 5, pp. 318-326. https://doi.org/10.1055/s-0036-1586214

Phenobarbital for neonatal seizures : response rate and predictors of refractoriness. / Spagnoli, Carlotta; Seri, Stefano; Pavlidis, Elena; Mazzotta, Silvia; Pelosi, Annalisa; Pisani, Francesco.

In: Neuropediatrics, Vol. 47, No. 5, 10.2016, p. 318-326.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Phenobarbital for neonatal seizures

T2 - response rate and predictors of refractoriness

AU - Spagnoli, Carlotta

AU - Seri, Stefano

AU - Pavlidis, Elena

AU - Mazzotta, Silvia

AU - Pelosi, Annalisa

AU - Pisani, Francesco

PY - 2016/10

Y1 - 2016/10

N2 - Background : Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45%. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited. Objective : To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy. Methods : We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness. Results : Out of 91 newborns receiving phenobarbital, 57 (62.6%) responded completely, 15 (16.5%) partially, and 19 (20.9%) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p ≤ 0.005) correlated with response to phenobarbital. However, EEG (p ≤ 0.02) and seizure type (p ≤ 0.001) were the only independent predictors. Conclusion : Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns.

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Spagnoli C, Seri S, Pavlidis E, Mazzotta S, Pelosi A, Pisani F. Phenobarbital for neonatal seizures: response rate and predictors of refractoriness. Neuropediatrics. 2016 Oct;47(5):318-326. https://doi.org/10.1055/s-0036-1586214