A 48-hour-old term neonate born by emergency LSCS for fetal distress is noted to have poor feeding, lethargy, and subtle multifocal clonic jerks. Blood glucose and calcium are normal. Temperature is 36.8°C. What is the most appropriate first-line anticonvulsant for this neonate with suspected hypoxic-ischemic encephalopathy-related seizures?

• A IV phenytoin 20 mg/kg
• B IV lorazepam 0.1 mg/kg
• C IV phenobarbital 20 mg/kg ✓
• D IV levetiracetam 40 mg/kg

Explanation

Phenobarbital 20 mg/kg IV is the first-line anticonvulsant for neonatal seizures per the WHO and neonatal seizure protocols. It achieves therapeutic levels rapidly and has the best evidence in neonates. Phenytobin is second-line due to its variable pharmacokinetics and cardiac effects in neonates. Benzodiazepines are less preferred as first-line in neonates due to respiratory depression risk.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.