A term newborn on day 2 develops repetitive focal clonic movements of the left arm with apnea. Point-of-care glucose is 92 mg/dL and calcium is normal. Which drug is the accepted first-line agent for this neonatal seizure?
- A Phenobarbital ✓
- B Phenytoin
- C Midazolam infusion
- D Pyridoxine
Correct answer: A. Phenobarbital
Explanation
Phenobarbital remains the standard first-line antiseizure drug for neonatal seizures worldwide, given as a loading dose of about 20 mg/kg intravenously. Phenytoin or levetiracetam is considered second-line if phenobarbital fails, and a midazolam infusion is reserved for refractory status. Pyridoxine is a specific therapy only for pyridoxine-dependent seizures, a rare metabolic cause suspected when seizures are refractory from the first hours of life. The commonest cause of neonatal seizures overall is hypoxic-ischemic encephalopathy.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.