A term neonate develops generalised myoclonic seizures at 4 hours of life. Blood glucose is 5.2 mmol/L, serum calcium is normal, and there is no history of asphyxia. The mother received isoniazid throughout pregnancy without pyridoxine supplementation. The MOST appropriate immediate treatment is:

• A Phenobarbitone 20 mg/kg IV
• B Lorazepam 0.1 mg/kg IV
• C Levetiracetam 40 mg/kg IV
• D Pyridoxine 100 mg IV ✓

Explanation

Isoniazid is a competitive inhibitor of pyridoxal phosphate synthesis, and neonates born to mothers on isoniazid without pyridoxine supplementation can develop pyridoxine-deficient seizures in the immediate neonatal period. These seizures are characteristically resistant to conventional anticonvulsants but respond dramatically to IV pyridoxine. Phenobarbitone and lorazepam will not address the underlying metabolic cause.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.