include infection, SAH, hypoglycemia, drug withdrawal, intracranial pathology,
electrolyte abnormalities
First line anticonvulsants used include Phenobarbital, Keppra and benzodiazepines
(lorazepam [ativan], diazepam [valium]) in the newborn period. Also, it is imperative to
treat the underlying cause, if it can be determined (i.e. correct glucose, electrolyte
abnormalities, treat the infection, etc.).
Phenobarbital: loading dose 20 mg/kg IV; side effects include respiratory depression
and hypotension. Very long half-life in the infant (days).
Keppra: 10mg/kg/day divided BID, same dose for PO and IV; most common side effects
include decreased appetite and diarrhea; half-life in neonates is approximately 5 hours.
Benzodiazepines: Ativan 0.1 mg/kg, Valium 0.1 mg/kg; half-life measured in minutes-
hours; ideal for use in treating uncertain seizures or in situations where airway
management may be compromised.
NOTE: Other anticonvulsants such as phenytoin (Dilantin), carbazepam
(Tegretol) and phosphenytoin are used in the infant, but have many additional
considerations such as bilirubin displacement and/or drug interactions. These tend to
be second-line agents and are used primarily in conjunction with a neurology consult.