Phenobarbital compared with phenytoin for the treatment of neonatal seizures
Phenobarbital compared with phenytoin for the treatment of neonatal seizures
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DOI：
10.1056/nejm199908123410704
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发表时间：
1999-08-12
影响因子：
158.5
通讯作者：
Alvin, J
中科院分区：
文献类型：
--
作者：
Painter, MJ;Scher, MS;Alvin, J
背景：重症监护病房新生儿中有1%~ 2%发生癫痫发作。方法1990 ~ 1995年对59例经脑电图证实的新生儿惊厥患儿进行回顾性分析。新生儿被随机分配接受苯巴比妥或苯妥英静脉注射，剂量足以达到游离血浆浓度为25 μ g/ml苯巴比妥和3 μ g/ml苯妥英。然后，对癫痫发作未被指定药物控制的新生儿进行两种药物治疗。癫痫控制进行了评估脑电图criterions.Results癫痫控制在13的30名新生儿分配到接受苯巴比妥（43%）和13的29名新生儿分配到接受苯妥英钠（45%; P = 1.00）。当考虑联合治疗时，17例（57%）被分配先接受苯巴比妥的新生儿和18例（62%）被分配先接受苯妥英的新生儿癫痫发作得到控制（P = 0.67）。癫痫发作的严重程度是治疗成功的一个更强的预测因子，而不是指定的药物。轻度癫痫发作或癫痫发作的严重程度降低治疗前的新生儿更有可能有他们的癫痫发作结束，无论治疗assignment.Conclusions苯巴比妥和苯妥英是同样的，但不完全有效的抗惊厥药在新生儿。单独使用任何一种药物，癫痫发作在不到一半的新生儿中得到控制。（N Engl J Med 1999;341：485-9.）(C)1999年，马萨诸塞州医学会。
Background Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit. The treatment is usually with either phenobarbital or phenytoin, but the efficacy of the two drugs has not been compared directly.Methods From 1990 to 1995, we studied 59 neonates with seizures that were confirmed by electroencephalography. The neonates were randomly assigned to receive either phenobarbital or phenytoin intravenously, at doses sufficient to achieve free plasma concentrations of 25 mu g per milliliter for phenobarbital and 3 mu g per milliliter for phenytoin. Neonates whose seizures were not controlled by the assigned drug were then treated with both drugs. Seizure control was assessed by electroencephalographic criteria.Results Seizures were controlled in 13 of the 30 neonates assigned to receive phenobarbital (43 percent) and 13 of the 29 neonates assigned to receive phenytoin (45 percent; P = 1.00). When combined treatment is considered, seizure control was achieved in 17 (57 percent) of the neonates assigned to receive phenobarbital first and 18 (62 percent) of those assigned to receive phenytoin first (P = 0.67). The severity of the seizures was a stronger predictor of the success of treatment than was the assigned agent. Neonates with mild seizures or with seizures that were decreasing in severity before treatment were more likely to have their seizures end, regardless of the treatment assignment.Conclusions Phenobarbital and phenytoin are equally but incompletely effective as anticonvulsants in neonates. With either drug given alone, the seizures were controlled in fewer than half of the neonates. (N Engl J Med 1999;341:485-9.) (C) 1999, Massachusetts Medical Society.