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Anticonvulsants for preventing mortality and morbidity in full term newborns with perinatal asphyxia
1Division of Paediatrics and Child Health, University of Leeds, D Floor Clarendon Wing, The General Infirmary at Leeds, Leeds, UK, LS2 9NS. d.j.evans@leeds.ac.uk
Insights
Anticonvulsant therapy for newborns after perinatal asphyxia is not recommended for routine use, as current evidence does not show benefits in preventing death or severe neurodevelopmental disability. Treatment may be considered for prolonged or frequent seizures.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Clinical Pharmacology
Background:
- Perinatal asphyxia poses significant risks to newborns, including mortality and severe neurodevelopmental disability.
- Anticonvulsant medications are sometimes used to manage seizures in affected infants.
Purpose of the Study:
- To evaluate the efficacy and safety of anticonvulsant administration in term infants (≥37 weeks gestation) following perinatal asphyxia.
- Primary objectives include assessing the prevention of death, severe neurodevelopmental disability, and neonatal seizures.
Main Methods:
- A systematic review of randomized and quasi-randomized controlled trials was conducted.
- Searches included electronic databases (MEDLINE), hand searches, and the Neonatal Review Group trials register.
- Studies compared anticonvulsant therapy versus control (placebo or conventional therapy) in term infants post-asphyxia, analyzing mortality, neurodevelopmental outcomes, seizures, and adverse events.
Main Results:
- Five trials met the inclusion criteria; however, none were of sufficient quality or size to demonstrate significant changes in mortality or severe neurodevelopmental disability.
- A meta-analysis of three studies on barbiturates versus conventional therapy showed no significant difference in mortality or severe neurodevelopmental disability.
Conclusions:
- Current evidence does not support the routine use of anticonvulsants for term infants following perinatal asphyxia, except for managing prolonged or frequent seizures.
- Future research requires high-quality, adequately powered randomized controlled trials with robust methodology (allocation concealment, blinding, minimal attrition) to assess primary outcomes.
Objectives:
To assess the benefits and harm of administering anticonvulsants to infants of 37 weeks gestation or more following perinatal asphyxia with the primary aims of prevention of death or subsequent severe neurodevelopmental disability and/or the prevention of seizures.
Search Strategy:
Relevant randomised controlled trials were identified using a combination of electronic database searches (MEDLINE), hand searches and a search of the Neonatal Review Group trials register.
Selection Criteria:
All randomised, or quasi-randomised, controlled clinical trials with reported data comparing the following outcomes: mortality, neurodevelopmental disability, neonatal seizures and adverse events, following anticonvulsant therapy in term infants (37 weeks or more), compared to controls with or without placebo, following perinatal asphyxia.
Data Collection And Analysis:
Methodological quality and validity of studies were assessed without consideration of the results. Data relevant to the outcome were extracted and analysed.
Main Results:
Five randomised or quasi-randomised controlled trials which met the selection criteria were identified. No studies were of sufficient methodological quality and size to demonstrate a valid, clinically significant change in the risk of mortality or severe neurodevelopmental disability. A meta-analysis combining three studies comparing barbiturates with conventional therapy following perinatal asphyxia demonstrated no difference in risks of death, severe neurodevelopmental disability, or death or severe neurodevelopmental disability.
Reviewer'S Conclusions:
At the present time, anticonvulsant therapy to term infants in the immediate period following perinatal asphyxia cannot be recommended for routine clinical practice, other than in the treatment of prolonged or frequent clinical seizures. Any future studies should be of high quality: randomised control trials with allocation concealment, performance and outcome assessment blinding. Such studies should be of sufficient size, with minimal attrition, to have the power to detect clinically important reductions in mortality and severe neurodevelopmental disability, as the primary outcome measures.