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Carbamazepine in phenobarbital-nonresponders: experience with ten preterm infants
T Hoppen1, C E Elger, P Bartmann
1Neonatology Division, Department of Paediatrics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Insights
Carbamazepine is effective for treating neonatal seizures in preterm infants when phenobarbital fails. This study shows excellent therapeutic success with no observed adverse effects in small preterm infants.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Pediatric Neurology
Background:
- Carbamazepine is a common anticonvulsant for children and adults.
- Limited data exists on its use in neonates, particularly preterm infants.
Purpose of the Study:
- To investigate the efficacy and safety of oral carbamazepine as a second-line treatment for phenobarbital-refractory neonatal seizures in preterm infants.
Main Methods:
- Ten preterm infants with neonatal seizures refractory to phenobarbital were treated with oral carbamazepine (7-23 mg/kg/day).
- Plasma drug levels were monitored to ensure therapeutic concentrations (3-12 mg/l).
Main Results:
- Nine out of ten infants, especially those under 30 weeks gestational age and weighing less than 1000g, showed excellent therapeutic success.
- Carbamazepine therapy, continued for 1-5 months, resulted in no further seizures, confirmed by EEG.
- No carbamazepine-induced adverse effects were observed during the study.
Conclusions:
- This is the first report detailing carbamazepine use in small preterm infants.
- Carbamazepine appears to be a safe and effective oral maintenance therapy for neonatal seizures in this vulnerable population.
Unlabelled:
Carbamazepine is a standard anticonvulsant in children and adults. Until now there is only little information available on its use in neonates. We investigated the oral administration of carbamazepine in refractory neonatal seizures treated with phenobarbital. Ten preterm infants (gestational age 23 + 6-34 + 6 weeks, birth weight 640 g-3080 g) with neonatal seizures were refractory to a primary therapy with phenobarbital. All patients subsequently received carbamazepine exclusively as a second choice anticonvulsant. A daily dose of 7-23 mg/kg carbamazepine was administered orally in two to three aliquots. All patients reached therapeutic plasma drug levels (3-12 mg/l; 13-50 mumol/l). In nine out of ten patients (complete group of small preterms with gestational age under 30 weeks and weight less than 1000 g), therapeutic success was excellent. Carbamazepine was continued for 1-5 months. After termination of therapy no further seizures occurred, also on EEG recordings. Finally, no carbamazepine-induced adverse effects were observed.
Conclusion:
This is the first report on the use of carbamazepine in small preterm infants. Carbamazepine may provide a useful and effective oral maintenance therapy in the management of neonatal seizures in these patients.