Related Experiment Videos
Anticonvulsants for preventing mortality and morbidity in full term newborns with perinatal asphyxia
1Neonatal Intensive Care Unit, Southmead Hospital, Neonatal Intensive Care Unit, Southmead Hospital, Bristol, UK, BS10 5NB. dj-evans@doctors.org.uk
Insights
Anticonvulsant therapy for newborns after perinatal asphyxia does not prevent death or severe neurodevelopmental issues. Current evidence does not support routine use, except for treating prolonged seizures.
Area of Science:
- Neonatal Medicine
- Neuroscience
- Pharmacology
Background:
- Perinatal asphyxia poses significant risks to newborns, including death and neurodevelopmental disabilities.
- Seizures are a common complication following perinatal asphyxia in term infants.
- Anticonvulsant medications are often considered for seizure management and potential neuroprotection.
Purpose of the Study:
- To evaluate the efficacy and safety of anticonvulsant administration in term infants (≥37 weeks gestation) following perinatal asphyxia.
- Primary objectives included preventing mortality, severe neurodevelopmental disability, and seizures.
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searches included electronic databases (MEDLINE, EMBASE) and the Cochrane Controlled Trials Registry.
- Studies compared anticonvulsant therapy to control groups (placebo or conventional care) for outcomes like mortality, neurodevelopmental disability, seizures, and adverse events.
Main Results:
- Five trials met the inclusion criteria, but 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 showed no difference in the risk of death or severe neurodevelopmental disability compared to conventional therapy.
Conclusions:
- Routine anticonvulsant therapy for term infants post-perinatal asphyxia is not currently recommended, 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 clinically important reductions in mortality and severe neurodevelopmental disability.
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 and EMBASE), hand searches and a search of the Cochrane Controlled Trials Registry.
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.