Carmo Kathryn Browning, Barr Peter
Department of Neonatology, Royal Alexandra Hospital for Children, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2005 Jul;41(7):313-6. doi: 10.1111/j.1440-1754.2005.00638.x.
To survey anti-epileptic drug (AED) treatment of early-onset neonatal seizures by neonatologists and paediatric neurologists.
A self-administered questionnaire was posted to Australian and New Zealand neonatologists and paediatric neurologists. Participants were given the hypothetical case of a full-term infant with early-onset seizures following perinatal asphyxia and asked to nominate their preferred AED for treatment of three seizure episodes during the first 24 h.
One hundred and seven (57%) of 187 individuals answered the questionnaire: neonatologists responded more often than neurologists (chi(2) (1,187) = 7.18, P = 0.007). Phenobarbitone was used by 95% of the respondents to treat the first episode of seizures and 75% of them used an appropriate loading dose (20 mg/kg). Phenobarbitone was used by 84 and 40% of the respondents to treat the second- and third-seizure episodes, respectively. Neonatologists used phenobarbitone, phenytoin and a benzodiazepine with equal frequency to treat a third episode of seizures, whereas neurologists rarely used a benzodiazepine. Neonatologists used significantly larger total doses of phenobarbitone than neurologists. Very few respondents used pyridoxine to treat recurrent seizures that were historically linked to perinatal asphyxia and hypoxic-ischaemic encephalopathy. Neonatologists were more likely than neurologists to discontinue AED within a few days of seizure cessation (chi(2) (1,106) = 11.60, P = 0.0006).
Australian and New Zealand neonatologists and paediatric neurologists generally use phenobarbitone to treat neonatal seizures presumed to be owing to hypoxic-ischaemic encephalopathy, though they do not always use appropriate doses. Neonatologists use phenobarbitone, phenytoin or a benzodiazepine for second and third episodes of seizures, whereas neurologists tend not to use benzodiazepines. Neonatologists use larger total doses of phenobarbitone than neurologists in pursuit of seizure control. Neonatologists discontinue AED earlier than neurologists.
调查新生儿科医生和儿科神经科医生对抗癫痫药物（AED）治疗早发性新生儿惊厥的情况。
向澳大利亚和新西兰的新生儿科医生和儿科神经科医生发放了一份自填式问卷。参与者被给予一个假设案例，即一名足月婴儿在围产期窒息后出现早发性惊厥，并被要求指出他们在婴儿出生后24小时内治疗三次惊厥发作时首选的抗癫痫药物。
187名受访者中有107名（57%）回答了问卷：新生儿科医生的回复率高于神经科医生（卡方检验（1,187）=7.18，P=0.007）。95%的受访者使用苯巴比妥治疗首次惊厥发作，其中75%使用了合适的负荷剂量（20mg/kg）。分别有84%和40%的受访者使用苯巴比妥治疗第二次和第三次惊厥发作。新生儿科医生使用苯巴比妥、苯妥英和苯二氮䓬治疗第三次惊厥发作的频率相同，而神经科医生很少使用苯二氮䓬。新生儿科医生使用的苯巴比妥总剂量明显高于神经科医生。很少有受访者使用维生素B6治疗既往与围产期窒息和缺氧缺血性脑病相关的反复惊厥发作。新生儿科医生比神经科医生更有可能在惊厥停止后的几天内停用抗癫痫药物（卡方检验（1,106）=11.60，P=0.0006）。
澳大利亚和新西兰的新生儿科医生和儿科神经科医生通常使用苯巴比妥治疗推测由缺氧缺血性脑病引起的新生儿惊厥，尽管他们并非总是使用合适的剂量。新生儿科医生在第二次和第三次惊厥发作时使用苯巴比妥、苯妥英或苯二氮䓬，而神经科医生则倾向于不使用苯二氮䓬。为了控制惊厥，新生儿科医生使用的苯巴比妥总剂量高于神经科医生。新生儿科医生比神经科医生更早停用抗癫痫药物。
