<prompt> A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Anti- epileptic of choice shall be:LeveteracetamPhenytoinPhenobarbitoneLorazepam  <response>: Ans. c. Phenobarbitone Ref: Nelson 19e p2037Phenobarbital:Drug of first choice in neonatal seizuresLoading dose: 20 mgKgIf this dose is not effective, then additional doses of 5-10 mgkg can be given until a dose of 40 mgkg is reached.After 24 hours of loading dose, maintenance dosing can be started at 3-6 mgKgday, usually administered in two separate doses.Treatment of Neonatal SeizuresA mainstay in the therapy of neonatal seizures is the diagnosis and treatment of underlying etiologyQ.Etiologies: HypoglycemiaQ, hypocalcemiaQ, meningitisQ, drug withdrawal and traumaQDrugs used in Neonatal SeizuresPhenobarbital Drug of first choice in neonatal seizuresQ Loading dose: 20 mgKg If this dose is not effective, then additional doses of 5-10 mgkg can be given until a dose of 40 mg kg is reached. After 24 hours of loading dose, maintenance dosing can be started at 3-6 mgKgday, usually administered in two separate doses. Metabolized by liver, excreted by kidneyPhenytoinFosphenytoin If a total loading dose of 40 mgkg of Phenobarbital was not effective, then a loading dose of 15-20 mgKg of Phenytoin or Fosphenytoin can be administered IV. Rate should not exceed 0.5-1 mgKgmin in order to prevent cardiac problem. Fosphenytoin, which is phosphate ester prodrug is preferred. It is highly soluble in water and can be administered very safely IV or IM, without causing injury to tissues.Lorazepam The initial drug used to control acute seizure is usually Lorazepam. Can be use either as the initial drug or as a 2nd line treatment in a newborn who does not respond to the treatment with Phenobarbital and Phenytoin. Lorazepam is distributed to brain very quickly and exerts its anticonvulsants action in 5 minutes.Diazepam and Midazolam Highly lipophilic, so it distributes very rapidly into the brain and then is cleared very quickly out, carrying the risk of recurrence of seizures. Carries the risk of apnea and hypotension However, the IV preparation contains sodium benzoate and benzoic acid, it is currently not recommended as a first line agent.Leveteracetam Dose: 10-30 mgKgday Drug of 2nd or 3rd choice 