1597
document
Phenobarbital compared with phenytoin for the treatment of neonatal seizures . BACKGROUND Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit . The treatment is usually with either phenobarbital or phenytoin , but the efficacy of the two drugs has not been compared directly . METHODS From 1990 to 1995 , we studied 59 neonates with seizures that were confirmed by electroencephalography . The neonates were randomly assigned to receive either phenobarbital or phenytoin intravenously , at doses sufficient to achieve free plasma concentrations of 25 microg per milliliter for phenobarbital and 3 microg per milliliter for phenytoin . Neonates whose seizures were not controlled by the assigned drug were then treated with both drugs . Seizure control was assessed by electroencephalographic criteria . RESULTS Seizures were controlled in 13 of the 30 neonates assigned to receive phenobarbital ( 43 percent ) and 13 of the 29 neonates assigned to receive phenytoin ( 45 percent ; P=1.00 ) . When combined treatment is considered , seizure control was achieved in 17 ( 57 percent ) of the neonates assigned to receive phenobarbital first and 18 ( 62 percent ) of those assigned to receive phenytoin first ( P=0.67 ) . The severity of the seizures was a stronger predictor of the success of treatment than was the assigned agent . Neonates with mild seizures or with seizures that were decreasing in severity before treatment were more likely to have their seizures end , regardless of the treatment assignment . CONCLUSIONS Phenobarbital and phenytoin are equally but incompletely effective as anticonvulsants in neonates . With either drug given alone , the seizures were controlled in fewer than half of the neonates .
1598
Intervention_Pharmacological
Phenobarbital
1599
Intervention_Pharmacological
phenytoin
1600
Intervention_Pharmacological
phenobarbital
1601
Intervention_Pharmacological
phenytoin
1602
Intervention_Pharmacological
phenobarbital
1603
Intervention_Pharmacological
phenytoin
1604
Intervention_Pharmacological
Phenobarbital
1605
Intervention_Pharmacological
phenytoin
1606
Outcome_Other
efficacy
1607
Outcome_Other
Seizure control
1608
Outcome_Physical
Seizures
1609
Outcome_Other
seizure control
1610
Outcome_Physical
severity of the seizures
1611
Outcome_Physical
mild seizures
1612
Outcome_Physical
seizures
1613
Outcome_Physical
seizures
1614
Outcome_Other
anticonvulsants
1615
Outcome_Physical
seizures
1616
Outcome_Other
controlled
1617
Participant_Condition
neonatal seizures .