A Cochrane review [Abstract] 1 included two studies with a total of 67 subjects. Both of the two most commonly used anticonvulsants (phenobarbital and phenytoin) were similarly effective (RR 1.03; 95% CI 0.96-1.62), controlling seizures in less than fifty percent of infants. In a study where infants failing to respond to phenobarbital received either lidocaine or midazolam as second-line agents, there was a trend for lidocaine to be more effective in reducing seizure burden (RR 0.40; 95% CI 0.14-1.17) but both groups had similarly poor long term outcomes assessed at one year.
There is little evidence from randomised controlled trials to support the use of any of the anticonvulsants currently used in the neonatal period. There remains a body of opinion that seizures should be treated because of the concern that seizures in themselves may be harmful, although this is only supported by relatively low grade evidence.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality.
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