A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Anti- epileptic of choice shall be:

Ans. c. Phenobarbitone (Ref: Nelson 19/e p2037)Phenobarbital:Drug of first choice in neonatal seizuresLoading dose: 20 mg/KgIf this dose is not effective, then additional doses of 5-10 mg/kg 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 mg/Kg/day, 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 mg/Kg* If this dose is not effective, then additional doses of 5-10 mg/kg 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 mg/Kg/day, usually administered in two separate doses.* Metabolized by liver, excreted by kidneyPhenytoin/Fosphenytoin* If a total loading dose of 40 mg/kg of Phenobarbital was not effective, then a loading dose of 15-20 mg/Kg of Phenytoin or Fosphenytoin can be administered IV.* Rate should not exceed 0.5-1 mg/Kg/min 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 mg/Kg/day* Drug of 2nd or 3rd choice