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Anticonvulsants for preventing mortality and morbidity in full term newborns with perinatal asphyxia

  • Review
  • Intervention

Authors

  • DJ Evans,

  • MI Levene


Dr David Evans, Consultant Neonatologist, Neonatal Intensive Care Unit, Southmead Hospital, Neonatal Intensive Care Unit, Southmead Hospital, Bristol, BS10 5NB, UK. dj-evans@doctors.org.uk.

Abstract

Background

Seizures are common following perinatal asphyxia and may exacerbate secondary neuronal injury by increasing cerebral metabolic demand, causing fluctuations in oxygenation and perfusion, and triggering the release of excitatory neurotransmitters. Long term anticonvulsant therapy may lead to inhibition of brain development and therefore the routine use of anticonvulsant therapy to prevent seizures following perinatal asphyxia needs to be evaluated.

Objectives

To assess the benefits and harm of administering anticonvulsants to infants of 37 weeks gestation or more following perinatal asphyxia with the primary aims of prevention of death or subsequent severe neurodevelopmental disability and/or the prevention of seizures.

Search strategy

Relevant randomised controlled trials were identified using a combination of electronic database searches (MEDLINE and EMBASE), hand searches and a search of the Cochrane Controlled Trials Registry.

Selection criteria

All randomised, or quasi-randomised, controlled clinical trials with reported data comparing the following outcomes: mortality, neurodevelopmental disability, neonatal seizures and adverse events, following anticonvulsant therapy in term infants (37 weeks or more), compared to controls with or without placebo, following perinatal asphyxia.

Data collection and analysis

Methodological quality and validity of studies were assessed without consideration of the results. Data relevant to the outcome were extracted and analysed.

Main results

Five randomised or quasi-randomised controlled trials which met the selection criteria were identified. No studies were of sufficient methodological quality and size to demonstrate a valid, clinically significant change in the risk of mortality or severe neurodevelopmental disability. A meta-analysis combining three studies comparing barbiturates with conventional therapy following perinatal asphyxia demonstrated no difference in risks of death, severe neurodevelopmental disability, or death or severe neurodevelopmental disability.

Authors' conclusions

At the present time, anticonvulsant therapy to term infants in the immediate period following perinatal asphyxia cannot be recommended for routine clinical practice, other than in the treatment of prolonged or frequent clinical seizures. Any future studies should be of high quality: randomised control trials with allocation concealment, performance and outcome assessment blinding. Such studies should be of sufficient size, with minimal attrition, to have the power to detect clinically important reductions in mortality and severe neurodevelopmental disability, as the primary outcome measures.

Plain language summary

Plain language summary

Synopsis pending.

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