Administration of Anticonvulsants in Neonates

Introduction to Anticonvulsant Administration

The American Academy of Pediatrics recommends administering phenobarbital intravenously at a loading dose of 15-20 mg/kg over 10-15 minutes without dilution for neonatal convulsions 1

For neonatal seizures, the American Academy of Pediatrics recommends phenobarbital as the first-line treatment, administered intravenously at a loading dose of 15-20 mg/kg over 10-15 minutes without dilution 1
Respiratory support equipment must be immediately available due to the risk of respiratory depression and hypotension from vasodilatory and cardiodepressive effects 1

Lorazepam should be administered intravenously at 0.05-0.10 mg/kg (maximum 4 mg per dose) over approximately 2 minutes, without dilution, and may be repeated every 10-15 minutes if seizures persist, as recommended by the American Academy of Pediatrics 2, 3, 4
The IV/IO route is preferred at 0.05-0.10 mg/kg, and intramuscular administration is acceptable at the same dose 3, 4, 5
There is an increased incidence of apnea, especially when given rapidly IV or combined with other sedative agents, and oxygen saturation and respiratory effort must be continuously monitored 2, 3, 4
Never administer flumazenil to reverse benzodiazepine effects in seizure patients, as it counteracts anticonvulsant effects and may precipitate seizures 2, 1, 4

Diazepam should be administered intravenously at 0.2-0.5 mg/kg (maximum 10 mg per dose) over at least 1 minute per 5 mg given, without dilution, though this agent is generally less preferred than lorazepam for neonatal seizures, according to the American Academy of Pediatrics 2
The IV route is strongly preferred for status epilepticus at 0.1-0.3 mg/kg every 5-10 minutes (maximum 10 mg per dose) 2
Diazepam must be followed immediately by a long-acting anticonvulsant (such as phenobarbital or phenytoin) because it is rapidly redistributed and seizures often recur within 15-20 minutes 2
There is an increased incidence of apnea when given rapidly IV or combined with other sedative agents, and oxygen saturation and respiratory effort must be continuously monitored 2

Never delay respiratory support preparation when administering any of these anticonvulsants, as recommended by the American Academy of Pediatrics 1
Never use flumazenil in patients receiving benzodiazepines for seizure control, as it counteracts anticonvulsant effects and may precipitate seizures 1, 4