| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
This review examines the value of early use of anticonvulsants to the newborn (prior to the development of seizures) in preventing death, seizures, or subsequent severe neurodevelopmental disability in asphyxiated term newborns. Seven randomized trials were identified. Five of these met the reviewers’ selection criteria. None were considered by the reviewers to be of sufficient methodological quality and size to confirm any evidence of benefit.
A meta-analysis of three of these trials comparing barbiturates with conventional therapy following perinatal asphyxia also failed to show any difference in death or disability rates. The most recent and best designed of these studies reported a 36% reduction in seizures. However, the confidence intervals were wide, ranging from a 63% reduction to a 13% increase in seizures (1). There was statistically significant improvement in neurological outcome at three years of age, suggesting that the subject warrants further study.
An unpublished randomized study, performed in 1987 in South Africa, was not included in the review (2). This study compared the administration of both phenobarbitone (20 mg/kg of body weight) and dexamethasone (2 mg/kg of body weight daily intramuscularly for three days) with no intervention in 56 infants (2). No difference in mortality or neurodevelopmental status at 12 months was found between the two groups. The results concur with this review’s conclusion.
The reviewers’ task was complicated by the paucity of suitable studies and the different anticonvulsants and controls being compared. The available studies also differed in their definition of asphyxia, study outcomes, period after birth when the intervention was offered and definition of study outcomes. Furthermore, the number of children contributing to the meta-analysis on mortality and developmental delay was small, only 110 and 77, respectively.
On the basis of this review, routine use of anticonvulsants in asphyxiated term infants, in the absence of seizures, cannot be recommended.
The search strategy was appropriate. Hand searching of abstracts was limited to European and American paediatric conference proceedings, resulting in the omission of at least one relevant abstract from a conference in a developing country. Trials have been analysed appropriately.
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