969 Could Early Neonatal Features Predict the Need for Use of a Certain Anticonvulsant to Control Neonatal Seizures?

Backgroudn and Aims: Using specific targeted anticonvulsivants in the postasphzxia seizures could result in an earlier control of these and less drug-associated toxicity. The aim of the study was to investigate if there are certain features in the case of newborns with postasphyxial seizures to predict that these will be controlled by only by Lidocaine. Methods: In 15 neonates with postasphyxial seizures the treatment was as follows: Phenobarbital 20 mmg/kg i.v loading dose followed by another dose of 20 mg/kg, followed by phenitoin 20 mg/kg loading dose and midazolam beginning with 0.06 mg/kg to 1.2 mg/kg/hour.. followed by Lidocaine 2 mg/kg loading dose -10 minutes followed by 6 mg/ kg/hour for 12 hours, 4 mg/kg/hour for 12 hours and 2 mg/kg/hour for 12 hours. There were noted: APGAR scores, pH and base excess in the umbilical artery at birth, time to first breath, aEEG pattern at 6 hours. Results: There were significantly associated with the appearance of seizures that were controlled only by Lidocaine a Base Excess > - 20 (OR 2.11 [95% CI 1.37- 3.32]), a time to first breath longer than 150 seconds (OR 1.92 [ 95% CI 0.37-2.92] and the appearance of a burst suppression (-) or low voltage background pattern at 6 hours OR 1.76 [95%CI 1.15-2.43]. Conclusions: Increased base excess in the umbilical artery, longer time to first breath and a depressed aEEG pattern could select from the population of neonates with postasphyxial seizures a cathegory in which the seizures could be controlled by lidocaine only.