Comparison of injectable phenytoin and leveracetam in control of neonatal seizure due to birth asphyxia related hypoxic ischemic encephalopathy (HIE) grade II

Abstract

Objectives:  To record and analyze the demographic data of enrolled neonates, type of clinically observed seizures and risk factors for birth asphyxia and to compare the efficacy of leveracetam and phenytoin as a sole agent in control of neonatal seizure due to grade II HIE.

Methodology: A prospective comparative study was conducted in the nursery of the Combined Military Hospital Malir Cantt for 7 months from June 2020 to Dec 2020. A total of 60 cases of grade II HIE (based on Sarnet staging) due to birth asphyxia (labeled on a predefined criterion) were reported during the study period and were enrolled using a consecutive sampling technique. Their demographic data, clinical features, and frequencies of the selected known risk factors for birth asphyxia were recorded. Sample was randomized into two groups using alternate sampling technique. I/V Phenytoin was given to group A, while I/V Leveracetam was given to group B. The response was measured in terms of seizure control with a single drug.

Results:  Out of 60 neonates, 35(58.33 %) were preterm.  Observed risk factors for birth asphyxia included gestational diabetes 14(23.3%), pregnancy induced hypertension 10(16.7%), meconium stained liquor 9(15%), fetal bradycardia 8(13.3%) and maternal infections 2(3.3%).  Phenytoin alone controlled seizures in 22 (73.3%) cases and was found significantly better than Leveracetam which alone controlled seizures in 19(63.3%) cases . (P-value < 0.001)

Conclusion: Perinatal asphyxia is more common in preterm neonates. Gestational diabetes is the most common risk factor for birth asphyxia. Phenytoin is significantly better first line sole antiepileptic  agent than Leveracetam.