Comparison of Injectable Phenytoin and Laveracetam in Control of Neonatal Seizure due to Hypoxic Ischemic Encephalopathy

Abstract

Objectives:  To compare the efficacy of leviracetam and phenytoin as a sole agent in the control of neonatal seizure due to grade II HIE.

Methodology:  A Prospective comparative study was conducted in the neonatal ICU of Combined Military Hospital Malir Cantt for 7 months from June 2020 to Dec 2020. Total 60 cases of grade II HIE due to perinatal asphyxia were reported during the study period and were enrolled using simple consecutive sampling technique. Their demographic data, clinical features and frequencies of the selected known risk factors for perinatal asphyxia were recorded. The samples were randomized into two groups using alternate sampling technique. Group A was given I/V Phenytoin while group B was given I/V Laveracetam. The response was measured in terms of seizure control with single drug.

Results:  Out of 60 neonates 35(58.33 %) were preterm.  Observed risk factors for perinatal 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 Laveracetam 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 perinatal asphyxia. Phenytoin is significantly better first line sole antiepileptic agent than Laveracetam.