Which anticonvulsant is considered first-line for treating neonatal seizures?

Phenobarbital is recognized as the first-line anticonvulsant for treating neonatal seizures. It is preferred due to its established efficacy and safety profile in the neonatal population. Phenobarbital works by enhancing the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which helps stabilize neuronal activity and reduce seizure activity effectively.

Additionally, its long half-life in neonates allows for less frequent dosing while maintaining therapeutic levels. This is particularly beneficial in a neonatal intensive care setting where consistent medication management is crucial for maintaining the delicate balance of care for vulnerable patients.

Other anticonvulsants, while effective, do not hold the same level of established priority for initial treatment in newborns. Choices such as phenytoin and levetiracetam have their utility but are not typically used as first-line agents in these cases due to concerns over their side effect profiles or the lack of extensive studies confirming their efficacy and safety in the fragile neonatal population. Lacosamide, while also an anticonvulsant, is generally not used as a first-line treatment in neonates and is considered for use in particular situations or when other treatments have failed.

This preference for phenobarbital ensures that healthcare providers have a reliable and recognized treatment option available