The drug of choice for neonatal seizure is:

Appeared in: HP CHO -9 October 2022

Explanation

Consensus guidelines and clinical data establish phenobarbitone as the first-choice treatment for seizures in newborns.
It has a long duration of action and a well-documented safety profile for this vulnerable population compared to other anticonvulsants.
A randomized controlled trial mentioned in pediatric textbooks confirms that phenobarbitone is significantly more effective as a first-line agent than other drugs like levetiracetam.

Option A: Phenytoin is not the first-line drug of choice for neonatal seizures.
Option C: Lorazepam is a benzodiazepine and not the standard first-line agent for routine management of neonatal seizures.
Option D: Diazepam is generally avoided in neonates due to significant safety concerns.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing First-line pharmacological treatment for neonatal seizures in acute care settings.
A nurse's primary responsibility during administration of phenobarbitone is continuous monitoring of the neonate's respiratory status and blood pressure, as respiratory depression is a major side effect.
Always ensure emergency airway equipment is at the bedside before administering a loading dose of any anticonvulsant to a neonate.
While administering medication, it is equally important to investigate and treat the underlying cause of the seizure, such as hypoglycemia, hypocalcemia, infection, or hypoxic-ischemic injury.

How to Approach the Question

First, identify the core of the question: it asks for the 'drug of choice' for a specific condition ('neonatal seizure'). This is a factual recall question.
Focus on the patient population: 'neonatal'. Treatments for newborns are often different from those for older children or adults due to metabolic and physiological differences.
Recall the standard treatment guidelines for this condition. For neonatal seizures, phenobarbitone is the established first-line therapy.
Evaluate the options based on this knowledge. Eliminate drugs that are second-line (Phenytoin) or those with significant contraindications in neonates (Diazepam).

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1429-1431

Practise the full HP CHO -9 October 2022

Attempt every question from this paper in a timed mock, then review the full solution for each one.