Abstract：
Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic-ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options.
摘要：
癫痫发作在新生儿中很常见，但是管理存在很大的可变性。国际抗癫痫联盟（ILAE）的新生儿工作组根据ILAE标准制定了有关新生儿抗癫痫药物（ASM）管理的循证建议。提出了六个优先问题，进行了系统的文献综述和荟萃分析，并根据PRISMA（系统审查和荟萃分析的首选报告项目）2020标准报告结果。在非随机干预研究（ROBINS-I）中，使用Cochrane工具和偏差风险进行了评估，并使用建议的分级来评估证据质量，评估，开发和评估(等级)。如果证据不足,然后使用德尔菲共识方法寻求专家意见。建议的强度是根据ILAE临床实践指南开发工具定义的。有六项主要建议。首先,苯巴比妥应为一线ASM（循证推荐），无论病因如何（专家同意），除非信道病可能是癫痫发作的原因(例如，由于家族史)，在这种情况下，应使用苯妥英或卡马西平。第二,在癫痫发作对一线ASM无反应的新生儿中，苯妥英,左乙拉西坦,咪达唑仑,或利多卡因可用作二线ASM（专家协议）。在患有心脏病的新生儿中，左乙拉西坦可能是首选的二线ASM（专家协议）。第三，急性癫痫发作停止后，没有新生儿发作癫痫的证据，应在出院回家前停用ASM，无论磁共振成像或脑电图检查结果（专家同意）。第四，治疗性低温可以减轻缺氧缺血性脑病新生儿的癫痫负担(循证推荐).第五,治疗新生儿惊厥(包括单纯脑电图惊厥)以实现较低的惊厥负担可能与改善预后相关(专家同意).第六,对于表现为维生素B6依赖性癫痫临床特征和对二线ASM无反应的癫痫发作的新生儿,可以尝试一项吡哆醇试验(专家同意).其他考虑因素包括在每个新生儿单元中管理新生儿癫痫发作的标准化途径，并告知父母/监护人癫痫发作的诊断和初始治疗方案。
