Efficacy and Safety of Phenobarbitone as First-Line Treatment for Neonatal Seizure: A Systematic Review and Meta-Analysis

Abstract Background and objective Phenobarbitone is used as a first-line drug for neonatal seizures. However, its poor short- long-term safety profile concerning. We aim to systematically synthesize the data on efficacy of phenobarbitone agent compare it against other anti-epileptic drugs (AEDs) in neonates. Methods Using keywords related study population (neonatal seizure) intervention (phenobarbitone), we searched CENTRAL, Embase, PubMed Web Science until 15 December 2020. Randomized controlled trials (RCTs) comparing with any AED therapy seizure control neonates were considered eligible. The random-effect meta-analysis was done using RevMan 5.3 software. Results screened through 443 records identified nine eligible studies (719 participants). Five RCTs levetiracetam did not find difference first dose [risk ratio (RR) 1.43, 95% CI 0.79–2.57] or adverse effects (RR 4.66; 0.33–65.83). Two phenytoin also 2.09; 0.31–14.03) outcomes. Only one RCT compared lorazepam found be more efficacious 0.71; 0.53–0.94). Three neurodevelopmental outcomes, which better two, whereas difference. Conclusion at least safe like levetiracetam. over outcome are lacking. existing evidence insufficient recommend phenobarbitone.