{
  "abstract": "Background and Importance Neonatal seizures are a frequent and challenging condition in neonatal intensive care units (NICUs), due to their diverse etiologies and variable response to pharmacological treatment. Phenobarbital and levetiracetam are standard first- and second-line treatments. Recent evidence supports lidocaine as an effective third-line option for refractory seizures. Based on these findings, lidocaine was incorporated into our hospital’s protocol in June 2022. Despite its therapeutic potential, clinical experience with lidocaine remains limited and underreported.Aim and Objectives To describe the pharmacological management of neonatal seizures in our NICU and assess the effectiveness and safety of lidocaine after its inclusion in the treatment protocol.Material and Methods A retrospective study was conducted in a tertiary hospital from December 2019 to November 2024. All neonates admitted to the NICU with a diagnosis or suspicion of seizures were included. Data collected included demographics, seizure aetiology, pharmacological treatments, therapeutic drug monitoring (TDM), therapeutic hypothermia, treatment at discharge and outcomes.Results Thirty-nine patients were included, 19 before and 20 after the protocol change. Mean birth weight was 3.1 ± 0.56 kg, mean gestational age 39 ± 2 weeks, and 24 were female. The most common aetiology was hypoxic-ischaemic encephalopathy (n=19), followed by unknown cause (n=5), haemorrhages/vascular lesions (n=4), infections (n=3), metabolic disorders (n=3) and others (n=5). Therapeutic hypothermia was applied in 11 cases.Five neonates did not receive pharmacological therapy. Among those treated, 14 received phenobarbital alone, while others required between 2 and 7 drugs. TDM was performed in 12 cases, mainly for phenobarbital (n=11). At discharge, 15 patients were medication-free, 10 were on monotherapy, and 1 was on dual therapy with lacosamide and oxcarbazepine; four patients were transferred to other centres and four died.Since its introduction, lidocaine has been administered to six neonates, showing effectiveness and good tolerability. Of these, two were discharged on monotherapy with lacosamide/oxcarbazepine and remain seizure-free without treatment, one on dual therapy with lacosamide and oxcarbazepine and maintained on a single agent (valproate), one was transferred and two died.Conclusion and Relevance Phenobarbital remains the first-line therapy in our NICU, followed by levetiracetam. Lidocaine has proven to be an effective and safe third-line therapy for refractory neonatal seizures.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "M Panisello Cardona"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "E Fernández De Gamarra Martínez"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Paediatrics , Barcelona, Spain"
      ],
      "name": "E Moliner Calderón"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "M Ferrando Riba"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "A Domínguez Navarro"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "M Fuentes Herrero"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Paediatrics , Barcelona, Spain"
      ],
      "name": "MJ García Borau"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Paediatrics , Barcelona, Spain"
      ],
      "name": "JJ Salazar Quiroz"
    },
    {
      "affiliations": [
        "Hospital De La Santa Creu I Sant Pau, Hospital Pharmacy, Barcelona, Spain"
      ],
      "name": "A Feliu Ribera"
    }
  ],
  "title": "4CPS-219 Neonatal seizures treatment protocol in a tertiary hospital: real-world use of lidocaine after protocol implementation",
  "uid": "804ae732-9e29-5991-addd-f4f39c58453d"
}