İleri derece preterm bebeklerde neonatal nöbetler için levetirasetam tedavisinin etkinliğinin ve güvenilirliğinin değerlendirilmesi

Öz

Amaç: Levetirasetam (LEV), yenidoğan döneminde nöbetleri tedavi etmek için giderek daha fazla kullanılmaktadır. Nöbet geçiren ileri derece preterm bebeklerde LEV kullanımı ile ilgili veriler yetersizdir ve sadece birkaç çalışma ile sınırlıdır. Bu çalışma, ileri derece preterm bebeklerde nöbetlerin tedavisinde LEV'in etkinliğini ve güvenilirliğini değerlendirmeyi amaçlamıştır.
Yöntemler: Bu retrospektif kohort çalışma, Eylül 2017-Şubat 2019 tarihleri arasında ≤28. haftalık gebelik haftasında doğan ve yenidoğan nöbeti nedeniyle ilk doz intravenöz levetirasetamı postnatal 44. haftaya kadar alan ileri derece preterm yenidoğanlarda yapılmıştır. LEV’in yükleme ve idame dozu, daha önce kullanılan antiepileptik ilaçları, tedaviye yanıtı ve LEV'in yan etkileri kaydedildi.
Bulgular: Levetirasetam alan 20 ileri derece preterm yenidoğan (9 erkek ve 11 kadın) değerlendirildi. Gestasyonel yaşları 23 ila 28 hafta arasında değişiyordu ve ortalama 26.5 hafta idi. Doğum ağırlıkları 520-1210 gr arasında değişiyordu 15 bebek (%75) aşırı düşük doğum ağırlıklıydı. Nöbetlerin tedavisi için başlangıçta birinci basamak tedavi olarak 12 hastaya (%60) levetirasetam başlandı ve sekiz hastaya (%40) ikinci veya üçüncü basamak antiepileptik ilaç olarak levetirasetam verildi. Tüm hastalarda LEV ile nöbet kontrolünün etkinlik oranı %60 (12/20) idi. Nöbet kontrolü sağlandığında ortalama LEV dozu 40 mg/kg olarak bulundu. LEV tedavisine bağlı herhangi bir yan etki gözlenmedi.
Sonuç: Bu çalışma, LEV'in ileri derece preterm bebeklerde nöbet yönetimi için etkili ve güvenli olabileceğini göstermektedir. İleri derecede preterm bebeklerde LEV birinci basamak antiepileptik ilaç olarak verildiğinde nöbet kontrolü daha iyi sağlanmıştır.

Anahtar Kelimeler

• Levetirasetam,Neonatal nöbetler,Preterm

Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Abstract

Aim: Levetiracetam (LEV) is increasingly being used to treat seizures in the neonatal period. Data about using LEV in extremely preterm infants with seizures is insufficient and limited with only a handful studies. This study aimed to evaluate the efficacy and safety of LEV in the treatment of seizures in extremely preterm infants.
Methods: This retrospective cohort study was conducted on extremely premature newborns, those who were born ≤28 weeks of gestational age, and took their first intravenous dose of levetiracetam due to neonatal seizure before their 44th gestational week between September 2017-February 2019. Loading and maintenance dosage of LEV, previously used antiepileptic medications, response to treatment and side effects of LEV were recorded.
Results: Twenty extremely preterm neonates (9 males and 11 females) who received LEV were evaluated. Gestational ages ranged from 23 to 28 weeks, with a median of 26.5 weeks. Birth weights ranged from 520-1210 gr and 15 infants (75%) had extremely low birth weights. For the treatment of seizures, 12 patients (60 %) were initially started on levetiracetam as first-line therapy and eight patients (40%) were administered levetiracetam as a second or third-line antiepileptic drug. The efficiency of seizure control with LEV was 60 % (12/20) in all patients. The median LEV dose at the time seizure control was achieved was 40 mg/kg. No side effects were observed due to LEV treatment.
Conclusion: This study shows that LEV can be efficient and safe for seizure management in extremely preterm infants. Seizure control was better achieved when LEV was given as the first-line antiepileptic medication in extremely preterm infants.

Keywords

• Levetiracetam,Neonatal seizures,Preterm

References

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