Phenytoin/phenobarbital/levetiracetam

Abstract

Phenytoin/phenobarbital/levetiracetamGeneralized tonic-clonic seizures: case report A 3-days-old neonate exhibited a lack of efficacy after administering phenytoin, phenobarbital, and levetiracetam for generalised tonic-clonic seizures [routes and dosages not stated].The neonate was born at 29 weeks of gestation via emergency caesarian section. He was intubated and provided a surfactant for respiratory distress. During the following 24 hours, he was kept on ventilator support and eventually developed hypoglycaemia, which was treated with a glucose. The newborn experienced severe hypotension, thrombocytopenia, and increasing hypoxaemia on his second day of life. His ampicillin and gentamicin [gentamycin] therapy started. Next day his health worsened, and he experienced increased abdominal distension with ileus-like symptoms; his liver function deteriorated abruptly; and coagulation tests revealed disseminated intravascular coagulation, despite therapy with fresh frozen plasma, unspecified cryoprecipitate, platelets, and vitamin K. He underwent exploration laparotomy and revealed minor ascites as well as several haemorrhages within the intestinal wall. He experienced generalised tonic-clonic seizures at the age of three days, which were resistant to phenytoin, phenobarbital, and levetiracetam treatment. Despite extensive resuscitation, his haemodynamic instability persisted, and he died at the age of four days. A liver autopsy led to the diagnosis of neonatal haemochromatosis.