Neonatal seizure management with lidocaine: Systematic review and meta-analysis on efficacy and safety

Iqlima Luthfita Sari; Prastiya Indra Gunawan; Risa Etika; Martono Tri Utomo; Riza Noviandi; Sunny Mariana Samosir

doi:10.23750/abm.v96i1.16765

Authors

Iqlima Luthfita Sari Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0009-0004-3901-399X
Prastiya Indra Gunawan Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0003-3199-2826
Risa Etika Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0001-5670-7775
Martono Tri Utomo Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0003-4828-2134
Riza Noviandi Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0002-8266-3099
Sunny Mariana Samosir Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia https://orcid.org/0000-0003-3584-6156

Keywords:

neonatal seizure management, neonatal seizure treatment, lidocaine for neonatal seizures, seizure therapy in newborns, brain damage, mortality, systemic review neonatal seizures, meta-analysis neonatal seizures, lidocaine therapy

Abstract

Background and aim: Seizures are common in neonates, especially preterm and low-birth-weight infants, with clinical seizures occurring in 1–3 per 1000 live births. Neonatal seizures are associated with increased mortality and risk of developing cerebral palsy. Additionally, these seizures can lead to brain damage, which may result in epilepsy and cognitive impairment. Rapid, protocol-driven therapy and drugs like lidocaine may help, but definitive treatment guidelines are limited. This study aims to systematically review and conduct a meta-analysis to investigate and determine the efficacy and safety of lidocaine treatment for neonatal seizures.

Methods: A systematic review and meta-analysis followed PRISMA 2020 standards utilizing the PICO framework. Comprehensive screening, data capture, bias risk evaluation, and statistical analysis were conducted to determine the efficacy and safety of lidocaine therapy for neonatal seizures.

Results: A total of 1,290 publications were obtained from online databases, including Proquest, Scopus, Web of Science, PubMed, Science Direct, and grey literature. Thirteen publications relevant to the meta-analysis were chosen for comprehensive reading and analysis following three rounds of screening. Lidocaine therapy for neonatal seizures showed 73% (RCT) and 75% (observational studies) proportionally in controlling neonatal seizures. The pooled risk ratio of 2.05 [1.47, 2.85] indicates effectiveness with statistical significance (Z = 4.23, p < 0.0001); lidocaine is better in controlling seizures compared to midazolam.

Conclusions: Lidocaine is effective in the treatment of neonatal seizures. However, its use must be guided by a thorough understanding of its mechanisms, benefits, and risks. The current evidence supports further investigation into its role alongside other anticonvulsants, focusing on optimizing safety and efficacy for this vulnerable population. (www.actabiomedica.it)

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