Research Article
Analytical Evaluations of Limitations of Phenobarbital as 1st-Line Therapy in Acute Neonatal Seizures: Comparison Assessment with Newer Antiepileptics
Mohammed Mahfuzur Rahman*
,
Saiful Islam,
Syeda Farzana Rahat,
Farhana Alam
Issue:
Volume 12, Issue 4, December 2026
Pages:
111-118
Received:
27 August 2026
Accepted:
7 September 2026
Published:
9 October 2026
Abstract: Background: Acute neonatal seizures are among the most common neurological emergencies during the neonatal period and are associated with increased mortality and long-term neurodevelopmental impairment. Phenobarbital has remained the conventional first-line antiseizure medication because of its rapid onset of action, intravenous availability, extensive clinical experience, and low cost. However, concerns regarding incomplete seizure control, adverse effects, and potential neurodevelopmental toxicity have raised questions regarding its position as the universal first-line therapy. Objectives: This analytical study aimed to evaluate the efficacy, safety limitations, and clinical outcomes associated with phenobarbital use in acute neonatal seizures and to compare its therapeutic profile with newer antiseizure medications, including levetiracetam, fosphenytoin, and lacosamide. Methods: A structured comparative analysis was performed using published clinical studies, randomized controlled trials, and evidence-based neonatal seizure management data. The analysis focused on seizure-control efficacy, adverse effects, pharmacological characteristics, neurodevelopmental concerns, and suitability of different antiseizure medications for individualized neonatal treatment strategies. Results: Phenobarbital demonstrated superior acute seizure-control efficacy, achieving complete seizure freedom in approximately 80% of neonates within 24 hours compared with approximately 28% with levetiracetam. However, 20–40% of neonates continued to experience seizures despite appropriate phenobarbital administration, particularly those with severe hypoxic-ischaemic encephalopathy, prematurity, structural brain injury, or refractory epilepsy. Higher cumulative phenobarbital exposure was associated with concerns regarding neuronal apoptosis, sedation, respiratory depression, hypotension, and adverse neurodevelopmental outcomes. Levetiracetam showed improved tolerability with fewer respiratory effects and less sedation but demonstrated lower immediate seizure-control efficacy. Fosphenytoin remained useful for refractory seizures but required cardiovascular monitoring, while lacosamide showed potential benefit with limited neonatal evidence. Conclusion: Phenobarbital remains an effective medication for rapid seizure termination in acute neonatal seizures; however, its limitations highlight the need for individualized treatment approaches. Future neonatal seizure management should balance rapid seizure suppression with neuroprotection and long-term developmental outcomes through integration of EEG monitoring, patient-specific characteristics, and emerging therapeutic options.
Abstract: Background: Acute neonatal seizures are among the most common neurological emergencies during the neonatal period and are associated with increased mortality and long-term neurodevelopmental impairment. Phenobarbital has remained the conventional first-line antiseizure medication because of its rapid onset of action, intravenous availability, exten...
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Case Report
Congenital Acute Myeloid Leukemia: A Series of Three Cases
Afaf Janati Sejjali*,
Mounir Chemsi,
Amal Badre,
Mouna Lehlimi,
Zineb El Korchi,
Lamyae Derrak,
Abderrahim Habzi
Issue:
Volume 12, Issue 4, December 2026
Pages:
119-123
Received:
30 September 2026
Accepted:
12 October 2026
Published:
11 November 2026
DOI:
10.11648/j.ajp.20261204.12
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Abstract: Congenital acute myeloid leukemia (C-AML) is a rare and aggressive hematologic malignancy diagnosed within the first month of life. It represents significant diagnostic and therapeutic challenges due to its nonspecific clinical presentation and the limited tolerance of neonates to intensive chemotherapy. Trisomy 21 is the most frequently associated chromosomal abnormality, and GATA1 mutations play a key role in leukemogenesis in this context. We report a retrospective, descriptive series of three male neonates diagnosed with C-AML at a single tertiary care center between 2011 and 2026. All three presented with dysmorphic facial features suggestive of trisomy 21, respiratory distress, and cutaneous or systemic involvement, with varying degrees of cytopenia and marked hyperleukocytosis. Immunophenotyping confirmed acute megakaryoblastic leukemia (AML M7) in two infants, both with aberrant CD7 expression, and AML M2 in the third. All three also had congenital heart defects. Management included supportive care, and chemotherapy where feasible. All patients died during the neonatal period. These cases illustrate the aggressive course and diagnostic complexity of C-AML. Early clinical suspicion, particularly in neonates with syndromic features such as Down syndrome, is essential. Prompt immunophenotypic confirmation, cardiac assessment before any chemotherapy, individualized supportive care, and multidisciplinary neonatal–hematologic management are critical to improving outcomes.
Abstract: Congenital acute myeloid leukemia (C-AML) is a rare and aggressive hematologic malignancy diagnosed within the first month of life. It represents significant diagnostic and therapeutic challenges due to its nonspecific clinical presentation and the limited tolerance of neonates to intensive chemotherapy. Trisomy 21 is the most frequently associated...
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