Tatalaksana Terkini Kejang pada Neonatus
DOI:
https://doi.org/10.35790/msj.v5i2.45371Abstract
Abstract: Seizures in neonates are caused by a large group of neurons experiencing excessive synchronous depolarization. The therapeutic management of neonates and their prognosis differ, depending on the etiology of the disorder causing the seizures. Management of seizures in neonates use anticonvulsant drugs (phenobarbital, phenytoin, levetiracetam, lidocaine, midazolam, diazepam) so far. This study aimed to determine the current therapy for seizures in neonates. This was a literature review study using the PubMed and Google Scholar databases with the PICOS framework as selection criteria. The results obtained 10 articles to be reviewed. Phenobarbital became the first-line treatment due to its proven efficacy level compared to other anticonvulsant drugs. There were trials of giving levetiracetam as the first-line therapy due to its fewer side effects than phenobarbital. Some other literatures stated that side effects after administration of anti-seizure drugs varied, depending on the underlying etiology. In conclusion, phenobarbital is still the first line treatment for neonatal seizures followed by phenytoin as the second line, midazolam as the third line, and diazepam as the fourth line treatment. However, it is possible that levetiracetam can be used as the first-line anti-seizure drug, or as an alternative treatment.
Keywords: neonatal seizures; pharmacologic treatment; current management; anticonvulsant drugs
Abstrak: Kejang pada neonatus disebabkan oleh sekelompok besar neuron mengalami depolarisasi sinkron yang berlebihan. Penatalaksanaan terapeutik neonatus dan prognosisnya berbeda, tergantung dari etiologi gangguan yang menyebabkan kejang. Tatalaksana kejang pada neonatus menggunakan obat antikonvulsan (fenobarbital, fenitoin, levetiracetam, lidokain, midazolam, diazepam). Penelitian ini bertujuan untuk mengetahui terapi terkini untuk kejang pada neonatus. Jenis penelitian ialah suatu literatur review dengan pencarian literatur dari database Pubmed dan Google Scholar menggunakan framework PICOS sebagai kriteria seleksi. Hasil penelitian mendapatkan 10 artikel untuk dikaji. Fenobarbital merupakan pengobatan lini pertama karena tingkat efikasi yang terbukti lebih manjur dari pada pengobatan obat antikonvulsan lainnya. Uji coba pemberian levetiracetam sebagai terapi lini pertama telah dilakukan dengan pertimbangan efek samping yang lebih lurang daripada fenobarbital. Beberapa literatur menyatakan efek samping setelah pemberian obat anti kejang bervariasi, tergantung etiologi yang mendasari. Simpulan penelitian ini fenobarbital masih menjadi pilihan pengobatan lini pertama untuk kejang pada neonates, lini kedua fenitoin, lini ketiga midazolam, dan lini keempat diazepam. Tidak menutup kemungkinan jika levetiracetam dapat digunakan sebagai obat anti kejang lini pertama, ataupun dijadikan sebagai pengobatan alternatif.
Kata kunci: kejang neonatus; pengobatan farmakologi; tatalaksana terkini; obat antikonvulsan
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