Differing attitudes toward phenobarbital use in the neonatal period among neonatologists and child neurologists in Sweden.

Objective: In spite of its known negative effects on brain development, phenobarbital is the most commonly used drug for neonatal seizures. We conducted a national survey among neonatologists and child neurologists to determine the variation in practice and attitudes.

Methods: Surveys were sent to all board-certified child neurologists and neonatologists in Sweden as well as to residents in subspecialty training. In addition to questions concerning respondent demographic characteristics, the survey contained questions related to overall attitudes and practices and specific patient scenarios.

Results: Responses were obtained from 170 physicians (corresponding to approximately 50% of all eligible respondents). We found a high level of agreement concerning the initiation of treatment of neonatal seizures, as well as choice of first- (phenobarbital) and second-line (midazolam) drugs. In contrast, third-line drug choice differed between specialties, with neurologists being more prone to use levetiracetam or other drugs. Neonatologists were more likely to treat premature infants differently. For continued phenobarbital treatment there was less agreement among respondents. Whereas almost 75% of neonatologists felt that phenobarbital should "seldom" or "never" be used in long term treatment following neonatal seizures, a majority of child neurologists indicated "often" or "always". The same pattern was seen in responses to individual scenarios.

Conclusion: The discrepancies between different specialties involved in treating neonatal seizures may reflect differences in training, but is also likely due to the lack of uniform guidelines. This highlights the importance of designing and carrying out clinical trials determining optimal treatment of neonatal seizures.