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Lidocaine dosing for neonatal seizures

Lidocaine dosing for neonatal seizures
Weight Bolus (mg/kg)
given over 10 minutes		 1st infusion 2nd infusion 3rd infusion Total infusion duration
(hours)		 Total dose
(mg/kg)
Normothermia
<2.5 kg 2 6 mg/kg/h x 4 hours 3 mg/kg/h x 12 hours 1.5 mg/kg/h x 12 hours 28 80
≥2.5 kg 2 7 mg/kg/h x 4 hours 3.5 mg/kg/h x 12 hours 1.75 mg/kg/h x 12 hours 28 93
Therapeutic hypothermia
<2.5 kg 2 6 mg/kg/h x 3.5 hours 3 mg/kg/h x 12 hours 1.5 mg/kg/h x 12 hours 27.5 77
≥2.5 kg 2 7 mg/kg/h x 3.5 hours 3.5 mg/kg/h x 12 hours 1.75 mg/kg/h x 12 hours 27.5 89.5
This table is provided as an example of a lidocaine dosing protocol that includes dose adjustments for infants with low body weight and those undergoing therapeutic hypothermia who are at increased risk of drug accumulation; it was used in a cohort of infants who received lidocaine as a second- or third-line antiseizure medication for neonatal seizures unresponsive to first-line therapy (eg, phenobarbital).

The optimal dosing regimen in these infants is unknown. Intravenous lidocaine administration may be arrhythmogenic and requires continuous noninvasive monitoring of ECG, heart rate, and blood pressure; it is contraindicated in congenital heart disease or in infants pretreated with phenytoin/fosphenytoin.
ECG: electrocardiography.
From: Weeke LC, Toet MC, van Rooij LGM, et al. Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants. Epilepsia 2016; 57:233. http://onlinelibrary.wiley.com/doi/10.1111/epi.13286/abstract. Copyright © 2016 International League Against Epilepsy. Reproduced with permission of Blackwell Publishing Ltd. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (http://onlinelibrary.wiley.com).
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