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Given the increasing use of LDC as add-on therapy for neonatal seizures, this retrospective cohort study evaluated methemoglobin (MetHb) levels in 51 neonates with (serial) measurements within 96\u00a0h before and after LDC infusion. Methemoglobinemia was defined as MetHb\u2009&gt;\u20092% in arterial or capillary blood gas samples. Prevalence increased from 6% (3\/51) before LDC to 47% (24\/51) after administration (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Most neonates had mildly elevated MetHb levels (&lt;\u20095%); three had a MetHb level\u2009&gt;\u20095%, with a highest peak of 9.5%. In one neonate LDC was discontinued due to hypoxemia, the others were asymptomatic. In neonates who developed methemoglobinemia after LDC, the mean time to peak MetHb was 29.1\u00a0h (95% CI 11.1\u201373.3), and mean time to recover to\u2009&lt;\u20092% after the peak was 27.5\u00a0h (95% CI 8.4\u201375.5). Over half of neonates receiving regimen III (&gt;\u200936\u00a0weeks without therapeutic hypothermia [TH]) developed methemoglobinemia, compared to none on regimen IV (with TH). This suggests an association with a higher cumulative dose and longer infusion duration.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : In conclusion, methemoglobinemia occurred in nearly half of neonates receiving continuous LDC for seizures and was associated with the dosing regimen. It is important to be aware of this complication, especially in infants who develop respiratory deterioration and oxygenation problems following continuous LDC administration.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"3\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Methemoglobinemia (MetHb\u2009&gt;\u20092%) is a rare but potentially serious complication of lidocaine used for local anesthesia in infants and young children<\/jats:italic>\n                              .\u2022\n                              <jats:italic>Data on its prevalence during continuous lidocaine infusion for neonatal seizures is currently lacking<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"3\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Methemoglobinemia occurs in approximately half of the neonates with continuous lidocaine infusion for neonatal seizures<\/jats:italic>\n                              .\u2022\n                              <jats:italic>The risk depends on the dosing regimen as it is associated with a longer duration and higher cumulative dose of lidocaine infusion<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-06958-8","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:15:02Z","timestamp":1777414502000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of methemoglobinemia after lidocaine as add-on therapy in neonatal seizures"],"prefix":"10.1007","volume":"185","author":[{"given":"Bregje O.","family":"van Oldenmark","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathies","family":"Rondagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten J. 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An opt-out informed consent protocol was used for use or use of participant data for research purposes. This consent procedure and study was reviewed and approved by the Institutional Review Board of the Leiden University Medical Center (approval number 23\u20133117, date of decision 12\u201312-2022).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"314"}}