Journal article
Epilepsy Incidence and Developmental Outcomes After Early Discontinuation of Antiseizure Medication in Neonatal Hypoxic-Ischemic Encephalopathy
Pediatric neurology, Vol.153, pp.48-55
04/2024
DOI: 10.1016/j.pediatrneurol.2024.01.009
Abstract
Background
Neonatal seizures caused by Hypoxic Ischemic Encephalopathy (HIE) have significant morbidity and mortality. There is variability in clinical practice regarding treatment duration with antiseizure medication (ASM) after the resolution of provoked neonatal seizures. We examined epilepsy incidence and developmental outcomes in post-HIE neonates discharged or not on ASM.
Methods
We conducted a retrospective chart review of all HIE-admitted neonates to the University of Iowa Hospitals & Clinics neonatal intensive care unit between January 2008 and February 2021 who presented with encephalopathy, underwent therapeutic hypothermia, and developed seizures. Neonates were divided into two groups depending on whether ASM was continued or discontinued on discharge. We evaluated the incidence of epilepsy and developmental outcomes on follow-up in these two cohorts up to 12 months. Developmental outcomes were evaluated from Bayley Scales of Infant and Toddler Development administered in the high-risk neonatology follow-up clinic.
Results
Sixty-nine neonates met the study criteria. ASM was continued on discharge in 41 neonates (59%) and discontinued before discharge in 28 (41%). At the 12-month follow-up, 9 neonates (13%) had a diagnosis of epilepsy, out of which 7 neonates had ASM continued on discharge [OR: 2.84 (95% CI: 0.48, 29.9)]. There was no statistical difference between the development of post-neonatal epilepsy between the two groups (p-value 0.29). There was no significant difference in developmental outcome between the two groups after adjusting for covariates like MRI brain abnormality and number of seizure days [OR: 0.68 (95% CI: 0.21, 2.22); p=0.52].
Conclusion
We found no significant risk of seizure recurrence by 12 months of age in infants who had discontinued ASM before discharge compared to those who had continued ASM. There was also no difference in developmental outcomes at the 12-month follow-up between groups after adjusting for brain MRI abnormality and the number of seizure days during admission. Our results support early discontinuation of ASM after resolution of acute provoked seizures in neonates with HIE.
Details
- Title: Subtitle
- Epilepsy Incidence and Developmental Outcomes After Early Discontinuation of Antiseizure Medication in Neonatal Hypoxic-Ischemic Encephalopathy
- Creators
- Spoorthi Jagadish - University of IowaTheresa Marie Czech - University of IowaM. Bridget Zimmerman - University of IowaJoseph Glykys - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Pediatric neurology, Vol.153, pp.48-55
- DOI
- 10.1016/j.pediatrneurol.2024.01.009
- ISSN
- 0887-8994
- eISSN
- 1873-5150
- Language
- English
- Electronic publication date
- 01/2024
- Date published
- 04/2024
- Academic Unit
- Biostatistics; Neurology; Iowa Neuroscience Institute; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984548411002771
Metrics
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