Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

Vi T. Le; Hibo H. Abdi; Pablo J. Sánchez; Lina Yossef; Patricia B. Reagan; Laurel A. Slaughter; Angela Firestine; Jonathan L. Slaughter

doi:10.1055/s-0039-1698457

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(05): 469-476
DOI: 10.1055/s-0039-1698457

Original Article

Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

Vi T. Le

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

,

Hibo H. Abdi

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

,

Pablo J. Sánchez

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

²Department of Pediatrics, The Ohio State University, Columbus, Ohio

³Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio

⁴Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio

,

Lina Yossef

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

,

Patricia B. Reagan

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

⁵Department of Economics, The Ohio State University, Columbus, Ohio

,

Laurel A. Slaughter

²Department of Pediatrics, The Ohio State University, Columbus, Ohio

⁶Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio

,

Angela Firestine

³Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio

,

Jonathan L. Slaughter

¹Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

²Department of Pediatrics, The Ohio State University, Columbus, Ohio

³Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio

⁷Division of Epidemiology, The Ohio State University, Columbus, Ohio

› Author Affiliations

Abstract

Objective This study aims to describe the frequency and characteristics of anticonvulsant medication treatments initiated in the neonatal period.

Study Design We analyzed a cohort of neonates with a seizure diagnosis who were discharged from institutions in the Pediatric Health Information System between 2007 and 2016. Adjusted risk ratios and 95% confidence intervals for characteristics associated with neonatal (≤ 28 days postnatal) anticonvulsant initiation were calculated via modified Poisson regression.

Results A total of 6,245 infants from 47 institutions were included. There was a decrease in both phenobarbital initiation within the neonatal period (96.9 to 91.3%, p = 0.015) and continuation at discharge (90.6 to 68.6%, p <0.001). Levetiracetam (7.9 to 39.6%, p < 0.001) initiation within the neonatal period and continuation at discharge (9.4 to 49.8%, p < 0.001) increased. Neonates born at ≥ 37 weeks' gestation and those diagnosed with intraventricular hemorrhage, ischemic/thrombotic stroke, other hemorrhagic stroke, and hypoxic ischemic encephalopathy (HIE) had a higher probability of anticonvulsant administration. The most prevalent diagnosis was HIE (n = 2,223, 44.4%).

Conclusion Phenobarbital remains the most widely used neonatal seizure treatment. Levetiracetam is increasingly used as a second line therapy. Increasing levetiracetam use indicates a need for additional study to determine its effectiveness in reducing seizure burden and improving long-term outcomes.

Keywords

anticonvulsant - antiepileptic - fosphenytoin - hypoxic-ischemic encephalopathy - levetiracetam - neonatal - phenobarbital - phenytoin - seizures

Full Text

References

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Supplementary Material

Supplementary Material