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Carrasco M, Bonifacio SL, deVeber G, Chau V. Early Discontinuation of Phenobarbital After Acute Symptomatic Neonatal Seizures in the Term Newborn. Neurol Clin Pract 2023; 13:e200125. [PMID: 36891461 PMCID: PMC9987207 DOI: 10.1212/cpj.0000000000200125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/07/2022] [Indexed: 02/18/2023]
Abstract
Acute symptomatic seizures in the term newborn are often seen after perinatal brain injury. Common etiologies include hypoxic-ischemic encephalopathy, ischemic stroke, intracranial hemorrhage, metabolic derangements, and intracranial infections. Neonatal seizures are often treated with phenobarbital, which may cause sedation and may have significant long-term effects on brain development. Recent literature has suggested that phenobarbital may be safely discontinued in some patients before discharge from the neonatal intensive care unit. Optimizing a strategy for selective early phenobarbital discontinuation would be of great value. In this study, we present a unified framework for phenobarbital discontinuation after resolution of acute symptomatic seizures in the setting of brain injury of the newborn.
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Affiliation(s)
- Melisa Carrasco
- Department of Neurology (MC), University of Wisconsin and University Hospital, Madison, WI; Department of Pediatrics (Neonatology) (SLB), Lucile Packard Children's Hospital and Stanford University, Stanford, CA; Department of Pediatrics (Neurology) (GdV), The Hospital for Sick Children, SickKids Research Institute (Child Health Evaluative Sciences) and University of Toronto, Toronto, Ontario, Canada; and Department of Pediatrics (Neurology) (VC), The Hospital for Sick Children, SickKids Research Institute (Neuroscience and Mental Health) and University of Toronto, Ontario, Canada
| | - Sonia Lomeli Bonifacio
- Department of Neurology (MC), University of Wisconsin and University Hospital, Madison, WI; Department of Pediatrics (Neonatology) (SLB), Lucile Packard Children's Hospital and Stanford University, Stanford, CA; Department of Pediatrics (Neurology) (GdV), The Hospital for Sick Children, SickKids Research Institute (Child Health Evaluative Sciences) and University of Toronto, Toronto, Ontario, Canada; and Department of Pediatrics (Neurology) (VC), The Hospital for Sick Children, SickKids Research Institute (Neuroscience and Mental Health) and University of Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Department of Neurology (MC), University of Wisconsin and University Hospital, Madison, WI; Department of Pediatrics (Neonatology) (SLB), Lucile Packard Children's Hospital and Stanford University, Stanford, CA; Department of Pediatrics (Neurology) (GdV), The Hospital for Sick Children, SickKids Research Institute (Child Health Evaluative Sciences) and University of Toronto, Toronto, Ontario, Canada; and Department of Pediatrics (Neurology) (VC), The Hospital for Sick Children, SickKids Research Institute (Neuroscience and Mental Health) and University of Toronto, Ontario, Canada
| | - Vann Chau
- Department of Neurology (MC), University of Wisconsin and University Hospital, Madison, WI; Department of Pediatrics (Neonatology) (SLB), Lucile Packard Children's Hospital and Stanford University, Stanford, CA; Department of Pediatrics (Neurology) (GdV), The Hospital for Sick Children, SickKids Research Institute (Child Health Evaluative Sciences) and University of Toronto, Toronto, Ontario, Canada; and Department of Pediatrics (Neurology) (VC), The Hospital for Sick Children, SickKids Research Institute (Neuroscience and Mental Health) and University of Toronto, Ontario, Canada
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Mehta N, Shellhaas RA, McCulloch CE, Chang T, Wusthoff CJ, Abend NS, Lemmon ME, Chu CJ, Massey SL, Franck LS, Thomas C, Soul JS, Rogers E, Numis A, Glass HC. Seizure Burden, EEG, and Outcome in Neonates With Acute Intracranial Infections: A Prospective Multicenter Cohort Study. Pediatr Neurol 2022; 137:54-61. [PMID: 36270133 DOI: 10.1016/j.pediatrneurol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Limited data exist regarding seizure burden, electroencephalogram (EEG) background, and associated outcomes in neonates with acute intracranial infections. METHODS This secondary analysis was from a prospective, multicenter study of neonates enrolled in the Neonatal Seizure Registry with seizures due to intracranial infection. Sites used continuous EEG monitoring per American Clinical Neurophysiology Society guidelines. High seizure burden was defined a priori as seven or more EEG-confirmed seizures. EEG background was categorized using standardized terminology. Primary outcome was neurodevelopment at 24-months corrected age using Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS). Secondary outcomes were postneonatal epilepsy and motor disability. RESULTS Twenty-seven of 303 neonates (8.9%) had seizures due to intracranial infection, including 16 (59.3%) bacterial, 5 (18.5%) viral, and 6 (22.2%) unknown. Twenty-three neonates (85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up, the WIDEA-FS score was, on average, 23 points lower in children with high compared with low seizure burden (95% confidence interval, [-48.4, 2.1]; P = 0.07). After adjusting for gestational age, infection etiology, and presence of an additional potential acute seizure etiology, the effect size remained unchanged (β = -23.8, P = 0.09). EEG background was not significantly associated with WIDEA-FS score. All children with postneonatal epilepsy (n = 4) and motor disability (n = 5) had high seizure burden, although associations were not significant. CONCLUSION High seizure burden may be associated with worse neurodevelopment in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.
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