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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
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
,
Hibo H. Abdi
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
,
Pablo J. Sánchez
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
2   Department of Pediatrics, The Ohio State University, Columbus, Ohio
3   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
4   Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
,
Lina Yossef
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
,
Patricia B. Reagan
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
5   Department of Economics, The Ohio State University, Columbus, Ohio
,
Laurel A. Slaughter
2   Department of Pediatrics, The Ohio State University, Columbus, Ohio
6   Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
,
Angela Firestine
3   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
,
Jonathan L. Slaughter
1   Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
2   Department of Pediatrics, The Ohio State University, Columbus, Ohio
3   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
7   Division of Epidemiology, The Ohio State University, Columbus, Ohio
› Author Affiliations Funding This study was supported in part by K08HL121182 (Slaughter) and the Research Institute at Nationwide Children's Hospital.
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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

Supplementary Material



Publication History

Received: 07 March 2019

Accepted: 26 August 2019

Article published online:
10 October 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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