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Comparative Study
. 2021 Apr;38(5):469-476.
doi: 10.1055/s-0039-1698457. Epub 2019 Oct 10.

Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

Vi T Le  1 , Hibo H Abdi  1 , Pablo J Sánchez  1   2   3   4 , Lina Yossef  1 , Patricia B Reagan  1   5 , Laurel A Slaughter  2   6 , Angela Firestine  3 , Jonathan L Slaughter  1   2   3   7
Affiliations
Comparative Study

Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

Vi T Le et al. Am J Perinatol. 2021 Apr.

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.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Antiepileptic medication utilization by discharge year.
Figure 2.
Figure 2.
Percent of infants receiving phenobarbital, fosphenytoin sodium/phenytoin, and levetiractam during the neonatal period by discharge year.
Figure 3.
Figure 3.
Variation of phenobarbital, fosphenytoin sodium/phenytoin, and levetiractam receipt among all hospitalized infants per service day.
Figure 4.
Figure 4.
First-line antiepileptic variation over time.
Figure 5.
Figure 5.
Reporting of HIE Severity per year among infants receiving hypothermia treatment
See this image and copyright information in PMC

References

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