Abstracts

Rationale: The overall incidence of neonatal seizures is approximately 3 per 1000 live births. Neonatal seizures occur in the first week of life most commonly as a result of hypoxic ischemic events and stroke or hemorrhage. Neonatal seizures may have deleterious effects on long-term outcomes and development. Managing neonatal seizures can be a challenge and there is little consensus on appropriate assessment, examination and optimal management of neonatal seizures. Our objective was to determine the most common treatments, to evaluate aggressiveness of management and perhaps be able to identify best practices in this field. Methods: We sent electronic surveys via Survey Monkey to 31 pediatric neurologists and current division chiefs at different institutions considered centers of research and clinical excellence around the country. The survey consisted of 24 questions. There were two hypothetical clinical scenarios addressing the management and aggressiveness of pharmacological control of seizures in term infants with hypoxic ischemic encephalopathy (HIE) and stroke. The last part of the survey consisted of demographic questions. Responses were analyzed using descriptive statistics to determine variation in practices.Results: Fifteen pediatric neurologists (48%) responded to our survey and 13 completed the survey. All were pediatric neurologists and some of them sub-specialize in neurocritical care, epilepsy and neonatal neurology. Forty six percent of the institutions follow a neonatal seizure protocol in these cases. Slight differences were noted between management of HIE and stroke in terms of choice of medications and aggressiveness of treatment. Phenobarbital was first choice for 93% for HIE and 76.9% for stroke and fosphenytoin was O% for both scenarios. Fosphenytoin was second choice in 54-55% for both scenarios, and the third choice was midazolam 40-42% for both scenarios and 33% choose levetiricetam. For both clinical scenarios, when clinical seizures ceased with continued electrographic seizures, some respondents would continue escalating therapy even if intubation was required or there was cardiorespiratory compromise, while others would treat only the clinical seizures. After a week of resolution of seizures and patient s clinical improvement, most respondents would wean to mono therapy with phenobarbital prior to discharge and treat for at least three months. The majority would base their decision regarding duration of treatment on follow up EEG. Conclusions: No general consensus exists in treatment practices regarding second and third line drugs or on escalation of therapy in relation to electrographic seizures once clinical events are well controlled. While some people would only treat for control of clinical seizures, others would attempt to achieve electrographic resolution of seizures. It remains unclear what the best practices are. More studies need to be performed in the near future to address this topic and determine the best practice for management of neonatal seizures.