Why do neonates receive antiseizure medications?

Area of Science:

• Neonatal neurology
• Clinical neurophysiology
• Pediatric pharmacology

Background:

• Continuous conventional video-electroencephalography (cVEEG) is the gold standard for neonatal seizure monitoring but is not widely available in Australia.
• Current practice relies on clinical observation and amplitude-integrated electroencephalography (aEEG), potentially leading to suboptimal antiseizure medication (ASM) management.

Purpose of the Study:

• To investigate the relationship between ASM usage and cVEEG-confirmed seizures in at-risk infants admitted to a neonatal intensive care unit (NICU).
• To evaluate the accuracy of current monitoring methods (clinical observation and aEEG) in guiding ASM treatment for neonatal seizures.

Main Methods:

• A diagnostic study comparing cVEEG with aEEG for neonatal seizure detection.
• Recruitment of 36 infants (≥35 weeks gestational age) at risk of seizures, with simultaneous 24-hour cVEEG monitoring alongside standard clinical/aEEG-based treatment.
• Data collection on ASM administration and cVEEG seizure burden, analyzed using Spearman's Rho correlation.

Main Results:

• Analysis of 35 infants' cVEEG recordings; common diagnosis was hypoxic-ischemic encephalopathy.
• Twelve infants received ASMs, but 42% (5 infants) had no cVEEG-confirmed seizures.
• A low correlation (Spearman's Rho: 0.44, p=0.148) was found between the number of ASM doses and cVEEG seizure burden.

Conclusions:

• Neonatal seizure treatment guided solely by clinical observation and aEEG, without cVEEG, frequently results in inappropriate ASM exposure.
• This highlights a significant risk of both under- and over-treatment, impacting patient outcomes and resource utilization.