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Neonatal Seizure Management: Is the Timing of Treatment Critical?

Andreea M Pavel1, Janet M Rennie2, Linda S de Vries3

  • 1INFANT Research Centre, Cork, Ireland; Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.

The Journal of Pediatrics
|October 9, 2021
PubMed

Insights

Prompt treatment of neonatal seizures within one hour of onset significantly reduces seizure burden and frequency. This highlights the critical timing for effective intervention in newborns with electrographic seizures, emphasizing the need for improved diagnostic and treatment strategies.

Area of Science:

  • Neonatal Neurology
  • Clinical Neurophysiology
  • Pediatric Epilepsy Research

Background:

  • Neonatal seizures are a significant concern in newborns, requiring prompt diagnosis and management.
  • Electroencephalographic (EEG) monitoring is crucial for identifying electrographic seizures in neonates.
  • The optimal timing for initiating antiseizure medication (ASM) in neonatal seizures remains an area of active investigation.

Purpose of the Study:

  • To evaluate the impact of the time to treatment for the first electrographic seizure on subsequent seizure burden in neonates.
  • To describe the overall management of seizures in a large cohort of newborns undergoing EEG monitoring.
  • To investigate the relationship between early ASM administration and seizure outcomes in neonatal populations.

Main Methods:

  • A cohort of newborns (36-44 weeks gestation) from two European multicenter studies requiring EEG monitoring were analyzed.
  • Infants receiving ASM exclusively after electrographic seizure onset were categorized by treatment delay: within 1 hour, 1-2 hours, or >2 hours.
  • Key outcomes included seizure burden, maximum seizure burden, status epilepticus, seizure count, and ASM dosage within the first 24 hours post-seizure onset.

Main Results:

  • Out of 472 neonates, 154 (32.6%) had confirmed electrographic seizures.
  • Infants treated with ASM within 1 hour of seizure onset demonstrated significantly lower seizure burden (P=.029) and fewer seizures (P=.035) compared to later treatment groups.
  • Overall, 54.7% of infants received ASM, with variations in treatment timing and necessity observed.

Conclusions:

  • Early treatment of neonatal seizures, particularly within the first hour of electrographic onset, appears critical in reducing seizure burden.
  • The findings suggest that timely intervention may be a key factor in managing neonatal seizures effectively.
  • Further research is warranted to confirm the time-critical nature of neonatal seizure treatment and to improve diagnostic and therapeutic approaches.
Abstract

Keywords:
antiseizure medicationencephalopathynewbornseizures

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