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Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: an observational study
Elizabeth K Sewell1,2, Seetha Shankaran3, Scott A McDonald4
1Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA elizabeth.sewell@emory.edu.
Insights
Continuation of antiseizure medications (ASMs) for infants with hypoxic-ischaemic encephalopathy (HIE) and seizures varies significantly across treatment centers. Discharging infants on ASMs was linked to a higher risk of death or disability at 18-22 months.
Area of Science:
- Neonatal Neurology
- Pediatric Epilepsy
- Clinical Neurophysiology
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Seizures are common in infants with HIE and are associated with poor neurodevelopmental outcomes.
- Antiseizure medications (ASMs) are frequently used to manage seizures in this population.
Purpose of the Study:
- To investigate the variability in the continuation of antiseizure medications (ASMs) at discharge for infants with HIE and seizures.
- To determine if continuing ASMs at discharge is associated with increased risk of death or moderate-to-severe disability.
Main Methods:
- Retrospective analysis of 302 infants with HIE and seizures from National Institute of Child Health and Human Development Neonatal Research Network Trials.
- Data collected from 22 US centers, focusing on ASM use at discharge and neurodevelopmental outcomes at 18-22 months.
- Multivariable logistic regression adjusted for HIE severity, hypothermia treatment, EEG use, feeding status, Apgar score, and birth year.
Main Results:
- 61% of infants were continued on ASMs at discharge, with significant center-to-center variation (13%-100%).
- Electroencephalogram (EEG) was used in 92% of the cohort.
- Infants discharged on ASMs had a higher risk of death or moderate-to-severe disability (44% vs. 28%, adjusted OR 2.14) compared to those without ASMs.
Conclusions:
- Continuation of ASMs at discharge for infants with HIE and seizures shows substantial variability across centers.
- Continuing ASMs at discharge may be associated with an increased risk of adverse neurodevelopmental outcomes at 18-22 months of age.
Objectives:
To assess variability in continuation of antiseizure medication (ASM) at discharge and to evaluate if continuation of ASM at discharge is associated with death or disability among infants with hypoxic-ischaemic encephalopathy (HIE) and seizures.
Design:
Retrospective study of infants enrolled in three National Institute of Child Health and Human Development Neonatal Research Network Trials of therapeutic hypothermia.
Setting:
22 US centres.
Patients:
Infants with HIE who survived to discharge and had clinical or electrographic seizures treated with ASM.
Exposures:
ASM continued or discontinued at discharge.
Outcomes:
Death or moderate-to-severe disability at 18-22 months, using trial definitions. Multivariable logistic regression evaluated the association between continuation of ASM at discharge and the primary outcome, adjusting for severity of HIE, hypothermia trial treatment arm, use of electroencephalogram, discharge on gavage feeds, Apgar Score at 5 min, birth year and centre.
Results:
Of 302 infants included, 61% were continued on ASMs at discharge (range 13%-100% among 22 centres). Electroencephalogram use occurred in 92% of the cohort. Infants with severe HIE comprised 24% and 22% of those discharged with and without ASM, respectively. The risk of death or moderate-to-severe disability was greater for infants continued on ASM at discharge, compared with those infants discharged without ASM (44% vs 28%, adjusted OR 2.14; 95% CI 1.13 to 4.05).
Conclusions:
In infants with HIE and seizures, continuation of ASM at discharge varies substantially among centres and may be associated with a higher risk of death or disability at 18-22 months of age.
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