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A Standardized, 3-Tiered, Seizure Burden-Based Protocol for the Treatment of Neonatal Seizures

Ashley A Moeller1, Andrei R Stefanescu2, Beatrice M Stefanescu1

  • 1Indiana University School of Medicine, Indianapolis, IN, USA.

Journal of Child Neurology
|April 5, 2023
PubMed

Insights

A new protocol for treating neonatal seizures in the neonatal intensive care unit (NICU) reduced midazolam use and electroencephalography (EEG) monitoring duration, improving short-term outcomes.

Area of Science:

  • Neonatal Neurology
  • Clinical Protocol Development
  • Pediatric Epilepsy

Background:

  • Neonatal seizures are a common neurological emergency requiring prompt and effective treatment.
  • Current treatment protocols vary, potentially leading to suboptimal seizure control and medication side effects.
  • Standardizing seizure management is crucial for improving patient outcomes in the neonatal intensive care unit (NICU).

Purpose of the Study:

  • To evaluate the effectiveness of a standardized, 3-tiered, seizure burden-based protocol for treating electroencephalography (EEG)-confirmed neonatal seizures.
  • To assess the impact of the protocol on short-term outcomes in infants admitted to a level IV NICU.

Main Methods:

  • A prospective study design comparing outcomes before and after protocol implementation.
  • Enrollment of 107 infants with EEG-confirmed seizures in the NICU over a 25-month period.
  • Analysis of medication use (midazolam infusions), EEG monitoring duration, and hospital length of stay.

Main Results:

  • Midazolam infusion use decreased by 53.7% (p=0.02) after protocol implementation.
  • Duration of EEG monitoring was significantly reduced from 5 to 3 days (p=0.005).
  • Hospital length of stay remained unchanged; however, midazolam infusion duration showed a non-significant increase when excluding outliers.

Conclusions:

  • Implementation of a standardized, 3-tiered protocol effectively improved short-term outcomes for neonatal seizures.
  • Reduced EEG duration and midazolam use suggest a decreased overall seizure burden.
  • Further research is warranted to determine the long-term neurodevelopmental effects of this protocol.
Abstract

Keywords:
EEGantiepileptic drugsantiseizure drugselectroencephalographyhypoxic-ischemic encephalopathyinfantneonatal seizuresneonatestatus epilepticustreatment

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