@article{a19bd7a3d01c4da1b0d9b132265f4f7d,
title = "Treatment of Neonatal Seizures: Comparison of Treatment Pathways From 11 Neonatal Intensive Care Units",
abstract = "Objective: Seizures are a common neonatal neurologic emergency. Many centers have developed pathways to optimize management. We evaluated neonatal seizure management pathways at level IV neonatal intensive care units (NICUs) in the United States to highlight areas of consensus and describe aspects of variability. Methods: We conducted a descriptive analysis of 11 neonatal seizure management pathways from level IV NICUs that specialize in neonatal neurocritical care including guidelines for electroencephalography (EEG) monitoring, antiseizure medication (ASM) choice, timing, and dose. Results: Study center NICUs had a median of 70 beds (interquartile range: 52-96). All sites had 24/7 conventional EEG initiation, monitoring, and review capability. Management pathways uniformly included prompt EEG confirmation of seizures. Most pathways included a provision for intravenous benzodiazepine administration if either EEG or loading of ASM was delayed. Phenobarbital 20 mg/kg IV was the first-line ASM in all pathways. Pathways included either fosphenytoin or levetiracetam as the second-line ASM with variable dosing. Third-line ASMs were most commonly fosphenytoin or levetiracetam, with alternatives including topiramate or lacosamide. All pathways provided escalation to continuous midazolam infusion with variable dosing for seizures refractory to initial medication trials. Three pathways also included lidocaine infusion. Nine pathways discussed ASM discontinuation after resolution of acute symptomatic seizures with variable timing. Conclusions: Despite a paucity of data from controlled trials regarding optimal neonatal seizure management, there are areas of broad agreement among institutional pathways. Areas of substantial heterogeneity that require further research include optimal second-line ASM, dosage, and timing of ASM discontinuation.",
keywords = "Antiseizure medication, Fosphenytoin, Guideline, Levetiracetam, Neonatal critical care, Neonatal seizures, Phenobarbital, Protocol",
author = "Keene, {Jennifer C.} and Morgan, {Lindsey A.} and Abend, {Nicholas S.} and Bates, {Sara V.} and {Bauer Huang}, {Sarah L.} and Taeun Chang and Chu, {Catherine J.} and Glass, {Hannah C.} and Massey, {Shavonne L.} and Betsy Ostrander and Pardo, {Andrea C.} and Press, {Craig A.} and Soul, {Janet S.} and Shellhaas, {Ren{\'e}e A.} and Cameron Thomas and Niranjana Natarajan",
note = "Funding Information: Conflict of interest: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr Shellhaas receives research support from the NIH, the PCORI, and the Pediatric Epilepsy Research Foundation. She receives honoraria from UpToDate for authorship of topics related to neonatal seizures, serves as a consultant for the Epilepsy Study Consortium, and is an Associate Editor for Neurology. Dr. Chang receives research support from the NIH and Rehabilitation Engineering Research Center (RERC) program. Dr. Chu receives research support from the NIH. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. Funding Information: Conflict of interest: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr Shellhaas receives research support from the NIH, the PCORI, and the Pediatric Epilepsy Research Foundation. She receives honoraria from UpToDate for authorship of topics related to neonatal seizures, serves as a consultant for the Epilepsy Study Consortium, and is an Associate Editor for Neurology. Dr. Chang receives research support from the NIH and Rehabilitation Engineering Research Center (RERC) program. Dr. Chu receives research support from the NIH. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. Funding: This research did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",
year = "2022",
month = mar,
doi = "10.1016/j.pediatrneurol.2021.10.004",
language = "English (US)",
volume = "128",
pages = "67--74",
journal = "Pediatric Neurology",
issn = "0887-8994",
publisher = "Elsevier Inc.",
}