Source:Pediatric Neurology
Author(s): Melanie A. McNally, Adam L. Hartman
ObjectiveSeizures occur commonly in neonates and growing evidence suggests they may cause added harm in neonates with hypoxic ischemic encephalopathy (HIE). However, specific recommendations about when and how to treat seizures in this context are lacking. The objective of this study was to determine the scope of practice nationally regarding management of non-status epilepticus electrographic-only seizures (ESzs) in neonates with HIE.Study DesignA case-based survey was distributed to members of the Child Neurology Society. Providers were asked about their preferred management strategy for sequential clinical scenarios.Results177 child neurologists responded to the survey. 77% of providers would treat 20 seconds or less of electrographic seizure activity. In a neonate with mild HIE and an ESz, there was no agreement among providers regarding whether to start maintenance therapy in addition to a one-time anti-seizure drug (ASD) load. In a neonate with moderate HIE on phenobarbital (PB) for early electro-clinical seizures, the majority of providers would escalate treatment for ongoing ESzs and would do so by increasing PB dosing. In a neonate with severe HIE complicated by status epilepticus on PB who subsequently develops recurrent ESzs, providers varied significantly in their management preferences. For all three cases, 75-85% of providers would not change their management preferences based on the presence or absence of a clinical correlate with the electrographic seizure.ConclusionsWe found marked variability among providers regarding preferred management of non-status epilepticus ESzs after HIE. Our results identified specific aspects of ESz management in neonatal HIE where there is limited consensus. These discrepancies may serve as opportunities for future investigation.
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