Seizure Control in Neonates Undergoing Screening vs Confirmatory EEG Monitoring.

Published on Jun 2, 2021in Neurology8.77
· DOI :10.1212/WNL.0000000000012293
Courtney J. Wusthoff28
Estimated H-index: 28
(Stanford University),
Vandana Sundaram25
Estimated H-index: 25
(Stanford University)
+ 12 AuthorsRenée A. Shellhaas32
Estimated H-index: 32
(UM: University of Michigan)
Sources
Abstract
OBJECTIVE To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures. METHODS We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. We compared two cEEG approaches: (1) Screening cEEG, initiated for indications of encephalopathy or paralysis without suspected clinical seizures, and (2) Confirmatory cEEG, initiated for the indication of clinical events suspicious for seizures, either alone or in addition to other indications. The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of anti-seizure medicine. Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment. RESULTS Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. Neonates with screening cEEG had a higher proportion of successful initial seizure treatment than neonates with confirmatory cEEG (39% versus 18%; p<0.0001). After adjusting for covariates, there remained a greater odds ratio (OR) for successful initial seizure treatment in the screening vs. confirmatory cEEG groups (adjusted OR 2.44, 95% CI: 1.45-4.11, p=0.0008). CONCLUSIONS These findings provide evidence from a large, contemporary cohort of neonates that a screening cEEG approach may improve odds of successful treatment of acute seizures. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for neonates a screening CEEG approach, compared to a confirmatory EEG approach, increases the probability of successful treatment of acute seizures.
📖 Papers frequently viewed together
5 Citations
References19
Newest
#1Cynthia Sharpe (UCSD: University of California, San Diego)H-Index: 9
#2Gail E. Reiner (UCSD: University of California, San Diego)H-Index: 7
Last. Richard H. Haas (UCSD: University of California, San Diego)H-Index: 44
view all 25 authors...
BACKGROUND AND OBJECTIVES: There are no US Food and Drug Administration–approved therapies for neonatal seizures. Phenobarbital and phenytoin frequently fail to control seizures. There are concerns about the safety of seizure medications in the developing brain. Levetiracetam has proven efficacy and an excellent safety profile in older patients; therefore, there is great interest in its use in neonates. However, randomized studies have not been performed. Our objectives were to study the efficac...
27 CitationsSource
#1Lila T. Worden (Children's Hospital of Philadelphia)H-Index: 8
#1Lila T. Worden (Children's Hospital of Philadelphia)H-Index: 1
Last. Catherine J. Chu (Harvard University)H-Index: 20
view all 9 authors...
OBJECTIVE: We evaluated the impact of monitoring indication, early electroencephalography (EEG), and clinical features on seizure risk in all neonates undergoing continuous EEG (cEEG) monitoring following a standardized monitoring protocol. METHODS: All cEEGs from unique neonates 34-48 weeks postmenstrual age monitored from 1/2011-10/2017 (n = 291) were included. We evaluated the impact of cEEG monitoring indication (acute neonatal encephalopathy [ANE], suspicious clinical events [SCEs], or othe...
7 CitationsSource
#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 37
#2Janet S. Soul (Boston Children's Hospital)H-Index: 37
Last. Renée A. Shellhaas (UM: University of Michigan)H-Index: 32
view all 13 authors...
: In a prospective cohort of 534 neonates with acute symptomatic seizures, 66% had incomplete response to the initial loading dose of antiseizure medication (ASM). Treatment response did not differ by gestational age, sex, medication, or dose. The risk of incomplete response was highest for seizures due to intracranial hemorrhage and lowest for hypoxic-ischemic encephalopathy, although the difference was not significant after adjusting for high seizure burden and therapeutic hypothermia treatmen...
14 CitationsSource
#1Courtney J. Wusthoff (Stanford University)H-Index: 28
#2Catherine L. Clark (Stanford University)H-Index: 4
Last. Sonia L. Bonifacio (Stanford University)H-Index: 24
view all 6 authors...
Cooling in neonatal hypoxic-ischemic encephalopathy: practices and opinions on minimum standards in the state of California
10 CitationsSource
#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 37
#2Renée A. Shellhaas (UM: University of Michigan)H-Index: 32
Last. Janet S. Soul (Boston Children's Hospital)H-Index: 37
view all 11 authors...
Abstract Background The purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society's neonatal electroencephalography monitoring guideline. Study Design Of 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extreme...
44 CitationsSource
#1Renée A. Shellhaas (UM: University of Michigan)H-Index: 32
#2Taeun Chang (GW: George Washington University)H-Index: 30
Last. Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 37
view all 11 authors...
We aimed to define determinants of duration of treatment for acute symptomatic neonatal seizures in a contemporary multicenter observational cohort study. After adjustment for potential confounders, only study site and seizure etiology remained significantly associated with the chance of continuing antiseizure medication after discharge to home.
32 CitationsSource
#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 37
#2Renée A. Shellhaas (UM: University of Michigan)H-Index: 32
Last. Janet S. Soul (Boston Children's Hospital)H-Index: 37
view all 13 authors...
Objective To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG). Study design We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks' postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at 7 US tertiary care pediatric centers following the guidelines of the American C...
98 CitationsSource
#1Ryan P. Williams (Children's Hospital of Philadelphia)H-Index: 1
#2Brenda Banwell (Children's Hospital of Philadelphia)H-Index: 71
Last. Nicholas S. Abend (Children's Hospital of Philadelphia)H-Index: 46
view all 13 authors...
Summary Objectives We aimed to determine whether implementation of a structured multidisciplinary electroencephalography (EEG) monitoring pathway improved the timeliness of administration of antiseizure medication in response to electrographic seizures in encephalopathic critically ill children. Methods A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizu...
28 CitationsSource
#1Lu Ann PapileH-Index: 30
#2Jill E. BaleyH-Index: 39
Last. Jim CoutoH-Index: 7
view all 16 authors...
: Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Infants selected for cooling must meet the criteria outlined in published clinical trials. The implementation of cooling needs to be performed at centers that have the capability to manage medically complex infants. Because the majority of infants who have neonatal encephalopathy are born at community hos...
168 CitationsSource
#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 37
#2Courtney J. Wusthoff (Stanford University)H-Index: 28
Last. Taeun Chang (Children's National Medical Center)H-Index: 30
view all 9 authors...
Objective: To assess the risk factors for electrographic seizures among neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). Methods: Three-center observational cohort study of 90 term neonates treated with hypothermia, monitored with continuous video-EEG (cEEG) within the first day of life (median age at onset of recording 9.5 hours, interquartile range 6.3–14.5), and continued for >24 hours (total recording 93.3 hours, interquartile range 80.1–112.8 among su...
61 CitationsSource
Cited By0
Newest