Management of seizures in neonates with neonatal encephalopathy treated with hypothermia. Issue 4 (August 2021)

• Record Type: Journal Article
• Authors: DeLaGarza-Pineda, Oscar; Mailo, Janette A.; Boylan, Geraldine; Chau, Vann; Glass, Hannah C.; Mathur, Amit M.; Shellhaas, Renée A.; Soul, Janet S.; Wusthoff, Courtney J.; Chang, Taeun
• Is Part Of: Seminars in fetal & neonatal medicine. Volume 26:Issue 4(2021)
• Publication Date: 2021-08
• Subjects: Electroencephalogram -- Neonate -- Neonatal encephalopathy -- Neonatal seizures -- Anti-Seizure medication -- Hypothermia treatment; ACNS American Clinical Neurophysiology Society -- aEEG amplitude-integrated electroencephalogram -- ANSeR Algorithm for Neonatal Seizure Recognition -- ASM anti-seizure medication -- cEEG continuous video EEG monitoring -- EEG electroencephalogram -- ILAE International League Against Epilepsy -- NE neonatal encephalopathy; Neonatology -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.9201
• DOI: 10.1016/j.siny.2021.101279
• Languages: English
• ISSNs: 1744-165X

Abstract

Abstract: Neonatal encephalopathy (NE) is the most common etiology of acute neonatal seizures – about half of neonates treated with therapeutic hypothermia for NE have EEG-confirmed seizures. These seizures are best identified with continuous EEG monitoring, as clinical diagnosis leads to under-diagnosis of subclinical seizures and over-treatment of events that are not seizures. High seizure burden, especially status epilepticus, is thought to augment brain injury. Treatment, therefore, is aimed at minimizing seizure burden. Phenobarbital remains the mainstay of treatment, as it is more effective than levetiracetam and easier to administer than fosphenytoin. Emerging evidence suggests that, for many neonates, it is safe to discontinue the phenobarbital after acute seizures resolve and prior to hospital discharge.