Among children with acute neurologic disorders who were reported to be neurodevelopmentally normal before PICU admission, ESE but not ES was associated with an increased risk of unfavorable global outcome, lower health-related quality of life scores, and an increased risk of subsequently diagnosed epilepsy even after adjusting for neurologic disorder category, EEG background category, and age.

Purpose Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in children in the pediatric intensive care unit (PICU) with acute neurologic conditions, and ESE is associated with worse functional and quality of life outcomes. As an exploratory study, we aimed to determine if ESE was associated with worse outcomes using more detailed neurobehavioral measures. Methods Three hundred children with an acute neurologic condition and altered mental status underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We obtained follow-up data from subjects who were neurodevelopmentally normal prior to PICU admission. We evaluated for associations between ESE and adaptive behavior (Adaptive Behavior Assessment System-II, ABAS-II), behavioral and emotional problems (Child Behavior Checklist, CBCL), and executive function (Behavior Rating Inventory of Executive Function, BRIEF) using linear regression analyses. A p-value of <0.05 was considered significant. Results 137 of 300 subjects were neurodevelopmentally normal prior to PICU admission. We obtained follow-up data from 36 subjects for CBCL, 32 subjects for ABAS, and 20 subjects for BRIEF. The median duration from admission to follow-up was 2.6 years (IQR 1.2–3.8). There were no differences in the acute care variables (age, sex, mental status category, intubation status, paralysis status, acute neurologic diagnosis category, seizure category, EEG background category, or short-term outcome) between subjects with and without follow-up data for any of the outcome measures. On univariate analysis, significant differences were not identified for CBCL total problem (ES coefficient −4.1, p=0.48; ESE coefficient 8.9, p=0.13) or BRIEF global executive function scores (ES coefficient 2.1, p=0.78; ESE coefficient 14.1, p=0.06), although there were trends towards worse scores in subjects with ESE. On univariate analysis, ES was not associated with worse scores (coefficient −21.5, p=0.051) while ESE (coefficient −29.7, p=0.013) was associated with worse ABAS adaptive behavioral global composite scores. On multivariate analysis, when compared to subjects with no seizures, both ES (coefficient −28, p=0.014) and ESE (coefficient −36, p=0.003) were associated with worse adaptive behavioral global composite scores. Discussion Among previously normal children with acute neurologic disorders, ES and ESE were associated worse adaptive behavior and trends toward worse behavioral-emotional and executive problems. This was a small exploratory study, and the impact of ES and ESE on these neurobehavioral measures may be clarified by subsequent larger studies.

Background Histamine-2 receptor (H2) blockers are often used in very low birth weight infants despite lack of population specific efficacy and safety data. Aims We sought to describe safety and temporal trends in histamine-2 receptor (H2) blocker use in hospitalized very low birth weight (VLBW) infants. Study Design We conducted a retrospective cohort study using a clinical database populated by an electronic health record shared by 348 neonatal intensive care units in the United States. Subjects We included all VLBW infants without major congenital anomalies. Outcome Measures We used multivariable logistic regression with generalizing estimating equations to evaluate the association between days of H2 blocker exposure and risk of: 1) death or necrotizing enterocolitis (NEC); 2) death or sepsis; and 3) death, NEC, or sepsis. Results Of 127,707 infants, 20,288 (16%) were exposed to H2 blockers for a total of 6,422,352 days. Median gestational age for infants exposed to H2 blockers was 27 weeks (25th 75th percentile 26, 29). H2 blocker use decreased from 18% of infants in 1997 to 8% in 2012 (p<0.001). On multivariable analysis, infants were at increased risk of the combined outcome of death, NEC, or sepsis on days exposed to H2 blockers (odds ratio = 1.14 (95% confidence interval 1.08, 1.19). Conclusions H2 blocker use is associated with increased risk of the combined outcome of death, NEC, or sepsis in hospitalized VLBW infants.