A Standardized, 3-Tiered, Seizure Burden–Based Protocol for the Treatment of Neonatal Seizures

Abstract

Objective To evaluate use of a standardized, 3-tiered, seizure burden-based protocol for treatment of all electroencephalography (EEG)-confirmed seizures in a level IV neonatal intensive care unit (NICU). Study Design All infants admitted to the NICU with EEG-confirmed seizures over a 25-month period were enrolled in the study. We compared short-term outcomes before and after implementation of a standardized, 3-tiered protocol. Results A total of 107 infants were enrolled in the study. Use of midazolam infusions was reduced by 53.7% ( p = 0.02). Midazolam infusion duration increased from 4 to 7.5 days ( p = 0.003); however, when excluding 3 outliers, there was no significant difference between groups (­ p = 0.67). Duration of EEG monitoring decreased from 5 to 3 days ( p = 0.005). Hospital length of stay was unchanged. Conclusion Implementation of a standardized, 3-tiered protocol for treatment of neonatal seizures improved short-term outcomes. Although not measured directly, reductions in EEG duration and midazolam use are promising indicators of overall seizure burden. More research is needed to evaluate impact on long-term neurodevelopmental outcomes.

Childhood Epilepsies and When to Refer for Epilepsy Surgery Evaluation

“…The treatment of status epilepticus at Riley Hospital for Children in the neonatal period starts with loads of phenobarbital 20 mg/kg IV given twice followed by keppra 30 mg/kg IV given twice, while considering treatment of underlying metabolic epilepsy from inborn errors of metabolism with pyridoxine, pyridoxyl-5-phosphate, folinic acid, and biotin followed by midazolam anesthetic drip [22].…”