Controversies in Neonatal Seizure Management

Glass, Hannah C.; Wirrell, Elaine

doi:10.1177/0883073808327832

Cited by 58 publications

(32 citation statements)

References 105 publications

(131 reference statements)

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“…Concerns about the potentially detrimental effects that medications may have on neurodevelopment have persisted in the neonatal neurology community and are echoed by parent respondents to our survey. 8,11,12 Therefore, although it is important to ensure adequate treatment of neonatal seizures to improve long-term developmental outcomes, future research should also focus on the riske benefit ratio of neonatal seizures and their treatments as parents indicated this is an important research priority. Research focusing on this riskebenefit ratio was followed closely by suggestions to find more effective medications, although it is unclear what respondents define as effective because previous research has shown that definitions of effectiveness often differ between families and the medical community.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Such variation may be related to a lack of evidence to support medication selection or to guide the optimal duration of therapy. 3,8 Importantly, studies of patient or parental opinions of seizure management for older children and adults demonstrate that their goals and priorities do not always match established medical definitions of success. 9 An extensive literature search revealed no published data regarding parental perspectives on neonatal seizures and antiseizure medication.…”

Section: Introductionmentioning

confidence: 99%

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Seizures and Antiseizure Medications are Important to Parents of Newborns With Seizures

Hill

Glass

Kelley³

et al. 2017

Pediatric Neurology

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BACKGROUND: Neonatal seizures and antiseizure medications both have potentially serious consequences on the developing brain. As such, optimal treatment of neonatal seizures remains unclear. Moreover, little is known about parental experiences, concerns, or unanswered questions. We conducted an online survey to assess parental perspectives regarding neonatal seizures and their management, along with their suggestions for specific high priority research topics. METHODS: Parents whose children had neonatal seizures were recruited through social media support groups to complete an online survey. Respondents progressed through a tiered series of questions about their experiences with neonatal seizures and antiseizure medications. RESULTS: There were 126 eligible respondents. On a Likert scale, parents reported that neonatal seizures had a major effect on their families (median 10 of 10; interquartile range 3; n ¼ 85). They also reported that antiseizure medications had a significant impact on their families (median 7 of 10; interquartile range 5.5; n ¼ 75). The emotional impact of the uncertainty regarding seizures and medications was highlighted. Effects on neurodevelopment, continued seizures, and adverse effects of medications were some of the most commonly reported parental concerns and their highest priority research topics. CONCLUSIONS: Both neonatal seizures and the medications used to treat them contribute to parental worries and have major impact on families. Patient-centered outcomes research should focus on the riskebenefit ratio of neonatal seizures and antiseizure medication. The emotional impact on parents related to the uncertainty regarding both immediate and long-term neonatal seizure management is important to address in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Seizures and Antiseizure Medications are Important to Parents of Newborns With Seizures

Hill

Glass

Kelley³

et al. 2017

Pediatric Neurology

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“…Seizures in the neonatal period can be classified into one of three categories, described by Glass et al as “clinical-only,” “electrographic only” and both [6]. “Clinical-only” seizures may be explained by non-epileptic phenomena such as sleep myoclonus, jitteriness from hypocalcemia or hypoglycemia, neonatal abstinence syndrome and breathing-holding spells [2].…”

Section: Seizures In the Term Infantmentioning

confidence: 99%

Advances in Management of Neonatal Seizures

Vesoulis

Mathur

2014

Indian J Pediatr

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Seizures are more common in the neonatal period than any other time in the human lifespan. A high index of suspicion for seizures should be maintained for infants who present with encephalopathy soon after birth, have had a stroke, central nervous system (CNS) infection or intracranial hemorrhage or have a genetic or metabolic condition associated with CNS malformations. Complicating the matter, most neonatal seizures lack a clinical correlate with only subtle autonomic changes and often no clinical indication at all. Over the last three decades, several tools have been developed to enhance the detection and treatment of neonatal seizures. The use of electroencephalography (EEG) and the later development of amplitude-integrated EEG (aEEG), allows for Neurologists and non-Neurologists alike, to significantly increase the sensitivity of seizure detection. When applied to the appropriate clinical setting, time to diagnosis and start of therapy is greatly reduced. Phenobarbital maintains the status of first-line therapy in worldwide use. However, newer anti-epileptic agents such as, levetiracetam, bumetanide, and topiramate are increasingly being applied to the neonatal population, offering the potential for seizure treatment with a significantly better side-effect profile. Seizures in premature infants continue to confound clinicians and researchers alike. Though the apparent seizure burden is significant and there is an association between seizures and adverse outcomes, the two are not cleanly correlated. Compounding the issue, GABA-ergic anti-epileptic drugs are not only less effective in this age group due to reversed neuronal ion gradients but may also cause harm. Selecting an appropriate treatment group remains a challenge.

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“…Encontramos un aumento del porcentaje de muerte fetal frente a la población de gestantes VIH negativas (5,18,19). De todos los recién nacidos con VIH se encontró un 2,8 % con convulsiones neonatales, datos mayores a los de la población general de embarazadas sin VIH (0,01 %), a nivel mundial (20). No se encontró relación significativa entre los bajos niveles de CD4 y el parto pretérmino, contrario a lo reportado en algunos estudios publicados (21).…”

Section: Discussionunclassified

Morbimortalidad materno-perinatal en pacientes con infección por VIH, Hospital Simón Bolívar, 2003-2011, Bogotá (Colombia)

Gómez-Ríos¹,

Carrillo-Rozo²,

Rodríguez-Ortiz³

2014

Rev. Colomb. Obstet. Ginecol.

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Objetivo: describir la morbilidad y mortalidad materna y perinatal asociadas a la infección por VIH en el Hospital Simón Bolívar entre el año 2003 y el 2011.Materiales y métodos: estudio descriptivo de cohorte histórica. Se incluyeron pacientes gestantes con diagnóstico confirmado de infección por VIH que asistieron al control prenatal y a quienes se les atendió el parto y el puerperio entre enero de 2003 y diciembre de 2011, en el Hospital Simón Bolívar, institución de tercer nivel de complejidad, centro de referencia para pacientes con VIH, ubicado en el noroccidente de Bogotá. Se realizó muestreo consecutivo y se evaluaron las características sociodemográficas y clínicas basales, y la morbilidad materna durante la gestación, al momento del parto o el puerperio, como también la morbilidad perinatal.Se realizó análisis descriptivo de la morbilidad por medio de proporciones y análisis exploratorio de la asociación entre el recuento de linfocitos CD4 y la carga viral con los resultados maternos y perinatales.Resultados: un total de 136 pacientes tenían diagnóstico de VIH confirmado en la institución, de estas se obtuvo información completa en 106 (78 %). No hubo ningún caso de muerte materna y se presentaron 2 casos de muerte fetal in utero. Las principales comorbilidades maternas encontradas fueron anemia (18 %), ETS (22,6 %), neumonía (5,7 %) y fiebre puerperal (4,7 %). Las comorbilidades perinatales más frecuentes fueron bajo peso al nacer (21,7 %) y convulsiones (2,8 %). No se encontró asociación entre la carga viral y el recuento CD4 con la morbilidad materna o perinatal.Conclusión: la paciente gestante con infección por VIH presenta en general un ligero aumento de las complicaciones maternas y perinatales. Es importante realizar nuevos estudios en los diferentes grupos poblacionales para poder valorar adecuadamente todas estas asociaciones.

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Controversies in Neonatal Seizure Management

Cited by 58 publications

References 105 publications

Seizures and Antiseizure Medications are Important to Parents of Newborns With Seizures

Seizures and Antiseizure Medications are Important to Parents of Newborns With Seizures

Advances in Management of Neonatal Seizures

Morbimortalidad materno-perinatal en pacientes con infección por VIH, Hospital Simón Bolívar, 2003-2011, Bogotá (Colombia)

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