Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy
| Autor: | Jeffrey Buchhalter, Khorshid Mohammad, Luis Bello-Espinosa, Leigh Irvine, Liza Espinoza, Sakeer Vayalthrikkovil, Rani A. Bashir |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Encephalopathy Video Recording Context (language use) Electroencephalography Hypoxic Ischemic Encephalopathy 03 medical and health sciences 0302 clinical medicine Cost of Illness Developmental Neuroscience Hypothermia Induced Seizures 030225 pediatrics medicine Humans Retrospective Studies medicine.diagnostic_test business.industry Infant Newborn Brain Neurointensive care Retrospective cohort study medicine.disease Neurophysiological Monitoring Patient Discharge Treatment Outcome Neurology Phenobarbital Anesthesia Hypoxia-Ischemia Brain Pediatrics Perinatology and Child Health Intensive Care Neonatal Gestation Anticonvulsants Female Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Pediatric Neurology. 64:38-43 |
| ISSN: | 0887-8994 |
| Popis: | Background We report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program. Methods Neonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider. Primary outcome: electrographic seizure detection; secondary outcome: use of maintenance antiseizure medications, discharge antiseizure medications, and cumulative burden for each antiseizure medication defined as total mg/kg during hospital stay. Results A total of 157 patients with a median gestation of 40 weeks were analyzed; 103 (66%) underwent therapeutic hypothermia. Baseline and clinical characteristics including disease severity and cooling were similar. Before continuous video-electroencephalography ( n = 86), 44 (51.2%) had clinical seizures, of those 35 had available routine electroencephalography; 12 of 35 (34%) had electrographic seizures. None of the infants without clinical seizures showed electrographic seizures. After continuous video-electroencephalography ( n = 71), 34 (47.9%) had clinical seizures, of those 18 (53%) had electrographic seizures; five of 37 (14%) of infants with no clinical seizures had electrographic seizures. The introduction of continuous video-electroencephalography significantly increased electrographic seizure detection ( P = 0.016). Although there was no significant difference in the initiation and maintenance use of antiseizure medications after continuous video-electroencephalography, fewer infants were discharged on any antiseizure medication ( P = 0.008). Also, the mean phenobarbital burden reduced ( P = 0.04), without increase in other antiseizure medications use or burden. Conclusion Use of continuous video-electroencephalography as part of the neonatal neuro-critical care program was associated with improved electrographic seizure detection, decreased phenobarbital burden, and antiseizure medication use at discharge. |
| Databáze: | OpenAIRE |
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