Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication.
This cohort study examines medication use in term neonates with hypoxic-ischemic encephalopathy and seizures before and after implementation of a Neonatal Neurocritical Care Service (N = 108), which included increased seizure monitoring. Nearly all neonates received phenobarbital (96% pre- vs 95% post-Neonatal Neurocritical Care Service) and total loading dose did not vary among groups (33 [95% confidence interval 29-37] vs 30 [26-34] mg/kg). After adjustment for seizure burden, neonates managed during the Neonatal Neurocritical Care Service era, on average, received 30 mg/kg less cumulative phenobarbital (95% confidence interval 15-46 mg/kg) and were on maintenance 5 fewer days (95% confidence interval 3-8 days) than those who were treated prior to implementation of the service. In spite of the enhanced ability to detect seizures because of improved monitoring and increased vigilance by bedside practitioners, implementation of the Neonatal Neurocritical Care Service was associated with decreased use of potentially harmful phenobarbital treatment among neonates with hypoxic-ischemic encephalopathy.
Departments of Pediatrics and Neurology, University of California, San Francisco, CA, USA.
Sharon O
SO
Wietstock
Department of Pediatrics, University of California, San Francisco, CA, USA.
Sonia L
SL
Bonifacio
Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
Charles E
CE
McCulloch
Department of Pediatrics, University of California, San Francisco, CA, USA Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Michael W
MW
Kuzniewicz
Department of Pediatrics, University of California, San Francisco, CA, USA Department of Neurology, University of California, San Francisco, CA, USA Hannah.Glass@ucsf.edu.
Hannah C
HC
Glass
D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000451:nursing*; D015931:Intensive Care, Neonatal; D008297:Male; D010634:Phenobarbital / Q000627:therapeutic use; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
D006993:Hypnotics and Sedatives; D010634:Phenobarbital
electroencephalogram; epilepsy monitoring; hypoxic-ischemic encephalopathy; neonatal seizures