title: Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Rani Ameena
authors.initials: RA
authors.lastname: Bashir
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Liza
authors.initials: L
authors.lastname: Espinoza
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sakeer
authors.initials: S
authors.lastname: Vayalthrikkovil
authors.affiliation: Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Buchhalter
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Leigh
authors.initials: L
authors.lastname: Irvine
authors.affiliation: Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Bello-Espinosa
authors.affiliation: Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. Electronic address: khorshid.mohammad@ahs.ca.
authors.forename: Khorshid
authors.initials: K
authors.lastname: Mohammad
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D017281:Cost of Illness; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D064926:Neurophysiological Monitoring; D010351:Patient Discharge; D010634:Phenobarbital / Q000627:therapeutic use; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014741:Video Recording
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital
keywords: antiepileptic drugs therapeutic hypothermia; continuous video-EEG; hypoxic-ischemic encephalopathy; neonatal neurocritical care; neonatal seizures