Abstracts

Rationale: Historically there is a poor response of neonatal seizures to typical anticonvulsants. We assess the ability of first line anticonvulsants to terminate seizures in infants undergoing whole body hypothermia. Methods: Hypothermia: Therapeutic whole-body hypothermia was performed in 56 infants ? 36 wks gestation transported to our hospital within 6 hrs of life with either severe acidosis or perinatal complications at birth, and who had moderate or severe encephalopathy [Shankaran et al 2005]. Infants were cooled to an esophageal temperature of 33.5 C for 72 hours, then rewarmed at 0.5 C/hr to 36.5 C. Continuous video-EEG monitoring was initiated within 24hrs of life and continued throughout cooling and rewarming. EEG Analysis: 53 patients had EEGs available for review for seizures. Medical records were reviewed for presence of clinical seizures and administration of anticonvulsants. Results: 15 infants had eeg confirmed seizures. 11/15 (73%) had at least 1 clinical seizure. 4 (26%) had no clinical seizures. 7 (46%) patients had seizures terminated by phenobarbital alone. 6 (40%) required phenobarbital and fosphenytoin for seizure termination. 1 (6%) continued to have seizures despite phenobarbital, fosphenytoin, and levetiracetam administration. Conclusions: Most seizures are controlled with either phenobarbital or phenobarbital and fosphenytoin, in contrast to literature on this population prior to hypothermia. Further work needs to be done to determine the relative contributions of hypothermia and continuous video eeg monitoring to improved seizure control in this population.