Neonatal Seizure Treatment Practices – A Multicenter US Study
Abstract number :
2.227
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2021
Submission ID :
1826094
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:52 AM
Authors :
Levon Utidjian, MD - Children's Hospital of Philadelphia; Moninder Kaur, MVSc, MSc – UCB Pharma, Slough; Nicholas Abend, MD, FACNS - Children's Hospital of Philadelphia; Kimberley Dickinson, BS – Children's Hospital of Philadelphia; Robert Roebling, MD – UCB Pharma, Monheim am Rhein; Mitch Maltenfort, PhD – Children's Hospital of Philadelphia; Nancy Yuen, PharmD – UCB Pharma, Raleigh; Sami Elmoufti, BS – UCB Pharma, Raleigh; Jill McDonald, MA – Children's Hospital of Philadelphia; Carrie McClung, MS – UCB Pharma, Raleigh; Nadia Foskett, MD, PhD – UCB Pharma, Slough; Christopher Forrest, MD, PhD – Children's Hospital of Philadelphia
Rationale: Although nearly 20 antiseizure medications (ASMs) have been approved in the United States (US) and Europe in the past three decades, none are approved for neonates. Hence, off-label use of new ASMs in neonates is common. We conducted a retrospective study to describe the use of ASM among neonates.
Methods: This is a retrospective cohort study that used electronic health records data (01 Jan 2009–30 Jun 2020) from PEDSnet (7 large pediatric hospitals in United States). All hospitalized neonates ( < 30 days at index date [first ASM dose] born at gestational age of 35+ weeks) with a diagnosis code for seizure and/or newborn seizure and treated with ASMs were included. Patients were followed until hospital discharge (maximum of 180 days).
Results: Among 2369 patients with median (interquartile range [IQR]) follow up period of 14.0 (6.00, 31.0) days, 1–11 ASMs were prescribed, and the median (IQR) number of unique ASMs prescribed was 2 (1, 3). The most commonly used initial ASMs were phenobarbital, PB (46.7%), midazolam, MDZ (26.3%), lorazepam, LZP (12.8%), and levetiracetam, LEV (12.5%) (Fig. 1). Most patients (68.8%) received a second ASM, and these included PB (36.9%), LZP (15.8%), LEV (14.5%), and MDZ (8.3%). PB was mostly followed by LEV (29.4%) and MDZ (15.9%). LZP was mostly followed by PB (45.7%) and MDZ (16.2%). LEV was mostly followed by PB (34.1%) and MDZ (25.0%). MDZ was mostly followed by PB (33.0%) and LZP (23.5%). Half (50.5%) of patients were discharged home on ASMs, including PB (31.4%) and LEV (28.1%).
Conclusions: The results of this large study are consistent with the recently published drug utilization studies and various regional and local treatment guidelines on neonatal seizures, with PB being the most frequently used initial ASM, followed by MDZ and LEV. Over half of neonates received > 1 ASM, indicating further study is needed regarding second-line ASM and overall management approaches.
Funding: Please list any funding that was received in support of this abstract.: UCB Pharma-funded.
Anti-seizure Medications