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Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy
An observational study
Sewell, E. K., Shankaran, S., McDonald, S. A., Hamrick, S., Wusthoff, C. J., Adams-Chapman, I., Chalak, L. F., Davis, A. S., Van Meurs, K., Das, A., Maitre, N., Laptook, A., Patel, R. M., & National Institute of Child Health and Human Development Neonatal Research Network (2023). Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: An observational study. Archives of Disease in Childhood - Fetal and Neonatal Edition, 108(4), 421-428. https://doi.org/10.1136/archdischild-2022-324612
OBJECTIVES: To assess variability in continuation of antiseizure medication (ASM) at discharge and to evaluate if continuation of ASM at discharge is associated with death or disability among infants with hypoxic-ischaemic encephalopathy (HIE) and seizures.
DESIGN: Retrospective study of infants enrolled in three National Institute of Child Health and Human Development Neonatal Research Network Trials of therapeutic hypothermia.
SETTING: 22 US centres.
PATIENTS: Infants with HIE who survived to discharge and had clinical or electrographic seizures treated with ASM.
EXPOSURES: ASM continued or discontinued at discharge.
OUTCOMES: Death or moderate-to-severe disability at 18-22 months, using trial definitions. Multivariable logistic regression evaluated the association between continuation of ASM at discharge and the primary outcome, adjusting for severity of HIE, hypothermia trial treatment arm, use of electroencephalogram, discharge on gavage feeds, Apgar Score at 5 min, birth year and centre.
RESULTS: Of 302 infants included, 61% were continued on ASMs at discharge (range 13%-100% among 22 centres). Electroencephalogram use occurred in 92% of the cohort. Infants with severe HIE comprised 24% and 22% of those discharged with and without ASM, respectively. The risk of death or moderate-to-severe disability was greater for infants continued on ASM at discharge, compared with those infants discharged without ASM (44% vs 28%, adjusted OR 2.14; 95% CI 1.13 to 4.05).
CONCLUSIONS: In infants with HIE and seizures, continuation of ASM at discharge varies substantially among centres and may be associated with a higher risk of death or disability at 18-22 months of age.
