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J Child Neurol. 2015 Aug;30(9):1135-41. doi: 10.1177/0883073814553799. Epub 2014 Nov 7.

Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication.

Author information

1
Departments of Pediatrics and Neurology, University of California, San Francisco, CA, USA.
2
Department of Pediatrics, University of California, San Francisco, CA, USA.
3
Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
4
Department of Pediatrics, University of California, San Francisco, CA, USA Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
5
Department of Pediatrics, University of California, San Francisco, CA, USA Department of Neurology, University of California, San Francisco, CA, USA Hannah.Glass@ucsf.edu.

Abstract

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.

KEYWORDS:

electroencephalogram; epilepsy monitoring; hypoxic-ischemic encephalopathy; neonatal seizures

PMID:
25380602
PMCID:
PMC4424192
DOI:
10.1177/0883073814553799
[Indexed for MEDLINE]
Free PMC Article

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