TY - JOUR
T1 - Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy
T2 - An observational study
AU - Sewell, Elizabeth K.
AU - Shankaran, Seetha
AU - McDonald, Scott A.
AU - Hamrick, Shannon
AU - Wusthoff, Courtney J.
AU - Adams-Chapman, Ira
AU - Chalak, Lina F.
AU - Davis, Alexis S.
AU - Van Meurs, Krisa
AU - Das, Abhik
AU - Maitre, Nathalie
AU - Laptook, Abbott
AU - Patel, Ravi Mangal
N1 - Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - 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.
AB - 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.
KW - Infant Development
KW - Intensive Care Units, Neonatal
KW - Neonatology
KW - Neurology
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U2 - 10.1136/archdischild-2022-324612
DO - 10.1136/archdischild-2022-324612
M3 - Article
C2 - 36732048
AN - SCOPUS:85148675989
SN - 1359-2998
VL - 108
SP - 421
EP - 428
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
IS - 4
ER -