Management of seizures in neonates with neonatal encephalopathy treated with hypothermia

Oscar DeLaGarza-Pineda; Janette A Mailo; Geraldine Boylan; Vann Chau; Hannah C Glass; Amit M Mathur; Renée A Shellhaas; Janet S Soul; Courtney J Wusthoff; Taeun Chang; Newborn Brain Society Guidelines and Publications Committee

doi:10.1016/j.siny.2021.101279

Management of seizures in neonates with neonatal encephalopathy treated with hypothermia

Semin Fetal Neonatal Med. 2021 Aug;26(4):101279. doi: 10.1016/j.siny.2021.101279. Epub 2021 Sep 15.

Affiliations

¹ Department of Neurology, University Hospital "Dr. Jose E. Gonzalez", Monterrey, Nuevo León, Mexico. Electronic address: odelagarza@neuropediatria.mx.
² Neurology & Pediatrics, Stollery Children's Hospital and Glenrose Rehabilitation Hospital University of Alberta, Alberta, Canada. Electronic address: jmailo@ualberta.ca.
³ Department of Pediatrics & Child Health University College Cork, Cork, Ireland. Electronic address: g.boylan@ucc.ie.
⁴ Division of Neurology, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada. Electronic address: vann.chau@sickkids.ca.
⁵ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA, Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: Hannah.Glass@ucsf.edu.
⁶ Division of Neonatal Perinatal Medicine, Saint Louis University School of Medicine, SSM-Health Cardinal Glennon Children's Hospital, Saint Louis, MO, USA. Electronic address: amit.mathur@health.slu.edu.
⁷ Division of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA. Electronic address: shellhaa@med.umich.edu.
⁸ Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA. Electronic address: Janet.Soul@childrens.harvard.edu.
⁹ Division of Child Neurology, Division of Pediatrics-Neonatal and Developmental Medicine Stanford Children's Health, Palo Alto, CA, USA. Electronic address: wusthoff@stanford.edu.
¹⁰ Neurology & Pediatrics, George Washington University School of Medicine & Health Sciences, Children's National Hospital, Washington, DC, USA. Electronic address: tchang@childrensnational.org.

PMID: 34563467
DOI: 10.1016/j.siny.2021.101279

Abstract

Neonatal encephalopathy (NE) is the most common etiology of acute neonatal seizures - about half of neonates treated with therapeutic hypothermia for NE have EEG-confirmed seizures. These seizures are best identified with continuous EEG monitoring, as clinical diagnosis leads to under-diagnosis of subclinical seizures and over-treatment of events that are not seizures. High seizure burden, especially status epilepticus, is thought to augment brain injury. Treatment, therefore, is aimed at minimizing seizure burden. Phenobarbital remains the mainstay of treatment, as it is more effective than levetiracetam and easier to administer than fosphenytoin. Emerging evidence suggests that, for many neonates, it is safe to discontinue the phenobarbital after acute seizures resolve and prior to hospital discharge.

Keywords: Anti-Seizure medication; Electroencephalogram; Hypothermia treatment; Neonatal encephalopathy; Neonatal seizures; Neonate.

Publication types

Review

MeSH terms

Anticonvulsants / therapeutic use
Electroencephalography
Humans
Hypothermia*
Hypothermia, Induced*
Hypoxia-Ischemia, Brain* / complications
Hypoxia-Ischemia, Brain* / diagnosis
Hypoxia-Ischemia, Brain* / therapy
Infant, Newborn
Seizures / drug therapy
Seizures / therapy

Substances

Anticonvulsants