Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: an observational study
Year: 2023
Type: article
Abstract: 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.
Institutions: Emory University, Henrietta Egleston Hospital for Children, Children's Healthcare of Atlanta, Wayne State University, Children's Hospital of Michigan, RTI International, Stanford University, The University of Texas Southwestern Medical Center, Lucile Packard Children's Hospital, Women & Infants Hospital of Rhode Island
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Health and Human Services, University of Cincinnati, RTI International, National Institutes of Health, Pritzker School of Medicine, National Institute of Child Health and Human Development, National Center for Research Resources, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1090600190, G110034798, G1112584313, Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1158962835, G1260873166, NICHD Cooperative Multicenter Neonatal Research Network, G1534123016, G1566466599, G158417946, G1612960859, GENERAL CLINICAL RESEARCH CENTER, G1633855309, G1655184841, G1667629460, G191108874, G1924766097, G1992509393, G2025316562, G210410618, G2320082243, G2529096535, Duke CTSA (Composite), G2586929027, G269169088, G2747972013, NICHD Neonatal Research Network (NRN), G2852463135, NICHD Cooperative Multicenter Neonatal Research Network, G3234155519, GENERAL CLINICAL RESEARCH CENTER, NICHD Cooperative Multicenter Neonatal Research Network, G3440629384, G3566384843, G3703661376, G4019174610, G4044615416, G4113560995, G415241174, G4178252161, G4402799323, G4423566278, G4436360461, G4572800114, NICHD Cooperative Multicenter Neonatal Research Network, G4923448371, General Clinical Research Center, G5163102165, G5332205520, G5535250973, G5587201283, G5781986915, G5831214190, G6224956123, G6272978657, G6279089317, G636831491, G6481205343, G6558373809, G661928818, G678220038, The University of Rochester's Clinical and Translational Science Institute, G7121236774, NICHD Cooperative Multicenter Neonatal Research Network, G7417610757, G756964556, G7667865566, G7702994873, G7749374313, G7874196946, G7903297134, Indiana Clinical and Translational Science Institute (UL1), University of Iowa Clinical and Translational Science Program, G796377885, Yale University Clinical and Translational Science Award Program, G8132388583, G8217206414, Rochester-Buffalo Neonatal Research Group, G871474445, G872040556, NICHD Neonatal Research Network - Stanford University, NICHD Neonatal Research Network, G924110136
OpenAlex ID: W4318973045