540 - Impact of Electroencephalogram vs. Clinical Diagnosis on Medication Management of Premature Neonatal Seizures

Poster Number: 540
Publication Number: 540.139

Avish Patel, Cooper Medical School of Rowan University, Philadelphia, PA, United States; Nikhil Bhana, Cooper Medical School of Rowan University, Cinnaminson, NJ, United States; Savina Reid-Herrera, Cooper Medical School of Rowan University, Camden, NJ, United States; Krystal Hunter, Cooper Medical School of Rowan University, Camden, NJ, United States; Alla Kushnir, The Children's Regional Hospital at Cooper, Camden, NJ, United States

Background: Seizures and subclinical seizures are difficult to diagnose in the neonatal population as clinical features are subtle and can resemble normal neonatal movement. While the use of video-EEG for monitoring is the preferred standard, it is not widely available nor is it feasible to use on preterm neonates. As a result, preterm infants may be medically undertreated or even overtreated with seizure medication based on clinical seizure diagnoses. Many preterm neonates with seizures are discharged on seizure medications with no clear guidelines on when to discontinue the medications, which this study will help further understand. 

Objective: To determine whether there is a difference in continuing need for medical seizure treatment at the time of neonatal intensive care unit (NICU) discharge and one year after discharge in preterm neonates diagnosed with seizures primarily via physical exam versus EEG.

Design/Methods: A retrospective chart review was performed on premature neonates ( < 37 weeks) born at Cooper University Hospital between January 2009 and September 2019 who were admitted to the NICU and underwent neurological examination due to suspected seizure activity. Infants were excluded if they were diagnosed with Neonatal Abstinence Syndrome (NAS), passed away prior to discharge, were transferred to another hospital, or had missing follow-up data at 1 year. Detailed seizure medication information was documented for each patient during hospital admission, upon discharge, and at 1-year follow-up.

Results: Out of the 335 infants, 56 preterm neonates were included. Seizure diagnosis was made via physical exam in 44 (78.5%) patients and via EEG in 12 (21.4%). Additionally, 23/44 (52.3%) of neonates diagnosed via physical exam were discharged on seizure medication compared to 10/12 (83.3%) diagnosed via EEG (p=0.096). There were 14/38 (38.6%) patients diagnosed via physical exam who continued to take seizure medication at 1-year follow-up compared to 6/11 (54.5%) patients diagnosed via EEG (p=0.320). EEG at 1-year follow-up was abnormal in 6/19 (31.6%) neonates originally diagnosed via physical exam and abnormal in 1/6 (16.7%) neonates originally diagnosed via EEG (p=0.239). Conclusion(s): There was no statistically significant difference in continuing need for seizure medication at 1-year follow-up for preterm neonates diagnosed with seizures via physical exam versus via EEG. Additionally, there was no difference in reported abnormal EEG at 1-year follow-up, suggesting the method of diagnosis does not significantly change outcomes of medication duration or need for premature neonates with seizures.