76 - Association between discharge on anti-seizure medication and neurodevelopmental outcomes among neonates with hypoxic-ischemic encephalopathy

Poster Board #: 76
Publication #: 1907-HP-QA.76

Background: Discharge home on anti-seizure medication (ASM) in infants with seizures associated with hypoxic-ischemic encephalopathy (HIE) is common despite a low risk of epilepsy. Exposure to ASMs following hospital discharge may be neurotoxic and potentially lead to worse neurodevelopmental outcomes independent of seizures.


Objective: To (1) assess variability in practice of ASM at discharge and (2) evaluate if discharge home on ASM is associated with post-discharge death or moderate/severe disability among infants who had HIE and seizures.


Design/Methods: We studied infants with HIE surviving to discharge enrolled in the Induced Hypothermia, Optimizing Cooling, and Late Hypothermia trials conducted by the NICHD Neonatal Research Network with documented clinical or electrographic seizures treated with ASMs. The primary outcome was post-discharge death or moderate/severe disability at 18 to 22 months corrected age, using trial definitions. Multivariable logistic regression models evaluated the association between ASM at discharge and the primary outcome, adjusting for severity of HIE, hypothermia trial treatment arm, use of electroencephalogram (EEG), discharge on gavage feeds, Apgar score at 5 minutes, birth year, and center. An additional analysis was performed among a subset of infants with EEG results that also included additional adjustment for electrographic seizures.


Results: 302 infants had clinical and/or electrographic seizures, and 184 (61%) were discharged home on ASM. Severity of HIE (P=0.69), trial treatment arm (p=0.22) and discharge on gavage feeds (p=0.13) did not differ between exposure groups, but use of EEG was higher among infants discharged on ASM (p=0.03, Tables 1 and 2). The percent of infants discharged on ASM varied between 13% and 100% by center (Figure 1). The risk of death or moderate/severe disability was greater for infants discharged home on ASM compared to those not discharged home on ASM (44% vs. 28%, adjusted OR 2.14; 95% CI 1.13-4.05). Among a subset of infants with EEG results (n=197), the adjusted OR between ASM at discharge and death or moderate/severe disability was 1.79 (95% CI 0.78-4.08).

Conclusion(s): In infants with HIE and seizures, discharge home on ASM varies substantially among centers and may be associated with a higher risk of death or disability.

---

Authors/Institutions: Elizabeth K. Sewell, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, GA, Georgia; Seetha Shankaran, Wayne State University, Detroit, Michigan, United States; Scott A. McDonald, RTI International, Raleigh, North Carolina, United States; Shannon E. Hamrick, Emory University, Atlanta, Georgia, United States; Courtney J. Wusthoff, Stanford University, Palo Alto, California, United States; Ira Adams-Chapman, Emory University, Atlanta, Georgia, United States; Lina F. Chalak, ut southwestern medical center, Dallas, Texas, United States; Alexis Davis, Stanford University, Palo Alto, California, United States; Krisa P. Van Meurs, Stanford University, Palo Alto, California, United States; Abbot R. Laptook, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Ravi M. Patel, Emory University School of Medicine, Atlanta, Georgia, United States; NICHD Neonatal Research Network, NICHD, Bethesda, Maryland, United States