Abstracts

Rationale: Infants with neonatal seizures are at an increased risk for developing postneonatal epilepsy. The length of treatment with phenobarbital remains controversial. We previously reported provider practices of longer phenobarbital treatment duration in neonates who developed postneonatal epilepsy, suggesting that providers maintained phenobarbital when concerned for the development of postneonatal epilepsy. The primary goal of this study was to evaluate the impact of a neonatal seizure management guideline of care that recommended early discontinuation on provider phenobarbital discontinuation practices. Methods: This study is a single center retrospective review of patients diagnosed with neonatal seizures with an ICD-9 or ICD-10 code for “seizures in the neonatal period”, or by review of an internal neonatology database.  Inclusion criteria for study required diagnosis of seizure in the neonatal period secondary to an acute symptomatic cause and treatment with phenobarbital.   Patients were excluded if they were admitted to the Cardiac Intensive Care Unit, did not receive treatment with phenobarbital, were diagnosed with neonatal epilepsy, or died prior to discharge.  Two time periods were identified; the “pre-guideline” period was from 1/1/2010-12/31/2013, while the “post-guideline period” was from 7/1/2015-3/31/2017, the 21-month period after implementation of Neonatal Seizure Guidelines of care.  The time between 1/1/2014 and 6/30/2015 was not evaluated, as the recommendations were under creation and discussion during this time.  Duration of treatment with phenobarbital in neonates with symptomatic seizures was compared between the two groups using nonparametric measures for continuous variables, and chi-square for categorical variables. Results: Eighty-four patients were identified in the pre-guideline period, of which 19 developed postneonatal epilepsy (23%), while 39 patients were identified in the post-guideline period, 3 of whom developed postneonatal epilepsy (8%).  In the pre-guideline period, 23% were weaned off phenobarbital within 30 days of seizure presentation compared to 71% in the later period (p= < .0001).    Duration of phenobarbital therapy decreased from a median of 80 days in the pre-guideline period, to 9 days in the post-guideline period (p= < .0001). Conclusions: Our study demonstrates that implementation and dissemination of a guideline of care for neonatal seizures significantly impacts the duration of phenobarbital therapy. Efforts to enact practice guidelines for phenobarbital discontinuation can be successful. We will continue to follow these cohorts over time for development of postneonatal epilepsy. Funding: None.