Neonatal Antiepileptic Medication Treatment Patterns: A Decade of Change

2019 ◽  
Author(s):  
Vi T. Le ◽  
Hibo H. Abdi ◽  
Pablo J. Sánchez ◽  
Lina Yossef ◽  
Patricia B. Reagan ◽  
...  
Keyword(s):  
Neonatal Period ◽  
Health Information System ◽  
Neonatal Seizure ◽  
Long Term Outcomes ◽  
Adjusted Risk ◽  
Antiepileptic Medication ◽  
Anticonvulsant Medication ◽  
Risk Ratios ◽  
Ischemic Encephalopathy

Abstract Objective This article aims to describe the frequency and characteristics of anticonvulsant medication treatments initiated in the neonatal period. Study Design We analyzed a cohort of neonates with a seizure diagnosis who were discharged from institutions in the Pediatric Health Information System between 2007 and 2016. Adjusted risk ratios and 95% confidence intervals for characteristics associated with neonatal (≤ 28 days postnatal) anticonvulsant initiation were calculated via modified Poisson regression. Results A total of 6,245 infants from 47 institutions were included. There was a decrease in both phenobarbital initiation within the neonatal period (96.9 to 91.3%, p = 0.015) and continuation at discharge (90.6 to 68.6%, p <0.001). Levetiracetam (7.9 to 39.6%, p < 0.001) initiation within the neonatal period and continuation at discharge (9.4 to 49.8%, p < 0.001) increased. Neonates born at ≥ 37 weeks' gestation and those diagnosed with intraventricular hemorrhage, ischemic/thrombotic stroke, other hemorrhagic stroke, and hypoxic ischemic encephalopathy (HIE) had a higher probability of anticonvulsant administration. The most prevalent diagnosis was HIE (n = 2,223, 44.4%). Conclusion Phenobarbital remains the most widely used neonatal seizure treatment. Levetiracetam is increasingly used as a second line therapy. Increasing levetiracetam use indicates a need for additional study to determine its effectiveness in reducing seizure burden and improving long-term outcomes.

scholarly journals Targeting ischemia-induced KCC2 hypofunction rescues refractory neonatal seizures and mitigates epileptogenesis in a mouse model

2020 ◽  
Author(s):  
Brennan J. Sullivan ◽  
Pavel A. Kipnis ◽  
Brandon M. Carter ◽  
Shilpa D. Kadam
Keyword(s):  
Mouse Model ◽  
Neonatal Seizure ◽  
Seizure Susceptibility ◽  
Neonatal Seizures ◽  
First Line ◽  
Chloride Homeostasis ◽  
Epilepsy Models ◽  
And Function ◽  
Ischemic Encephalopathy

AbstractNeonatal seizures pose a clinical challenge for their early detection, acute management, and mitigation of long-term comorbidities. A major cause of neonatal seizures is hypoxic-ischemic encephalopathy that results in seizures that are frequently refractory to the first-line anti-seizure medication phenobarbital (PB). One proposed mechanism for PB-inefficacy during neonatal seizures is the reduced expression and function of the neuron-specific K+/Cl− cotransporter 2 (KCC2), the main neuronal Cl− extruder that maintains chloride homeostasis and influences the efficacy of GABAergic inhibition. To determine if PB-refractoriness after ischemic neonatal seizures is dependent upon KCC2 hypofunction and can be rescued by KCC2 functional enhancement, we investigated the recently developed KCC2 functional enhancer CLP290 in a CD-1 mouse model of refractory ischemic neonatal seizures quantified with vEEG. We report that acute CLP290 intervention can rescue PB-resistance, KCC2 expression, and the development of epileptogenesis after ischemic neonatal seizures. KCC2 phosphorylation sites have a strong influence over KCC2 activity and seizure susceptibility in adult experimental epilepsy models. Therefore, we investigated seizure susceptibility in two different knock-in mice in which either phosphorylation of S940 or T906/T1007 was prevented. We report that KCC2 phosphorylation regulates both neonatal seizure susceptibility and CLP290-mediated KCC2 functional enhancement. Our results validate KCC2 as a clinically relevant target for refractory neonatal seizures and provide insights for future KCC2 drug development.

scholarly journals Clinical profile, etiology, type and outcome of neonatal seizures: a hospital-based study

2021 ◽  
Vol 9 (1) ◽  
pp. 104
Author(s):  
Mohmad Saleem Chesti ◽  
Naveed Shahzad ◽  
Shilakha Chaman ◽  
Sheenam Gazala
Keyword(s):  
Birth Asphyxia ◽  
Clinical Profile ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Medical Sciences ◽  
Long Term Outcomes ◽  
Acute Symptomatic Seizure ◽  
Ethical Clearance ◽  
Common Infections

Background: Our study was undertaken to study the etiological factor, clinical profile, types and outcome of newborn with neonatal seizures (NNS).Methods: Our study was hospital based prospective study was done in Sheri Kashmir institute of medical sciences (SKIMS) Bemina from April 2013 to April 2015 in NICU, after obtaining ethical clearance from institutional ethical committee. All neonates fulfilling inclusion criteria were included in our study.Results: In our study, 80 neonates with seizures were included in our study, among them 48 were males and 32 were females. Majority of neonates (57.5%) developed seizures during first 72 hours of life due to birth asphyxia. Commonest types of neonatal seizures observed in our study were subtle observed in 46 cases, followed by tonic (21.2 %), clonic (14.9 %) and mixed (6.2%) seizures. Birth asphyxia was commonest cause (57.5%) of NNS, sepsis with meningitis (18.7%) followed by hypoglycemia (13.7%) and hypocalcemia (5%). Cases of birth asphyxia were associated with higher mortality (58.3%) as compared to cases with metabolic seizures.Conclusions: From our study we conclude that commonest cause of neonatal seizure was birth asphyxia occurring within 72 hours of birth. Sepsis and meningitis were also common infections resulting in neonatal seizure, while as hypoglycaemia and hypocalcemia were common biochemical abnormalities leading to NNS. Early identification and treatment are likely important for long-term outcomes in acute symptomatic seizure.

scholarly journals The evaluation and management of neonatal brachial plexus palsy

2021 ◽  
Vol 26 (8) ◽  
pp. 493-497
Author(s):  
Vibhuti Shah ◽  
Christopher J Coroneos ◽  
Eugene Ng
Keyword(s):  
Brachial Plexus ◽  
Neonatal Period ◽  
Position Statement ◽  
Brachial Plexus Palsy ◽  
Long Term Outcomes ◽  
Early Referral ◽  
Neonatal Brachial Plexus Palsy ◽  
Active Range Of Motion ◽  
Specialized Team

Abstract Neonatal brachial plexus palsy presents at birth and can be a debilitating condition with long-term consequences. Presentation at birth depends on the extent of nerve injury, and can vary from transient weakness to global paresis, with active range of motion affected. Serial clinical examination after birth and during the neonatal period (first month of life) is crucial to assess recovery and predicts long-term outcomes. This position statement guides the evaluation of neonates for risk factors at birth, early referral to a multidisciplinary specialized team, and ongoing communication between community providers and specialists to optimize childhood outcomes.

scholarly journals Primary Transplantation for Congenital Heart Disease in the Neonatal Period: Long-term Outcomes

2019 ◽  
Vol 108 (6) ◽  
pp. 1857-1864 ◽  
Author(s):  
Mohan M. John ◽  
Anees J. Razzouk ◽  
Richard E. Chinnock ◽  
Matthew J. Bock ◽  
Michael A. Kuhn ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Neonatal Period ◽  
Long Term Outcomes

scholarly journals Long-Term Outcomes after Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia: A Longitudinal, Prospective, Multicenter Case-Control Study in Children without Overt Brain Damage

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1076
Author(s):  
Elisa Cainelli ◽  
Luca Vedovelli ◽  
Emmanuele Mastretta ◽  
Dario Gregori ◽  
Agnese Suppiej ◽  
...  
Keyword(s):  
Executive Functions ◽  
Therapeutic Hypothermia ◽  
Parental Stress ◽  
Neuropsychological Functioning ◽  
Hypoxic Ischemic Encephalopathy ◽  
Sample Population ◽  
Long Term Outcomes ◽  
Visuomotor Skills ◽  
Ischemic Encephalopathy

Background. Data on long-term outcomes in the era before therapeutic hypothermia (TH) showed a higher incidence of cognitive problems. Since the introduction of TH, data on its results are limited. Methods. Our sample population consisted of 40 children with a history of hypoxic-ischemic encephalopathy (HIE) treated with TH, with an average age of 6.25 years (range 5.5, 7.33), 24 (60%) males; and 33 peers with an average age of 8.8 years (6.08, 9.41), 17 (51%) males. Long-term follow-up data belong to two centers in Padova and Torino. We measured general intelligence (WPPSI-III or WISC-IV) and neuropsychological functioning (language, attention, memory, executive functions, social skills, visual motor abilities). We also administered questionnaires to their parents on the children’s psychopathological profiles and parental stress. Results. We found differences between groups in several cognitive and neuropsychological domains: intelligence, visuomotor skills, executive functions, and attention. Interestingly, IQ test results effectively differentiated between the groups (HIE vs. controls). Furthermore, the incidence of psychopathology appears to be significantly higher in children with HIE (35%) than in control peers (12%). Conclusions. Our study supports previous findings on a higher incidence of neuropsychological, cognitive, and psychopathological sequelae after HIE treated with TH. As hypothesized, TH does not appear to ameliorate the outcome after neonatal HIE in those children who survive without major sequelae.

scholarly journals A study of biochemical abnormalities and manifestations of neonatal seizures

2019 ◽  
Vol 6 (5) ◽  
pp. 1867
Author(s):  
Sahaya Nirmala ◽  
Sahana Giliyaru ◽  
S. C. Karat
Keyword(s):  
Neonatal Period ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Central Nervous System Disorder ◽  
Biochemical Abnormality ◽  
Neurological Problem ◽  
System Disorder ◽  
Work Up ◽  
Ischemic Encephalopathy ◽  
Biochemical Abnormalities

Background: Neonatal seizure is a common neurological problem in the neonatal period with a frequency of 1.5 to 14/1000 neonates1. Neonatal seizures have always been a topic of particular interest because of their universal occurrence. A varied number of conditions are capable of causing seizures in the neonatal period. The presence of a seizure does not constitute a diagnosis but is a symptom of an underlying central nervous system disorder due to systemic or biochemical disturbances. This study aims to study the various clinical types of seizures and the biochemical abnormalities associated with them.Methods: This prospective study was conducted in the neonatology unit, department of pediatrics, C.S.I. Holdsworth Memorial Hospital, Mysore. Details of history, examination and investigations were recorded on predesigned proforma.Results: Out of total 54 cases, 47(87%) cases had seizures during first 3 days of life and hypoxic ischemic – encephalopathy (HIE) remains the main etiological factor in 20 (37.04%) cases. More than one metabolic abnormality was present in 6 cases. Hypoglycemia & hypomagnesemia were the commonest abnormality in neonates having seizures.Conclusions: A biochemical work up is necessary for all cases of neonatal seizures. The type of seizure does not give much information as to whether the seizures are purely metabolic or organic or about the type of biochemical abnormality.

Acute versus chronic myocardial injury and long-term outcomes

Heart ◽  
2019 ◽  
Vol 105 (24) ◽  
pp. 1905-1912 ◽  
Author(s):  
Erik Kadesjö ◽  
Andreas Roos ◽  
Anwar Siddiqui ◽  
Liyew Desta ◽  
Magnus Lundbäck ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Myocardial Injury ◽  
Troponin T ◽  
Long Term Outcomes ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Acute Myocardial Injury ◽  
Similar Risk

ObjectiveThere is a paucity of data regarding prognosis in patients with acute versus chronic myocardial injury for long-term outcomes. We hypothesised that patients with chronic myocardial injury have a similar long-term prognosis as patients with acute myocardial injury.MethodsIn an observational cohort study of 22 589 patients who had high-sensitivity cardiac troponin T (hs-cTnT) measured in the emergency department during 2011–2014, we identified all patients with level >14 ng/L and categorised them as acute myocardial injury, type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI) or chronic myocardial injury through adjudication. We estimated adjusted HRs with 95% CIs for the primary outcome all-cause mortality and secondary outcomes MI, and heart failure in patients with acute myocardial injury, T1MI and T2MI compared with chronic myocardial injury.ResultsIn total, 3853 patients were included. During 3.9 (±2) years of follow-up, 48%, 24%, 44% and 49% of patients with acute myocardial injury, T1MI, T2MI and chronic myocardial injury died, respectively. Patients with acute myocardial injury had higher adjusted risks of death (1.21, 95% CI 1.08 to 1.36) and heart failure (1.24, 95% CI 1.07 to 1.43), but a similar risk for myocardial infarction (MI) compared with the reference group. Patients with T1MI had a lower adjusted risk of death (0.86, 95% CI 0.74 to 1.00) and higher risk of MI (2.09, 95% CI 1.62 to 2.68), but a similar risk of heart failure. Patients with T2MI had a higher adjusted risk of death (1.46, 95% CI 1.18 to 1.80) and heart failure (1.30, 95% CI 1.00 to 1.69) compared with patients with chronic myocardial injury.ConclusionsAbsolute long-term risks for death are similar, and adjusted risks are slightly higher, among patients with acute myocardial injury and T2MI, respectively, compared with chronic myocardial injury. The lowest risk of long-term mortality was found in patients with T1MI. Both acute and chronic myocardial injury are associated with very high risks of adverse outcomes.

Effects of menthol use and transitions in use on short-term and long-term cessation from cigarettes among US smokers

2021 ◽  
pp. tobaccocontrol-2021-056596
Author(s):  
Eric C Leas ◽  
Tarik Benmarhnia ◽  
David R Strong ◽  
John P Pierce
Keyword(s):  
Cigarette Smoking ◽  
Lower Probability ◽  
Short Term ◽  
Demographic Groups ◽  
Adjusted Risk ◽  
Quit Attempt ◽  
Quit Smoking ◽  
Quit Attempts ◽  
Risk Ratios

ObjectivesTo estimate the effect of menthol use and transitions in use (switching to or from menthol) on short-term and long-term cessation from cigarette smoking and whether this differed across demographic groups (age, sex, race).MethodsWe compared the probability of 30+ day and 12-month abstinence from cigarette smoking by menthol use status using two cohorts of US adult cigarette smokers who attempted to quit smoking in the Population Assessment of Tobacco and Health (wave 1 to wave 3 and wave 2 to wave 4; n=5759), inverse probability of treatment weighting and adjusted risk ratios (aRRs).ResultsUsing menthol (vs non-menthol) prior to a quit attempt decreased the probability of 30+ day abstinence by 28% (aRR=0.78; 95% CI 0.67 to 0.91) and the probability of 12-month abstinence by 53% (aRR=0.65; 95% CI 0.47 to 0.88). Additionally, switching from menthol (vs maintaining menthol use) increased the probability of 30+ day abstinence by 58% (aRR=1.58; 95% CI 1.00 to 2.50) and the probability of 12-month abstinence by 97% (aRR=1.86; 95% CI 0.92 to 3.74). Switching to menthol (vs maintaining non-menthol use) was associated with a lower probability of 30+ day (aRR=0.70; 95% CI 0.42 to 1.16) and 12-month abstinence (aRR=0.64; 95% CI 0.30 to 1.36), but these associations were imprecise. The effects of menthol use on impaired quitting were slightly larger for non-Hispanic Black smokers, but not different for other demographic groups.ConclusionThese results demonstrate that menthol impaired menthol smokers’ attempts to quit smoking but switching from menthol improved success. This suggests that removing menthol may improve menthol smokers’ success during quit attempts.

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