TOP 66 - Impact of Practice Change on NICU Experience: Early discontinuation of Antiseizure Medication in Neonatal Encephalopathy–Related Seizures

Publication Number: 3797.TOP 66

Ahmed Ismaiel, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, United States; James R. Barnett, The Children's Hospital at Montefiore, Bronx, NY, United States; Shana Yazdanpanah, The Children's Hospital at Montefiore, Bronx, NY, United States; Marianna B. Castellanos, The Children's Hospital at Montefiore, Bronx, NY, United States; Elissa Yozawitz, The Children's Hospital at Montefiore, Bronx, NY, United States

Background: Newborns with neonatal encephalopathy (NE) frequently develop acute symptomatic seizures requiring antiseizure medications (ASMs). The optimal duration of ASM therapy for provoked seizures is an area of active investigation. Recent guidelines recommend early discontinuation of ASMs before NICU discharge, regardless of EEG background, brain imaging, or neurological exam, based on evidence showing no impact on epilepsy risk or neurodevelopmental (ND) outcomes. However, broader effects of this practice, including time to achieve full oral feeds, duration of respiratory support, and healthcare resource utilization, have not been well studied. Earlier attainment of these milestones may reduce central line days, decrease ventilator-associated morbidity, and lower healthcare costs. In 2021, our level IV NICU implemented early ASM discontinuation as standard practice, prompting an evaluation of its broader clinical and family impact

Objective: To evaluate impact of early ASM discontinuation on clinical outcomes, discharge disposition, and healthcare utilization in neonates with NE-related seizures, and to assess parent perspectives on this practice change

Design/Methods: This is a retrospective cohort study of neonates admitted to NICU (2016-2025) with acute seizures (clinical or electrographic) secondary to NE who received at least one ASM. Exclusion criteria include preterm infants ( < 35 weeks), confirmed genetic conditions, and neonatal epilepsy. Patients are categorized by ASM exposure: early ASM discontinuation (before discharge) vs discharged on ASM. Primary outcomes include NICU length of stay, time to full oral feeds, duration of respiratory support, and days on vasoactive agents. Secondary outcomes include destination at discharge (home vs. rehabilitation), inpatient cEEG duration, outpatient EEGs, emergency department visits, readmissions, laboratory testing for ASM monitoring, and ND outcomes at 1 year of age. To compare outcomes among infants of similar illness severity, key covariates (to be adjusted for in multivariable regression) include gestational age, size for gestational age, Sarnat stage, resuscitation at birth, therapeutic hypothermia, EEG background severity, seizure burden, number of ASMs, MRI and MRS findings, neuro exam at discharge, and major labor/delivery complications. Additionally, a parent questionnaire (Fig 1) was designed and initiated through REDCap to capture family perspectives on ASM management, outpatient challenges, and medication burden. Responses to be collected confidentially per institutional standards.
IRB approved Ref #131069 and data collected

Figure 1 :Parent Survey: Experiences with Antiseizure Medication After NICU Discharge
A brief questionnaire designed to capture parents' experiences, challenges, and confidence in managing antiseizure medications during the first month after their baby's NICU discharge.

Figure 2. Parent Experience Survey Domains
REDCap survey capturing five key domains of family experience with antiseizure medication use after NICU discharge.