Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Maria L. V. Dizon, Rakesh Rao, Shannon E. Hamrick, Isabella Zaniletti, Robert DiGeronimo, Girija Natarajan, Jeffrey R. Kaiser, John Flibotte, Kyong-Soon Lee, Danielle Smith, Toby Yanowitz, Amit M. Mathur, An N. Massaro

ABSTRACT

BACKGROUND: While intercenter variation (ICV) in anti-epileptic drug (AED) use in neonates with seizures has been previously reported, variation in AED practices across regional NICUs has not been specifically and systematically evaluated. This is important as these centers typically have multidisciplinary neonatal neurocritical care teams and protocolized approaches to treating conditions such as hypoxic ischemic encephalopathy (HIE), a population at high risk for neonatal seizures. To identify opportunities for quality improvement (QI), we evaluated ICV in AED utilization for neonates with HIE treated with therapeutic hypothermia (TH) across regional NICUs in the US. METHODS: Children's Hospital Neonatal Database and Pediatric Health Information Systems data were linked for 1658 neonates ≥36 weeks' gestation, > 1800 g birthweight, with HIE treated with TH, from 20 NICUs, between 2010 and 2016. ICV in AED use was evaluated using a mixed-effect regression model. Rates of AED exposure, duration, prescription at discharge and standardized AED costs per patient were calculated as different measures of utilization. RESULTS: Ninety-five percent (range: 83-100%) of patients with electrographic seizures, and 26% (0-81%) without electrographic seizures, received AEDs. Phenobarbital was most frequently used (97.6%), followed by levetiracetam (16.9%), phenytoin/fosphenytoin (15.6%) and others (2.4%; oxcarbazepine, topiramate and valproate). There was significant ICV in all measures of AED utilization. Median cost of AEDs per patient was $89.90 (IQR $24.52,$258.58). CONCLUSIONS: Amongst Children's Hospitals, there is marked ICV in AED utilization for neonatal HIE. Variation was particularly notable for HIE patients without electrographic seizures, indicating that this population may be an appropriate target for QI processes to harmonize neuromonitoring and AED practices across centers. More... »

PAGES

67

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12887-019-1441-7

DOI

http://dx.doi.org/10.1186/s12887-019-1441-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112435440

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30813933


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