Correlation between Electroencephalogram and Clinical Assessment of Neonatal Seizures in Full Term Neonates

Background: There is minimal consensus on how to properly treat subclinical seizure events detected on physical exam without electroencephalogram (EEG) findings, or how aggressively to treat seizures detected on EEG. Many of these newborns are discharged from neonatal intensive care units (NICU), while on anticonvulsant medications, without clear guidance on when to discontinue medication and the factors supporting this decision. Objective: To determine whether there is a difference in continuing need for medical seizure treatment at the time of NICU discharge and one year after discharge in full term babies diagnosed with seizures primarily via physical exam versus physical exam and EEG. Methods: A retrospective cohort study design of full term infants admitted to the NICU at a tertiary urban hospital in NJ from 01/01/2010 to 09/01/19, who had an exam and or EEG suspicious for seizures using our neonatal database (Neonatal Information System) and electronic medical record (EPIC). Neonates who were clinically diagnosed with seizures were compared with neonates with EEG diagnosis of seizures to detect if there was a difference in medications use at discharge and one year after discharge. Additional variables included birth weight, gestation age, small for gestational age, and demographic information. A descriptive analysis, independent T-tests and chi-square tests were used. Results: Of a total of 335 neonates, 48 full term neonates (GA \u3e 37 weeks) with seizures were included. Seizure diagnosis via EEG was confirmed in 18 (37.5%) neonates and the remaining 30 (62.5%) neonates were diagnosed clinically. Of the 18 neonates diagnosed via EEG, 16/18 (88.9%) were discharged on seizure medications, 7/18 (38.9%) were taking seizure medications at 1 year, and 4/10 (40%) had an abnormal EEG after discharge but prior to 1 year follow-up. Of the 30 neonates diagnosed clinically, 21/30 (70%) were discharged on seizure medications, 6/30 (20%) were taking seizure medications at time of 1 year, and 1/6 (16.7%) had an abnormal EEG after discharge but prior to 1 year follow-up. The difference in medication use at discharge was not statistically different, (p=0.171), nor was use at 1 year (p=0.190). Furthermore, there was no difference in abnormal EEGs reported before 1-year follow-up (p=0.588). Conclusion: These results suggest that the method of neonatal seizure diagnosis is not associated with medications use at discharge or at 1 year