Emerging Trends of Antiepileptic Drug (AED) Use amongst Neonatologists in Intensive Care

Background: Limited clinical trial data exists regarding the therapeutics of neonatal seizures.Objective: To evaluate national trends in neonatal seizure therapeutics over a 10-year period in the United States utilizing an objective and nationally representative dataset.Design/Methods: Data from the Pediatrix Clinical Data Warehouse (CDW), a large de-identified database of infants born at Pediatrix-managed Neonatal Intensive Care Units (NICUs) was accessed and analyzed. The CDW is HIPAA-compliant and approved by the Western IRB. Infants with a diagnosis of seizures from 2005-2014 were selected.Results: There were 10,405 infants across 341 facilities with a seizure diagnosis. Of those we excluded 1,039 with incomplete data due to acute transfer leaving 9,366 infants for analysis across 275 facilities. At least 85[percnt] of the neonatal seizures were treated with an AED and between 34-52[percnt] of the time ≥2 AEDs were used (pu003c0.0001). Phenobarbital was consistently the most commonly used AED ranging between 933/1135 or 82[percnt] to 782/859 or 91[percnt] of patients annually (pu003c0.0001). Phenytoin or fosphenytoin use remained constant at between 10-14[percnt]. Levetiracetam use increased gradually and substantially with 1[percnt] (7/1135) of patients exposed in 2005 and 14[percnt] (117/817) in 2014 (pu003c0.0001). We also found an approximately 1/3 increase in benzodiazepine use over this time, inclusive of lorazepam, midazolam and diazepam (least common). Other AEDs without intravenous formulations were extremely seldom used.Conclusions: Phenobarbital continues to be the most commonly utilized AED in the treatment of neonatal seizures. Benzodiazepine use has remained common and is increasing among sick neonates. A minority of seizure patients are exposed to multiple AEDs. Levetiracetam, for which very little efficacy data exists in neonates, has gained increasing popularity over the past 10 years in this patient population. Although there have been a number of newer AEDs, neonatologists have continued to use older AEDs with the added exception of benzodiazepines. Disclosure: Dr. Ahmad has nothing to disclose. Dr. Desai has nothing to disclose. Dr. Bennett has nothing to disclose. Dr. Ahmad has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Clark has nothing to disclose. Dr. Tolia has nothing to disclose.