| Description |
Critically ill neonates face the potential for numerous complications. One problem that many neonates suffer from are electrographic and/or clinical seizures. Neonatal seizures disrupt homeostasis in the fragile, immature neurological neonatal system. Potential long-term complications of neonatal seizures include, but are not limited to, cerebral palsy, cerebral atrophy, epilepsy, and feeding difficulties. Seizure activity is most frequently seen in the first year of life. A preterm infant is at an increased risk for seizures, compared to their term counterpart. There is growing focus on the diagnosis of neonatal seizures, but the best anticonvulsant medication remains unclear. Currently, there is a lack of evidenced-based studies identifying the best anticonvulsant medication. Due to the lack of evidence, each provider prescribes medications differently. This project aimed to provide a standardized approach in treating neonatal seizures. By implementing a standardized pharmacological approach, the infant will get the appropriate medication in a timely manner, along with successful management, by eliminating gray areas in treatment practices. Objectives of this project were to: 1. Develop a standardized pharmacological approach for neonatal seizures in the newborn intensive care unit; 2. Simplify the process, in regards to which medication to prescribe and the correct dosage based on the best literature; 3. Disseminate findings to peers through professional poster or podium presentation. The literature is extremely limited in regard to the best anticonvulsant medication to use in the neonatal population. At this point in time, there is insufficient data from randomized controlled trials to support the best choice of anticonvulsant drugs for neonatal seizures. Phenobarbital and fosphenytoin are the most frequently used medications. Both medications only treat seizure activity about 40% of the time. Phenobarbital is typically used first, as it has less severe side effects than fosphenytoin. Levetiracetam is a newer medication that has been used to control seizures in older children since 2006. Data is inadequate in regards to neonatal use, with only retrospective studies being used. Other medications, such as Depakote and Lamictal, are not recommended in the neonatal population, due to the significantly increased risk of developing fatal hepatotoxicity. Current seizure medication research is limited with trifling success, but used regardless. Implementation steps included identifying standards of care from neurological newborn intensive care units. Using the literature that was available along with an expert opinion, I compiled the information into a standardized pharmacological approach for controlling neonatal seizures. This standardized approach was reviewed by my content expert and program chair for accuracy. After approval, I presented the information to the Neurology Newborn Intensive Care Unit Steering Committee at Primary Children's Hospital. I obtained approval from the College of Nursing and directors of the newborn intensive care unit at local hospitals. I presented the standardized approach through a PowerPoint presentation to neonatologists and neonatal nurse practitioners at local level III and IV newborn intensive care units. I will share my standardized approach through a professional poster presentation. In summary, the literature for the best seizure medication in neonates is inconclusive. Anticonvulsant medications have been studied and approved for the treatment of neonatal seizures, but none have demonstrated superior efficacy over the others. Due to this, the best course of treatment can become hazy to many providers. The key in treating neonatal seizures is to control seizure activity quickly to prevent further damage to the fragile brain. Developing a standardized pharmacological approach for neonatal seizures will ensure the infant will receive the appropriate medication quickly. |
