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Association between anti-seizure medication and outcomes in infants

Journal of Perinatology volume 42, pages 359–364 (2022)Cite this article

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A Correction to this article was published on 16 December 2021

This article has been updated

Abstract

Objective

To compare treatment failure between: (1) infants treated with phenobarbital versus levetiracetam for first-line treatment and (2) infants treated with phenytoin versus levetiracetam for second-line treatment following phenobarbital.

Study design

This retrospective cohort study included infants with seizures receiving phenobarbital or levetiracetam as the initial anti-seizure medication. Treatment failure was defined as the need for additional anti-seizure medication within 24–72 h and compared using mixed-effect logistic regression after adjustment for confounding factors, including center.

Results

In this cohort of 6842 infants, the incidence of treatment failure was 31% vs. 38% in infants receiving first-line phenobarbital versus levetiracetam (adjusted OR: 0.70; 95% CI 0.58–0.84). There was no significant difference in second-line treatment failure (adjusted OR: 1.31; 95% CI 0.92–1.86).

Conclusions

First-line treatment of neonatal seizures with phenobarbital is associated with a lower rate of treatment failure than levetiracetam. There was no significant difference in second-line treatment failure.

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Fig. 1: Flowchart of the study population.
Fig. 2: Trends in anti-seizure medication over time.

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Author contributions

ES contributed to the study design and data interpretation, drafted the primary manuscript and subsequent revisions, and approved the final version of the manuscript. SH contributed to the study design and data interpretation, critically reviewed all drafts of the manuscript, and approved the final version of the manuscript. RP contributed to the study design and data interpretation, critically reviewed all drafts of the manuscript, and approved the final version of the manuscript. MB completed the data analysis, critically reviewed all drafts of the manuscript, and approved the final version of the manuscript. VT contributed to the study design, data acquisition, and data interpretation, critically reviewed all drafts of the manuscript, and approved the final version of the manuscript. KA contributed to the study design, data acquisition, and data interpretation, critically reviewed all drafts of the manuscript, and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Authors and Affiliations

  1. Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, USA

    Elizabeth K. Sewell, Shannon E. G. Hamrick & Ravi M. Patel

  2. Baylor Scott and White Research Institute, Dallas, TX, USA

    Monica Bennett & Veeral N. Tolia

  3. Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA

    Veeral N. Tolia

  4. Pediatrix Medical Group, Dallas, TX, USA

    Veeral N. Tolia

  5. Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA

    Kaashif A. Ahmad

  6. Pediatrix Medical Group of San Antonio, San Antonio, TX, USA

    Kaashif A. Ahmad

  7. Pediatrix and Obstetrix Specialists of Houston, Houston, TX, USA

    Kaashif A. Ahmad

Authors
  1. Elizabeth K. Sewell
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  4. Monica Bennett
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Corresponding author

Correspondence to Elizabeth K. Sewell.

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The authors declare no competing interests.

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The original online version of this article was revised: The Supplementary information was corrected and a second table was added.

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Sewell, E.K., Hamrick, S.E.G., Patel, R.M. et al. Association between anti-seizure medication and outcomes in infants. J Perinatol 42, 359–364 (2022). https://doi.org/10.1038/s41372-021-01240-1

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  • DOI: https://doi.org/10.1038/s41372-021-01240-1

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