Abstract Details

Title Standardization of Evaluation for Seizures During Therapeutic Hypothermia (TH) in Neonates with Hypoxic Ischemic Encephalopathy (HIE): A Quality Improvement (QI) Initiative

Topic Child Neurology and Developmental Neurology

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-001

Objective Evaluate timing and duration of conventional EEG (cEEG) monitoring for neonates with Hypoxic Ischemic Encephalopathy (HIE) as part of the institutional Therapeutic Hypothermia (TH) protocol.

Background TH reduces morbidity and mortality in neonates with HIE (Committee on the Fetus and Newborn, 2014). HIE is the most common cause of neonatal seizures. Greater than 50% of neonates with HIE have seizures, with 60% occurring within 12 hours of birth (Glass et al., 2009). Higher seizure burden is associated with more severe brain injury and worse neurodevelopmental outcomes (Srinivasakumar et al., 2015). Our institutional TH protocol includes cEEG within 6 hours with repeat cEEG 12-24 hours after re-warming.

Design/Methods

TH was initiated in 12 subjects at a tertiary care academic medical center from June 2018-October 2019. The metric for evaluation was whether cEEG was performed, timing of cEEG, and duration of cEEG. Adherence to the institutional TH protocol was defined as obtaining pre and post-cooling cEEG and Neurology consultation. Neurology outpatient follow up was also tracked.

Results In this cohort, 12 had cEEG, 2 had cEEG within 6 hours of birth, 8 had cEEG throughout TH, 2 had repeat cEEG after 12-24 hours of re-warming, and 4 were treated for status epilepticus. 9 had Neurology consultation and 5 had Neurology outpatient follow-up.

Conclusions A cEEG was universally obtained; however, the timing and duration was variable. Neurology consultation and follow-up were not routinely established. Our baseline data suggests that there is low compliance to seizure evaluation protocol during TH at our institution. We propose 3 interventions through PDSA cycles to improve treatment of neonatal seizures associated with HIE: (1) develop explicit guidelines on timing and duration of cEEG during TH, (2) increase Neurology consultation when obtaining cEEG to 75% within 6 months, and (3) improve compliance to institutional TH protocol to 75% within 6 months.

Authors/Disclosures
Justin Rosati, MD (University of Rochester Medical Center) PRESENTER	Dr. Rosati has nothing to disclose.
Jennifer T. Nguyen, MD (University of Rochester Medical Center)	Dr. Nguyen has received research support from Teva Pharmaceuticals LTD.

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Abstract Details