A Standardized, 3-Tiered, Seizure Burden-Based Protocol for the Treatment of Neonatal Seizures

Objective: To evaluate use of a standardized, 3-tiered, seizure burden-based protocol for treatment of all electroencephalography (EEG)-confirmed seizures in a level IV neonatal intensive care unit (NICU).

Study Design: All infants admitted to the NICU with EEG-confirmed seizures over a 25-month period were enrolled in the study. We compared short-term outcomes before and after implementation of a standardized, 3-tiered protocol.

Results: A total of 107 infants were enrolled in the study. Use of midazolam infusions was reduced by 53.7% (= 0.02). Midazolam infusion duration increased from 4 to 7.5 days ( = 0.003); however, when excluding 3 outliers, there was no significant difference between groups (-= 0.67). Duration of EEG monitoring decreased from 5 to 3 days (= 0.005). Hospital length of stay was unchanged.

Conclusion: Implementation of a standardized, 3-tiered protocol for treatment of neonatal seizures improved short-term outcomes. Although not measured directly, reductions in EEG duration and midazolam use are promising indicators of overall seizure burden. More research is needed to evaluate impact on long-term neurodevelopmental outcomes.