Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs
Abstract Background While intercenter variation (ICV) in anti-epileptic drug (AED) use in neonates with seizures has been previously reported, variation in AED practices across regional NICUs has not been specifically and systematically evaluated. This is important as these centers typically have mu...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-02-01
|
| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12887-019-1441-7 |
| _version_ | 1818901244862791680 |
|---|---|
| author | Maria L. V. Dizon Rakesh Rao Shannon E. Hamrick Isabella Zaniletti Robert DiGeronimo Girija Natarajan Jeffrey R. Kaiser John Flibotte Kyong-Soon Lee Danielle Smith Toby Yanowitz Amit M. Mathur An N. Massaro |
| author_facet | Maria L. V. Dizon Rakesh Rao Shannon E. Hamrick Isabella Zaniletti Robert DiGeronimo Girija Natarajan Jeffrey R. Kaiser John Flibotte Kyong-Soon Lee Danielle Smith Toby Yanowitz Amit M. Mathur An N. Massaro |
| author_sort | Maria L. V. Dizon |
| collection | DOAJ |
| description | Abstract Background While intercenter variation (ICV) in anti-epileptic drug (AED) use in neonates with seizures has been previously reported, variation in AED practices across regional NICUs has not been specifically and systematically evaluated. This is important as these centers typically have multidisciplinary neonatal neurocritical care teams and protocolized approaches to treating conditions such as hypoxic ischemic encephalopathy (HIE), a population at high risk for neonatal seizures. To identify opportunities for quality improvement (QI), we evaluated ICV in AED utilization for neonates with HIE treated with therapeutic hypothermia (TH) across regional NICUs in the US. Methods Children’s Hospital Neonatal Database and Pediatric Health Information Systems data were linked for 1658 neonates ≥36 weeks’ gestation, > 1800 g birthweight, with HIE treated with TH, from 20 NICUs, between 2010 and 2016. ICV in AED use was evaluated using a mixed-effect regression model. Rates of AED exposure, duration, prescription at discharge and standardized AED costs per patient were calculated as different measures of utilization. Results Ninety-five percent (range: 83–100%) of patients with electrographic seizures, and 26% (0–81%) without electrographic seizures, received AEDs. Phenobarbital was most frequently used (97.6%), followed by levetiracetam (16.9%), phenytoin/fosphenytoin (15.6%) and others (2.4%; oxcarbazepine, topiramate and valproate). There was significant ICV in all measures of AED utilization. Median cost of AEDs per patient was $89.90 (IQR $24.52,$258.58). Conclusions Amongst Children’s Hospitals, there is marked ICV in AED utilization for neonatal HIE. Variation was particularly notable for HIE patients without electrographic seizures, indicating that this population may be an appropriate target for QI processes to harmonize neuromonitoring and AED practices across centers. |
| first_indexed | 2024-12-19T20:16:41Z |
| format | Article |
| id | doaj.art-71b993e24eb0436da38b8c631907ef3d |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-19T20:16:41Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-71b993e24eb0436da38b8c631907ef3d2022-12-21T20:07:08ZengBMCBMC Pediatrics1471-24312019-02-0119111310.1186/s12887-019-1441-7Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUsMaria L. V. Dizon0Rakesh Rao1Shannon E. Hamrick2Isabella Zaniletti3Robert DiGeronimo4Girija Natarajan5Jeffrey R. Kaiser6John Flibotte7Kyong-Soon Lee8Danielle Smith9Toby Yanowitz10Amit M. Mathur11An N. Massaro12Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern UniversityWashington UniversityChildren’s Healthcare of AtlantaChildren’s Hospital AssociationSeattle Children’s Hospital/University of WashingtonChildren’s Hospital of MichiganPenn State Health Children’s HospitalChildren’s Hospital of PhiladelphiaHospital for Sick ChildrenChildren’s Hospital ColoradoUniversity of Pittsburgh School of MedicineWashington UniversityChildren’s National Health SystemsAbstract Background While intercenter variation (ICV) in anti-epileptic drug (AED) use in neonates with seizures has been previously reported, variation in AED practices across regional NICUs has not been specifically and systematically evaluated. This is important as these centers typically have multidisciplinary neonatal neurocritical care teams and protocolized approaches to treating conditions such as hypoxic ischemic encephalopathy (HIE), a population at high risk for neonatal seizures. To identify opportunities for quality improvement (QI), we evaluated ICV in AED utilization for neonates with HIE treated with therapeutic hypothermia (TH) across regional NICUs in the US. Methods Children’s Hospital Neonatal Database and Pediatric Health Information Systems data were linked for 1658 neonates ≥36 weeks’ gestation, > 1800 g birthweight, with HIE treated with TH, from 20 NICUs, between 2010 and 2016. ICV in AED use was evaluated using a mixed-effect regression model. Rates of AED exposure, duration, prescription at discharge and standardized AED costs per patient were calculated as different measures of utilization. Results Ninety-five percent (range: 83–100%) of patients with electrographic seizures, and 26% (0–81%) without electrographic seizures, received AEDs. Phenobarbital was most frequently used (97.6%), followed by levetiracetam (16.9%), phenytoin/fosphenytoin (15.6%) and others (2.4%; oxcarbazepine, topiramate and valproate). There was significant ICV in all measures of AED utilization. Median cost of AEDs per patient was $89.90 (IQR $24.52,$258.58). Conclusions Amongst Children’s Hospitals, there is marked ICV in AED utilization for neonatal HIE. Variation was particularly notable for HIE patients without electrographic seizures, indicating that this population may be an appropriate target for QI processes to harmonize neuromonitoring and AED practices across centers.http://link.springer.com/article/10.1186/s12887-019-1441-7Hypoxic-ischemic encephalopathyAnti-epileptic drugsNeonatal seizures |
| spellingShingle | Maria L. V. Dizon Rakesh Rao Shannon E. Hamrick Isabella Zaniletti Robert DiGeronimo Girija Natarajan Jeffrey R. Kaiser John Flibotte Kyong-Soon Lee Danielle Smith Toby Yanowitz Amit M. Mathur An N. Massaro Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs BMC Pediatrics Hypoxic-ischemic encephalopathy Anti-epileptic drugs Neonatal seizures |
| title | Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs |
| title_full | Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs |
| title_fullStr | Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs |
| title_full_unstemmed | Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs |
| title_short | Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs |
| title_sort | practice variation in anti epileptic drug use for neonatal hypoxic ischemic encephalopathy among regional nicus |
| topic | Hypoxic-ischemic encephalopathy Anti-epileptic drugs Neonatal seizures |
| url | http://link.springer.com/article/10.1186/s12887-019-1441-7 |
| work_keys_str_mv | AT marialvdizon practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT rakeshrao practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT shannonehamrick practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT isabellazaniletti practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT robertdigeronimo practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT girijanatarajan practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT jeffreyrkaiser practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT johnflibotte practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT kyongsoonlee practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT daniellesmith practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT tobyyanowitz practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT amitmmathur practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus AT annmassaro practicevariationinantiepilepticdruguseforneonatalhypoxicischemicencephalopathyamongregionalnicus |