The purpose of this quality improvement project is to decrease the duration of days of anti-seizure medication use in neonates in the Neonatal ICU with acute symptomatic seizures by 25% within a 2 month timeframe.

With minimal guidelines in regards to duration of medication use in neonates, antiseizure medications are being continued in 73% of survivors of acute symptomatic seizures even though the risk of post-neonatal epilepsy remains less than 25% for all etiologies of acute symptomatic neonatal seizures. The variability in actual practice is due to lack of hospital-specific treatment pathways. The purpose of this QI project is to determine current practice of duration of anti-seizure medication use based on etiology and to start implementation of a guideline which may impact this duration and overall limit the prolonged use of antiseizure medications in this patient population.

A general weaning protocol template at seizure onset was provided to the NICU team and was followed based on the infant’s seizure etiology. The success of the template was measured by calculating the number of days of anti-seizure medication use both before and after the use of the protocol with a goal to decrease the duration by 25% for acute symptomatic seizure etiologies.

The data collection after the use of the protocol for 3 months was analyzed and divided by symptomatic seizure etiology. It was found that epileptic spasms (ES) and hypoxic ischemic encephalopathy (HIE) contributed to the most days of anti-seizure medication use and a 30% and 36% reduction in duration of medications for ES and HIE respectively was found. These values met the project aim goal of a reduction of 25%. 

Ongoing quality improvement is necessary to formulate a standard guideline in regards to duration of medication use in neonates with acute symptomatic seizures.