Harris Mandy L, Malloy Katherine M, Lawson Sheena N, Rose Rebecca S, Buss William F, Mietzsch Ulrike
Department of Neurology, Division of Child Neurology, Indiana University, School of Medicine, Indianapolis, IN, USA.
Department of Clinical Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
J Child Neurol. 2016 Dec;31(14):1546-1554. doi: 10.1177/0883073816664670. Epub 2016 Aug 31.
We aimed to decrease practice variation in treatment of neonatal status epilepticus by implementing a standardized protocol. Our primary goal was to achieve 80% adherence to the algorithm within 12 months. Secondary outcome measures included serum phenobarbital concentrations, number of patients progressing from seizures to status epilepticus, and length of hospital stay. Data collection occurred for 6 months prior and 12 months following protocol implementation. Adherence of 80% within 12 months was partially achieved in patients diagnosed in our hospital; in pretreated patients, adherence was not achieved. Maximum phenobarbital concentrations were decreased (56.8 vs 41.0 µg/mL), fewer patients progressed from seizures to status epilepticus (46% vs 36%), and hospital length of stay decreased by 9.7 days in survivors. In conclusion, standardized, protocol-driven treatment of neonatal status epilepticus improves consistency and short-term outcome.
我们旨在通过实施标准化方案来减少新生儿癫痫持续状态治疗中的实践差异。我们的主要目标是在12个月内使对该算法的依从率达到80%。次要结局指标包括血清苯巴比妥浓度、从癫痫发作进展为癫痫持续状态的患者数量以及住院时间。在方案实施前6个月和实施后12个月进行数据收集。在我院诊断的患者中，部分实现了12个月内80%的依从率；在接受过预处理的患者中，未实现依从率。苯巴比妥的最高浓度有所降低（56.8 vs 41.0 µg/mL），从癫痫发作进展为癫痫持续状态的患者减少（46% vs 36%），幸存者的住院时间缩短了9.7天。总之，标准化的、基于方案的新生儿癫痫持续状态治疗可提高一致性和短期结局。
