• neonatology
• neurology
• infant development

Neonatal seizures remain a complex challenge for those of us involved in these babies’ care. While relatively common, our approaches to these patients vary between clinicians, subspecialties and centres. Nearly every facet of detection, investigation, treatment and follow-up of these patients is subject to some variation in practice.

Sewell et al, on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, provide more evidence on the enormous variation in practice that exists for these infants, with an observational study on antiseizure medication (ASM) use after discharge for infants with hypoxic-ischaemic encephalopathy (HIE).1 The data were collected on infants who had been enrolled into various cooling trials over the preceding 15 years. Despite recommendations about cessation of ASM for neonates with a normal neurological examination and normal electroencephalogram (EEG), continuation of ASM is still commonplace. Rates of ASM continuation at hospital discharge between centres ranged from 13% to 100%. For those infants who were discharged on ASM a concerning higher rate of death and disability at 18–22 months was evident (adjOR 2.14), reminding us that we cannot be complacent about the continuation of commonly employed ASMs. Infants who survive HIE and seizures are at risk of complex illnesses long after their discharge from the neonatal intensive care unit.

This study extends the previous work of Glass et al 2 in which no differences in neurodevelopment at 2 years, or postneonatal epilepsy, were reported between those infants who had ASM discontinued at time of hospital discharge and those for whom ASM was maintained. The conclusion was that discontinuation of ASM …