What are the guidelines for discharge of a neonate who has experienced seizures?

Guidelines for Discharge of Neonates with Seizures

Neonates who have experienced seizures should be discharged only when they demonstrate physiologic stability, have a sustained pattern of weight gain, maintain normal body temperature in an open bed, establish competent feeding without cardiorespiratory compromise, and have a comprehensive follow-up care plan in place. 1

Discharge Readiness Criteria

Clinical Stability Requirements

• Seizures must be adequately controlled with appropriate anti-seizure medication (ASM) management 2
• Phenobarbital remains the first-line ASM for neonatal seizures regardless of etiology 2
• After cessation of acute provoked seizures without evidence of neonatal-onset epilepsy, ASMs should be discontinued before discharge home 2
• Physiologically mature and stable cardiorespiratory function must be documented for a sufficient duration 1
• A sustained pattern of weight gain must be demonstrated 1
• The infant must maintain normal body temperature fully clothed in an open bed with normal ambient temperature (20-25°C) 1
• Competent feeding by breast or bottle without cardiorespiratory compromise must be established 1

Pre-Discharge Evaluations

• Appropriate metabolic screening must be completed 1
• Appropriate immunizations must be administered 1
• Hematologic status must be assessed and appropriate therapy instituted if indicated 1
• Neurological and neurodevelopmental assessment must be performed and demonstrated to parents 1
• Car seat evaluation must be completed 1
• Complete review of hospital course with identification of unresolved medical issues 1

Family and Home Readiness Assessment

Caregiver Preparation

• Identify at least two family caregivers and assess their ability, availability, and commitment 1
• Provide comprehensive education to parents/caregivers on seizure recognition and management 1
• Offer repetitive education in different formats (spoken, practical demonstrations, written materials) 1
• Ensure parents demonstrate competence in recognizing seizures and administering medications 1
• Conduct psychosocial assessment for parenting strengths and risks 1

Home Environment

• Complete a home environmental assessment that may include on-site evaluation 1
• Review available financial resources and identify adequate financial support 1
• Ensure necessary medical equipment and medications are available 1

Follow-Up Care Planning

Medical Follow-Up

• Identify a primary care physician ("medical home") well before discharge 1
• Schedule an initial appointment with the primary care physician before discharge 1
• Arrange specific follow-up appointments with each involved specialist 1
• Enroll infant in a follow-up clinic specializing in neurodevelopmental assessment of high-risk infants 1
• Develop a plan for emergency care and transportation to a hospital if necessary 1

Care Coordination

• Establish a comprehensive care coordination plan with appointments, contacts, and emergency management protocols 1
• Provide a discharge summary to the primary care physician before the infant's discharge 1
• Ensure open communication between the hospital team and community providers 1
• Provide a single contact point for seizure emergency management 1
• Consider using community resources, both public and private, to provide coordinated care and family support 1

Special Considerations

Seizure Management Education for Caregivers

• Educate caregivers on when to activate emergency medical services (EMS) for seizures: first-time seizure, seizures lasting >5 minutes, multiple seizures without return to baseline, difficulty breathing, or choking 1
• Teach proper positioning during seizures (recovery position) and clearing the area around the infant 1
• Instruct caregivers not to restrain the infant or put anything in the mouth during a seizure 1
• Inform that antipyretics are not effective for stopping or preventing febrile seizures 1

Common Pitfalls to Avoid

• Discharging before physiologic stability is established, which may lead to increased mortality and morbidity 1
• Inadequate parental education on seizure recognition and management 1
• Failure to establish a clear follow-up plan with appropriate specialists 1
• Lack of coordination between hospital and community providers 1
• Insufficient assessment of home environment and family support systems 1

By following these guidelines, healthcare providers can ensure a safe transition from hospital to home for neonates who have experienced seizures, minimizing risks and optimizing outcomes for these vulnerable infants.