Abstract
We assessed the risk factors of post-neonatal anti-epileptic medications after neonatal intensive care unit discharge (PD-AED) and neurodevelopmental (ND) outcomes by age three in very-low-birth-weight infants (VLBWIs), with 7,292 VLBWIs born in 2013-2020 using the Korean Neonatal Network data. We assessed the risk factor of PD-AED and compared the risks for cerebral palsy (CP), blindness, deafness, and ND impairments between five groups: group 1, no seizure; group 2, neonatal seizure only; group 3, neonatal seizure + PD-AED before age three; group 4, neonatal seizure + PD-AED up to age three; group 5, PD-AED without neonatal seizure. By age three, 515 infants (7.1%) had seizures and 241 infants (3.8%) had PD-AED. Higher GA, intra-ventricular hemorrhage ≥ grade 3, post-hemorrhagic hydrocephalus, neonatal seizures, cystic periventricular leukomalacia, necrotizing enterocolitis ≥ stage 2, and moderate to severe bronchopulmonary dysplasia increased the risk of PD-AED. Compared to other groups, group 1 had the lowest risk of CP, while group 4 had the highest. The risk of hearing loss was higher in group 4 compared to groups 1, 2, and 5. Seizures at any time point increased the risk of CP. In infants with neonatal seizures, longer time on anti-epileptic medications also increased the CP risk.