Oral Topiramate in Neonates with Hypoxic Ischemic Encephalopathy Treated with Hypothermia: A Safety Study

Objective

To investigate whether topiramate associated with mild or deep hypothermia in asphyxiated term infants is safe in relation to the short-term outcome.

Study design

We report on 27 consecutive asphyxiated newborns who were treated with whole body hypothermia and 27 additional consecutive newborns with hypothermia who were co-treated with oral topiramate, once a day for 3 consecutive days, at 2 different doses.

Results

Newborns were divided in 6 groups according to the depth of hypothermia and the association with higher or lower topiramate dosage. A statistical comparison of the groups identified some differences in biochemical and hemodynamic variables, but no adverse effects attributable to topiramate were detected. There were no statistically significant differences in the groups in short-term outcomes, survival rate at discharge, or incidence of pathologic brain magnetic resonance imaging.

Conclusion

Although the number of newborns in this study was limited, the short-term outcome and the safety data appear to support the evaluation of topiramate in clinical trials to explore its possible additive neuroprotective action.

aPTT, Activated partial thromboplastin time, DH, Deep hypothermia, DH-highTPM, Deep hypothermia and high topiramate dose, DH-lowTPM, Deep hypothermia and low topiramate dose, HIE, Hypoxic-ischemic encephalopathy, MH, Mild hypothermia, MH-highTPM, Mild hypothermia and high topiramate dose, MH-lowTPM, Mild hypothermia and low topiramate dose, MRI, Magnetic resonance imaging, NICU, Neonatal intensive care unit, TPM, Topiramate