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Updated: Feb 10, 2026

Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse

Published on: October 24, 2018

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Phenobarbital pharmacokinetics in neonates and infants during extracorporeal membrane oxygenation

Pavla Pokorná1,2,3, Martin Šíma2, Václav Vobruba1

  • 11 Department of Pediatrics - PICU/NICU, General University Hospital, 1st Faculty of Medicine Charles University, Prague 2, Czech Republic.

Perfusion
|May 24, 2018
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) significantly impacts phenobarbital pharmacokinetics in neonates and infants. Body weight is a key factor influencing drug dosing, necessitating adjusted nomograms for optimal therapeutic drug monitoring.

Area of Science:

  • Neonatal and Pediatric Pharmacology
  • Critical Care Medicine
  • Pharmacokinetics

Background:

  • Drug disposition can be altered in neonates and infants during extracorporeal membrane oxygenation (ECMO).
  • Understanding phenobarbital pharmacokinetics is crucial for effective treatment in this vulnerable population.

Purpose of the Study:

  • To evaluate the individual pharmacokinetics (PK) of phenobarbital in neonates and infants undergoing ECMO.
  • To identify pharmacokinetic covariates affecting phenobarbital disposition during ECMO.
  • To provide guidance for phenobarbital dosing in neonates and infants on ECMO.

Main Methods:

  • A pharmacokinetic study involving 16 neonates and infants treated with phenobarbital during ECMO.
  • Phenobarbital serum concentrations were measured using fluorescence polarization immunoassay.
  • Individual PK parameters (Vd, CL) were calculated using a one-compartmental model.

Main Results:

  • High inter-individual variability in phenobarbital clearance (CL) and volume of distribution (Vd) was observed (CVs of 52% and 53%, respectively).
  • Body weight and length were identified as significant covariates affecting Vd and CL.
  • Therapeutic drug monitoring (TDM) improved achievement of target phenobarbital concentrations from 50% to 88.6%.

Conclusions:

  • Body weight is the primary covariate influencing phenobarbital disposition during ECMO.
  • Dosing nomograms are provided to aid in optimizing phenobarbital therapy for neonates and infants on ECMO.
  • Individualized dosing strategies are essential due to high inter-individual PK variability.
Abstract

Keywords:
ECMOinfantspharmacokineticspharmacotherapyphenobarbital

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