Related Experiment Videos
Routine administration of phenobarbital for the prevention of intraventricular hemorrhage in premature infants: five
1Shanghai Institute for Pediatric Research, China.
Insights
Phenobarbital prophylaxis continues to reduce intraventricular hemorrhage in premature infants. However, timing of administration and infant origin impact its effectiveness, highlighting the need for individualized treatment strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Pharmacology
Background:
- Intraventricular hemorrhage (IVH) is a serious complication in premature infants.
- Phenobarbital was previously shown to reduce IVH incidence.
- Routine phenobarbital prophylaxis was implemented for low birth weight infants.
Purpose of the Study:
- To assess the continued efficacy of phenobarbital prophylaxis for preventing IVH.
- To identify factors influencing phenobarbital's effectiveness in preventing IVH.
Main Methods:
- Retrospective review of records for premature infants (< or = 1800 gm) from 1985-1989.
- Analysis of overall IVH incidence, severe IVH rates, and risk factors.
- Comparison of IVH incidence based on timing of phenobarbital loading and infant origin (inborn vs. outborn).
Main Results:
- Overall IVH incidence was 27.5%, with 41.1% being severe (grade 3-4).
- Lower IVH incidence observed with phenobarbital loading < 4 hours (25.9%) vs. > 4 hours (32.8%).
- Outborn infants had a significantly higher IVH incidence (45.3%) than inborn infants (23.0%).
- Additional risk factors identified include hyperoxia, hypocarbia, hypercarbia, and blood pressure extremes.
Conclusions:
- Phenobarbital prophylaxis remains a viable strategy against intraventricular hemorrhage in premature infants.
- Variations in phenobarbital efficacy may be attributed to differences in administration timing and patient population.
- Further research is needed to optimize phenobarbital prophylaxis protocols.
Abstract:
After it was reported in 1981 that phenobarbital reduced the incidence of intraventricular hemorrhage from 46.7% in control infants to 13.3% in treated premature infants, routine phenobarbital prophylaxis (loading dose, 20 mg/kg; maintenance, 5 mg/kg per day for 5 days) was introduced at the hospital of the original trial for all premature infants with birth weights of < or = 1800 gm. To assess continued efficacy, we reviewed all records of these infants from 1985 through 1989. The overall incidence of intraventricular hemorrhage was 27.5% (168/612); the proportion of severe intraventricular hemorrhage (grade 3 and 4) was 41.1% (69/168). The incidence of intraventricular hemorrhage was lower when loading occurred at < 4 hours: 25.9% (124/478) versus 32.8% (44/134). Outborn infants had a higher incidence of intraventricular hemorrhage than inborn infants (45.3% vs 23.0%). In addition to already known risk factors (gestational age, vaginal delivery, outborn status, pneumothorax, birth asphyxia, patent ductus arteriosus), intraventricular hemorrhage occurred more often in infants with hyperoxia (PO2 > 180 mmHg), hypocarbia (PcO2 > 28 mmHg), hypercarbia (PcO2 > 55 mmHg), and hypotension and hypertension (blood pressure > norm +/- 15 mmHg). These results support the hypothesis that phenobarbital has a role in the prophylaxis against intraventricular hemorrhage. Differences in the efficacy of phenobarbital prophylaxis between various studies may be caused by variations of age at loading and differences in the proportion of very low birth weight infants.(ABSTRACT TRUNCATED AT 250 WORDS)