Does phenobarbitone prevent periventricular hemorrhage in very low-birth-weight babies?: a controlled trial. Early high-dose phenobarbital treatment for prevention of hypoxic-ischemic brain damage in very low birth weight infants. Effect of phenobarbital on motor activity and intraventricular hemorrhage in preterm infants with respiratory disease weighing less than 1500 grams. Effect of prophylactic phenobarbital on intraventricular hemorrhage in high-risk infants. [The effect of phenobarbital on the severity of intraventricular hemorrhage]. [Prevention of brain hemorrhage in infants with low and extremely low birth weight and infants treated with surfactants. Late observation].
nan In a randomized prospective trial, we studied the effect of early high-dose phenobarbital treatment on the early (intraventricular hemorrhage) and late (neurodevelopmental abnormalities) manifestations of hypoxic-ischemic encephalopathy in preterm infants weighing 1500 g or less at birth. The first intravenous dose of 15 mg/kg was given at a mean age of 110 minutes, followed by 15 mg/kg after 4 hours and then by 5 mg/kg at 24-hour intervals for 5 days. The overall incidence of intraventricular hemorrhage was 32% in treated and 46% in control infants, a nonsignificant difference. An ultrasound brain scan at 9 months old revealed no significant difference in the incidence of ventricular dilatation between treated (19%) and control (29%) infants. At 27 months, a similar incidence of mild (10%) and severe (10%) neurodevelopmental handicaps was found in both treated and control groups. Since beneficial effects could not be documented by any of the criteria used, we conclude that routine administration of phenobarbital to low birth weight infants is not justified. The use of prophylactic phenobarbital to reduce motor activity and intraventricular hemorrhage was investigated in a controlled exploratory trial with 19 low birthweight premature infants with respiratory disease. Although phenobarbital significantly suppressed movement, it was associated with an increased incidence of intraventricular hemorrhage (IVH). Phenobarbital-treated infants were over eight times more likely to experience IVH than were untreated infants. These data indicate that inhibition of motor activity by phenobarbital may not alleviate the key pathogenetic factors in IVH. Forty-two premature infants less than 24 hours of age, with normal admission echoencephalograms, were randomly assigned to control or phenobarbital treatment groups. Infants in the treated group received two loading doses of 10 mg/kg of phenobarbital 12 hours apart, followed by a maintenance dose of 2.5 mg/kg every 12 hours for 6 days. Serial echoencephalograms were obtained in both groups. The groups were comparable with regard to birth weight, gestational age, and potential risk factors for subependymal-intraventricular hemorrhage. Ten infants (48%) in each group developed hemorrhage. The hemorrhages in the phenobarbital-treated group were significantly less severe than those in the control group. The phenobarbital-treated infants who bled, however, were also significantly larger and more mature than control infants who bled. The results of this study indicate no effect of phenobarbital on the incidence of subependymal-intraventricular hemorrhage, but a possible beneficial effect on the severity of hemorrhage. During an eight-months period, we studied every newborns under 34 gestation weeks who needed mechanical ventilation (MV) from the moment they were born and whom had an ultrasonogram without intraventricular hemorrhage in the first six hours after birth. Patient were separated in two groups: the first, a group of 30 patients received phenobarbital 20 mg/kg IV in the first 6 hours of life and then 2.5 mg/kg, I.V., every 12 hours for the next five days. Blood levels were measured 24 and 96 hours after the initial dose was given. The second group of 30 patients was not treated with phenobarbital. In both groups a brain ultrasonogram was made every 48 hours until 15 days of life. There were no difference in weight, gestational age, Apgar score, way of birth, initial diagnosis, incidence of pneumothorax, mortality and days with MV between the two groups. During the first three days were measured blood glucose, blood pressure, mean airway pressure, PCO2, PO2 and found no significant difference between both groups. The blood pH showed statistically significant difference, with better values at 48-72 hours in the group treated with phenobarbital. The global incidence of intraventricular hemorrhage was 16 (53%) in the group treated and 14 (46%) in the not treated, this difference was not statistically significant. The degree of hemorrhage, found was: I and II degree, eleven (69%) in the treated group and four (28%), in the control group; III and IV degree five (31%), in the treated group and ten (71%), in the control group.(ABSTRACT TRUNCATED AT 250 WORDS) Prematurely born infants with intraventricular haemorrhage (IVH) suffer significant morbidity and mortality, particularly those infants with high grade haemorrhage. The more premature infants have a higher incidence, experiencing more severe IVH. The etiology of IVH is clearly multifactorial. Prevention, both prenatal and postnatal. These include efforts to prevent preterm delivery. Postnatally, the importance of optimal resuscitation and neonatal care practices is stressed, particularly those which minimize cerebral blood flow fluctuation. 130 premature infants of less than 32 weeks gestation with a very low birth weight (VLBW) and extremely low birth weight (ELBW) were studied. They were divided in four groups: group I (n=35) received Indocid; group II (n=42) received Indocid and Phenobarbital; group III (n=53) received Indocid and Phenobarbital; surfactant. These three groups were compare to a reference group (n=45). Newborns from the main group were given Indocid 0.1 mg/kg from 6-12 h of life and during next three days, Phenobarbital 5 mg/kg first five days after delivery and surfactant in the first 4 hours of life according to the protocol provided with the specific surfactant replacement product. Cerebral netrasaund in 24 hours, day 3, 5 and 10 of life and follow up till one year age were performed. We found that IVH/PVH percentage is lowest in newborns from group III, followed by newborns from group II and group I.