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Neonatal Intensive Care Drug Manual
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| bet | 452/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Evidence
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Efficacy:
Treatment of neonatal seizures: Phenobarbital has been recommended as first-line treatment for neonatal seizures.[1] In RCTs, phenobarbital (target plasma concentration 25 mg/L) was reported to be similarly as effective as phenytoin (target plasma concentration 3 mg/L) for control of electrical seizures (43% versus 45%)[2]; and phenobarbital 20 mg/kg was reported to be more effective than phenytoin 20 mg/kg at controlling clinical seizures (72% versus 15%)[3] (LOE II, GOR C).
Prevention of seizures in infants with perinatal asphyxia: In term or near-term infants with perinatal asphyxia, prophylactic phenobarbital (20−40 mg/kg loading dose) prevents seizures. There was no reduction in mortality and there are few data addressing long-term outcomes (LOE I, GOR C).
Treatment of neonatal abstinence syndrome (NAS): Phenobarbital is recommended as add on treatment of NAS secondary to opioid withdrawal not controlled by an opioid (LOE I, GOR C).[4] Phenobarbital is recommended as initial treatment of NAS secondary to sedative withdrawal (LOE I, GOR C).[4] Phenobarbital should be commenced at a dose of 5 mg/kg/day split into two divided doses. The dose should be titrated to achieve control of NAS according to the NAS score. It is unclear whether a loading dose of phenobarbital should be used. If used as initial therapy (rather than in addition to an opioid), then a loading dose is likely to achieve more rapid control of symptoms.[5, 6]
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