Rapid sequential phenobarbital treatment of neonatal seizures

J. T. Gilman, P. Gal, M. S. Duchowny, R. L. Weaver, J. L. Ransom

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

The optimal serum concentration of phenobarbital in newborns and its safety at high doses are not well established. The dose response relationship of rapid sequential phenobarbital loading in the newborn was examined and the efficacy of high-dose monotherapy was compared with the addition of a second anticonvulsant for persistent seizure activity. A single loading dose of phenobarbital 15 to 20 mg/kg was initially administered to 120 newborns. Nonresponders received sequential bolus doses of 5 to 10 mg/kg until seizures ceased or a serum concentration of 40 μg/mL was obtained. Infants with refractory seizures received additional phenobarbital to a maximum serum concentration of 100 μg/mL. The seizures of 48 babies (40%) were controlled after initial loading and 37 of the remaining 72 subjects (51%) responded at serum concentrations of as great as 40 μg/mL. The seizures of only seven subjects were controlled at greater concentrations. A second anticonvulsant controlled seizures in 13 of the 28 subjects (46%) whose seizures were refractory to phenobarbital. A gestational age of less than 32 weeks was associated with a significantly better response to phenobarbital. Serum phenobarbital concentrations greater than 50 μg/mL produced only occasional feeding difficulty and sedation. It was concluded that sequentially administered IV phenobarbital controls seizures in both term and preterm newborns (77%). This therapeutic effect is dose dependent but plateaus at a serum concentration of 40 μg/mL. At greater serum concentrations, unresponsive patients should receive a second antiepileptic agent.

Original languageEnglish (US)
Pages (from-to)674-678
Number of pages5
JournalPediatrics
Volume83
Issue number5
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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