Antenatal phenobarbital for the prevention of neonatal intracerebral hemorrhage

Antenatal Phenobarbital in Preventing Intraventricular Hemorrhage in Premature Newborns

“…In agreement with the results of Shanka ran et al [ 12] and Morales and Koerten [ 13], antenatal phénobarbital treatment reduces the incidence and the severity of IVH in our premature infants. We observed no cases of grade-3 to 4 IVH in the infants treated with antenatal phénobarbital versus 5 of 18 in fants (27%) in the control group (p < 0.01).…”

“…At variance with the study by Shankaran et al [ 12] who stud ied a population of less than 35 weeks of ges tation, we selected a group of pregnant women with less than 32 weeks of gestation as the risk of IVH is much higher in this period [1,2]. Shankaran et al [12] used a loading dose of 500 mg of phénobarbital, while we preferred to use a loading dose of 700 mg of phénobarbital, according to Mo rales and Koerten [13], in order to achieve what are considered therapeutic levels.…”

“…However, since IVH develops in the early postnatal hours and phénobarbital crosses the placenta [11], it was suggested to treat premature newborns antenatally to cover the period of highest risk for IVH. Two randomized studies were performed to evaluate this form of pre vention, which appears to be effective [12,13],…”

Phenobarbital and Cerebral Blood Flow during Hypotension in Newborn Pigs

“…CBF during hypotension at MABP of 41 f 5 (SD) mm Hg was significantly higher in controls than was CBF at MABP of 39 + 6 (SD) mm Hg in the PhS-treated group (p = 0.044); CBF in the two groups during the second hypotensive phase was not significantly different. However, LOWESS regression suggested that the CBF from the controls dropped as the arterial pressure de-LOWESS, locally weighted regression and smoothing scatter plots TX, thromboxane Some clinical studies have reported that the incidence and/or severity of PIVH in preterm infants decreases when anticonvulsant dosages of PhS are given either antenatally or early in the postnatal period (1)(2)(3)(4)(5). Other studies have questioned the effectiveness of PhS in preventing PIVH (6)(7)(8)(9)(10).…”

Effect of Phenobarbital on Cerebral Blood Flow in the Newborn Piglet under Stress

“…Although numerous fac tors are involved in the pathophysiology of IC-IVH [3], pressure passivity of the cerebral circulation [4,5] seems to play a major role [6]. Phénobarbital may decrease the inci dence and/or severity of IC-IVH [7,8] with optimal results when the drug is given antenatally [9]. The mechanisms of this apparent preventive action are not well understood.…”