Phenobarbital for Treatment of Seizures in Preterm Infant:
A New Administration Scheme

Carolis, Maria Pia De; Muzii, Umberto; Romagnoli, Costantino; Zuppa, Antonio Alberto; Zecca, Enrico; Tortorolo, Giuseppe Gio Batta

doi:10.1159/000480923

Cited by 8 publications

(1 citation statement)

References 14 publications

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“…Identified studies of CYP2C19 and CYP2C9 activity are displayed in Table 2 . Only phenobarbital was found reported as an in vivo probe for CYP2C9 ( Pitlick et al, 1978 ; Ribon et al, 1984 ; Grasela and Donn, 1985 ; MP et al, 1989 ; Touw et al, 2000 ; Völler et al, 2017 ), although additional minor metabolism occurs via CYP2C19 and CYP2E1 (approximately 5%). A general trend towards reduced phenobarbital clearance was observed in premature neonates.…”

Section: Exploring the Available Data On Premature Neonates: An Examp...mentioning

confidence: 99%

The Blind Spot of Pharmacology: A Scoping Review of Drug Metabolism in Prematurely Born Children

et al. 2022

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The limit for possible survival after extremely preterm birth has steadily improved and consequently, more premature neonates with increasingly lower gestational age at birth now require care. This specialized care often include intensive pharmacological treatment, yet there is currently insufficient knowledge of gestational age dependent differences in drug metabolism. This potentially puts the preterm neonates at risk of receiving sub-optimal drug doses with a subsequent increased risk of adverse or insufficient drug effects, and often pediatricians are forced to prescribe medication as off-label or even off-science. In this review, we present some of the particularities of drug disposition and metabolism in preterm neonates. We highlight the challenges in pharmacometrics studies on hepatic drug metabolism in preterm and particularly extremely (less than 28 weeks of gestation) preterm neonates by conducting a scoping review of published literature. We find that >40% of included studies failed to report a clear distinction between term and preterm children in the presentation of results making direct interpretation for preterm neonates difficult. We present summarized findings of pharmacokinetic studies done on the major CYP sub-systems, but formal meta analyses were not possible due the overall heterogeneous approaches to measuring the phase I and II pathways metabolism in preterm neonates, often with use of opportunistic sampling. We find this to be a testament to the practical and ethical challenges in measuring pharmacokinetic activity in preterm neonates. The future calls for optimized designs in pharmacometrics studies, including PK/PD modeling-methods and other sample reducing techniques. Future studies should also preferably be a collaboration between neonatologists and clinical pharmacologists.

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Section: Exploring the Available Data On Premature Neonates: An Examp...mentioning

confidence: 99%

The Blind Spot of Pharmacology: A Scoping Review of Drug Metabolism in Prematurely Born Children

et al. 2022

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The effect of phenobarbital on cerebral blood flow in newborn infants with foetal distress

1994

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The effect of phenobarbital on cerebral blood flow (CBF) was investigated by the intravenous Xenon133 clearance technique in seven term newborn infants with signs of mild to moderate hypoxic ischaemic encephalopathy, all on sustained spontaneous ventilation. Phenobarbital treatment had no significant effect on CBF 60 min after loading dosage (20 mg/kg i.v.). Likewise, no significant change in mean arterial blood pressure, heart rate or transcutaneous gas tensions was observed. Though slight changes in CBF of short duration cannot be excluded, conventional dosage of phenobarbital to term newborn infants with foetal distress apparently imposes no risk of cerebrovascular damage.

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Phenobarbital in newborns with neonatal seizures

Gherpelli

Cruz

Tsanaclis

et al. 1993

Brain and Development

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Phenobarbital for Treatment of Seizures in Preterm Infant: A New Administration Scheme

Cited by 8 publications

References 14 publications

The Blind Spot of Pharmacology: A Scoping Review of Drug Metabolism in Prematurely Born Children

The Blind Spot of Pharmacology: A Scoping Review of Drug Metabolism in Prematurely Born Children

The effect of phenobarbital on cerebral blood flow in newborn infants with foetal distress

Phenobarbital in newborns with neonatal seizures

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