Abstract
A total of 40 cases of neonatal convulsions of different nonmetabolic aetiological factors were studied. Patients with kernicterus were included in the study. Peak plasma phenobartibal concentrations after incremental loading doses of phenobarbital i.e. 10 mg/kg, 15 mg/kg, and 20 mg/kg were determined. Diphenylhydantoin was added if phenobarbital alone was unable to control seizures. In three patients, a combination of phenobarbital and diphenylhydantoin was used as the initial loading therapy. Increase in the loading dose of phenobarbital was associated with an increase in its peak plasma concentration. Despite increase in the plasma phenobarbital concentration beyond the ‘therapeutic’ levels suggested by the Western studies, doses of 15 mg/kg and 20 mg/kg of phenobarbital were unable to score over the traditional regimen of 10 mg/kg. Convulsions were controlled in 50% of the patients with any of these three regimens, irrespective of the aetiology. Convulsions were controlled in 7 out of the 9 cases where diphenylhydantoin was added, because of the failure of phenobarbital in controlling the convulsions as a single drug. Convulsions of all the three patients, in whom a combination of phenobarbital and diphenylhydantoin was used by random selection as the initial bolus, were controlled. Seizure effects were difficult to distinguish from drug effects but major side effects were not encountered despite the fluctuating drug levels in the sick neonate.
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Painter MJ, Bergman Ira, Crimrine Patricia. Neonatal seizures.Pediatr Clin North Am 1986; 33: 91–109.
Painter MJ, Pippenger C, MacDonald H et al. Phenobarbital and diphenylhydantoin levels in neonates with seizures.J Pediatr 1978; 92: 315–319.
Painter MJ, Pippenger C, Wasterlain C et al. Phenobarbital and phenytoin in neonatal seizures-metabolism and tissue distribution.Neurology 1981; 31: 1107–1112.
Kabra PK, Gotelli G, Stanfill R et al. Simultaneous measurement of phenobarbital, diphenylhydantoin and primidone in blood by high pressure liquid chromatographyClin Chem 1976; 23: 824–827.
Szebo GK, Browna TR. Improved isocratic liquid chromatographic simultaneous measurement of phenytoin, phenobarbital, primidone, carbamazepine, ethosuximide and N. desmethyl succimide in serum.Clin Chem 1982; 28: 100–104.
Volpe Joseph. Current concepts: Neonatal seizures.N Engl J Med 1978; 289: 413–417.
Lockman LA, Kriel R, Zaske D et al. Phenobarbital: dosage for control of neonatal seizures.Neurology 1979; 29: 1445–1449.
Staudt F, Scholl ML, Coen RW et al. Phenobarbital therapy in neonatal seizures and the prognostic value of EEG.Neuropediatrics 1982; 13: 24–33.
Gal P, Toback J, Boet H et al. Efficacy of phenobarbital monotherapy in treatment of neonatal seizures: Relationship to blood levels.Neurology 1982; 32: 1401–1404.
Svenningsen N, Blennow G, Tindroth M et al. Brain oriented intensive care in severe neonatal asphyxia.Arch Dis Child 1982; 57: 176–182.
Kuban Karl, Neonatal seizures. In: Cloherty JP, Stark AR, eds.Manual of Neonatal Care. London: Little Brown Publishers, 1985: 293–303.
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Jawadekar, Y.M., Shah, K.N., Kshirsagar, N.A. et al. A study of phenobarbital and dilantin in neonatal seizures. Indian J Pediatr 59, 729–734 (1992). https://doi.org/10.1007/BF02859409
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DOI: https://doi.org/10.1007/BF02859409