Prophylactic phenobarbital administration after resolution of neonatal seizures: survey of current practice.

OBJECTIVE: Child neurologists and neonatologists often discharge newborn infants with phenobarbital treatment for weeks to months despite the absence of continuing seizure activity. We conducted a national survey to determine the degree of variation in this practice.
METHODS: Surveys were sent to a randomly generated list of board-certified child neurologists (N = 609) and neonatologists (N = 579). The survey consisted of 3 parts, that is, questions related to overall attitudes and practices, specific patient scenarios, and respondent demographic characteristics. Responses were tabulated and analyzed for all respondents combined and for child neurologists and neonatologists separately. Variation in practices between respondents and the consistency between the respondents' stated use of phenobarbital in practice and their answers to various clinical scenarios were evaluated.
RESULTS: Responses were received from 118 child neurologists (20.7%) and 125 neonatologists (23.1%). There was wide variation in practices, with little difference in the response frequencies between child neurologists and neonatologists. Physicians were more likely to respond yes to continuation of phenobarbital treatment in a given clinical situation than would be predicted on the basis of their answers regarding overall frequency of use.
CONCLUSIONS: Since the survey of practices 15 years ago, child neurologists and neonatologists are reporting less frequent and shorter phenobarbital treatment after resolution of neonatal seizures, although there remains considerable variation in practices. Moreover, what physicians report as their practice in general is inconsistent with how they respond to specific clinical cases of neonatal seizures.