OBJECTIVE: Phenobarbital is the first-line treatment for neonatal seizures. Many neonates with hypoxic ischemic encephalopathy are treated with therapeutic hypothermia, and about 40% have clinical seizures. Little is known about the pharmacokinetics of phenobarbital in infants with hypoxic ischemic encephalopathy who undergo therapeutic hypothermia. The objective of this study was to determine the effect of therapeutic hypothermia on phenobarbital pharmacokinetics, taking into account maturational changes. SETTING: Level 3 neonatal ICU. PATIENTS: Infants with hypoxic ischemic encephalopathy and suspected seizures, all treated with phenobarbital. Some of these infants also received treatment with therapeutic hypothermia. INTERVENTIONS: None. DESIGN: A retrospective cohort study of 39 infants with hypoxic ischemic encephalopathy treated with phenobarbital (20 were treated with therapeutic hypothermia and 19 were not). MEASUREMENTS AND MAIN RESULTS: Data on phenobarbital plasma concentrations were collected in 39 subjects with hypoxic ischemic encephalopathy with or without therapeutic hypothermia. Using nonlinear mixed-effects modeling, population pharmacokinetics of phenobarbital were developed with a total of 164 plasma concentrations. A one-compartment model best described the pharmacokinetics. The clearance of phenobarbital was linearly related to body weight and matured with increasing age with a maturation half-life of 22.1 days. Therapeutic hypothermia did not influence the pharmacokinetic parameters of phenobarbital. CONCLUSIONS: Therapeutic hypothermia does not influence the clearance of phenobarbital after accounting for weight and age. Standard phenobarbital dosing is appropriate for the initial treatment of seizures in neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia.
OBJECTIVE:Phenobarbital is the first-line treatment for neonatal seizures. Many neonates with hypoxic ischemicencephalopathy are treated with therapeutic hypothermia, and about 40% have clinical seizures. Little is known about the pharmacokinetics of phenobarbital in infants with hypoxic ischemicencephalopathy who undergo therapeutic hypothermia. The objective of this study was to determine the effect of therapeutic hypothermia on phenobarbital pharmacokinetics, taking into account maturational changes. SETTING: Level 3 neonatal ICU. PATIENTS: Infants with hypoxic ischemicencephalopathy and suspected seizures, all treated with phenobarbital. Some of these infants also received treatment with therapeutic hypothermia. INTERVENTIONS: None. DESIGN: A retrospective cohort study of 39 infants with hypoxic ischemicencephalopathy treated with phenobarbital (20 were treated with therapeutic hypothermia and 19 were not). MEASUREMENTS AND MAIN RESULTS: Data on phenobarbital plasma concentrations were collected in 39 subjects with hypoxic ischemicencephalopathy with or without therapeutic hypothermia. Using nonlinear mixed-effects modeling, population pharmacokinetics of phenobarbital were developed with a total of 164 plasma concentrations. A one-compartment model best described the pharmacokinetics. The clearance of phenobarbital was linearly related to body weight and matured with increasing age with a maturation half-life of 22.1 days. Therapeutic hypothermia did not influence the pharmacokinetic parameters of phenobarbital. CONCLUSIONS: Therapeutic hypothermia does not influence the clearance of phenobarbital after accounting for weight and age. Standard phenobarbital dosing is appropriate for the initial treatment of seizures in neonates with hypoxic ischemicencephalopathy treated with therapeutic hypothermia.
Authors: Agnes I Bartha; Jessica Shen; Karol H Katz; Rebecca E Mischel; Katherine R Yap; Judith A Ivacko; Ena M Andrews; Donna M Ferriero; Laura R Ment; Faye S Silverstein Journal: Pediatr Neurol Date: 2007-08 Impact factor: 3.372
Authors: Anikó Róka; Kis Tamas Melinda; Barna Vásárhelyi; Tamás Machay; Denis Azzopardi; Miklós Szabó Journal: Pediatrics Date: 2008-04 Impact factor: 7.124
Authors: Denis V Azzopardi; Brenda Strohm; A David Edwards; Leigh Dyet; Henry L Halliday; Edmund Juszczak; Olga Kapellou; Malcolm Levene; Neil Marlow; Emma Porter; Marianne Thoresen; Andrew Whitelaw; Peter Brocklehurst Journal: N Engl J Med Date: 2009-10-01 Impact factor: 91.245
Authors: Chee M Ng; Erin Dombrowsky; Hopi Lin; Michelle E Erlich; David E Moody; Jeffrey S Barrett; Walter K Kraft Journal: Pharmacotherapy Date: 2015-07-14 Impact factor: 4.705
Authors: Sharon O Wietstock; Sonia L Bonifacio; Charles E McCulloch; Michael W Kuzniewicz; Hannah C Glass Journal: J Child Neurol Date: 2014-11-07 Impact factor: 1.987
Authors: Samuel Dubinsky; Kevin Watt; Steven Saleeb; Bilal Ahmed; Caitlin Carter; Cindy H T Yeung; Andrea Edginton Journal: Clin Pharmacokinet Date: 2021-11-30 Impact factor: 6.447
Authors: Kacey B Anderson; Samuel M Poloyac; Patrick M Kochanek; Philip E Empey Journal: Ther Hypothermia Temp Manag Date: 2016-09-13 Impact factor: 1.286
Authors: Maria D Donovan; Brendan T Griffin; Liudmila Kharoshankaya; John F Cryan; Geraldine B Boylan Journal: Drugs Date: 2016-04 Impact factor: 9.546
Authors: Céline Thibault; Shavonne L Massey; Nicholas S Abend; Maryam Y Naim; Alexandra Zoraian; Athena F Zuppa Journal: J Clin Pharmacol Date: 2020-09-22 Impact factor: 3.126