Use of Prophylactic Phenobarbitone for Prevention of Morbidity and Mortality in Term Neonates Following Perinatal Asphyxia

Background: Seizures are common following perinatal asphyxia and may exacerbate secondary neuronal injury. Barbiturate therapy has been used for infants with perinatal asphyxia in order to prevent seizures. However, barbiturate therapy may adversely affect neurodevelopment leading to concern regarding its aggressive use in neonates. The objective of the study was to determine the effect of administering prophylactic barbiturate therapy on seizure control and mortality in term neonates following perinatal asphyxia.Methodology: This was a randomized controlled trial (RCT) of prophylactic phenobarbitone therapy in term asphyxiated neonates without clinical evidence of seizures when compared to controls conducted in the neonatal ward of Sher-e-Bangla Medical College Barisal from 1st January 2016 to 30th June 2016.Results: Among the 100 neonates equally divided into two groups, there was no significant difference found in clinical outcome e.g. seizures (8% vs. 12%, p > 0.05), neurological abnormality at discharge (10% vs. 14%, p >0.05), mortality (12% vs. 14%, p >0.05) and major neurological disability (14% vs. 18%, p >0.05).Conclusion: In this study, prophylactic phenobarbitone therapy did not significantly prevent seizures in asphyxiated neonates.Bangladesh J Child Health 2017; VOL 41 (3) :165-169

Decrease in white blood cell counts after thiopentone barbiturate therapy for refractory intracranial hypertension: A common complication

ABSTRACT Background: Leucopenia has been reported after induction of thiopentone barbiturate therapy for refractory intracranial hypertension. However, the incidence and characterisitics are not well described. Aims: We performed a retrospective review to describe the incidence and characteristics of leucopenia after induction of thiopentone barbiturate therapy. Setting and Design: Our centre is a national referral centre for neurotrauma and surgery in a tertiary medical institution.Materials and Methods: We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18 month period from January 2004 to June 2005 in our neurosurgical intensive care unit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 15.0. All data are reported as mean ± standard deviation or median (interquartile range). The Chi square test was used to analyze categorical data and student t test done for comparison of means. For paired data, the paired t?test was used.-test was used. Results: Thirty eight (80.9%) out of 47 patients developed a decrease in white blood cell (WBC) count after induction of thiopentone barbiturate coma. The mean decrease in WBC from baseline to the nadir was 6.4 × 10 9 /L (P <lt; 0.001) and occurred 57 (3-147) h after induction. The mean nadir WBC was 8.6 < 3.6 × 10 9 /L. Three (6.4%) patients were leucopenic, with a WBC count of 2.8, 3.1, and 3.6 < 10 9 /L. None of them were neutropenic. We did not find an association between decrease in WBC count and clinical diagnosis of infection. We did not find any association between possible risk factors such as admission GCS, maximum ICP prior to induction of barbiturate coma, APACHE II score, total duration and dose of thiopentone given, and decrease in WBC count. Conclusions: Decrease in WBC count is common, while development of leucopenia is rare after thiopentone barbiturate coma. Regular monitoring of WBC counts is recommended.