Document Detail

Population pharmacokinetics of phenobarbital in infants with neonatal encephalopathy treated with therapeutic hypothermia.
MedLine Citation:
PMID:  23254984     Owner:  NLM     Status:  MEDLINE    
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.
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.
Renée A Shellhaas; Chee M Ng; Christina H Dillon; John D E Barks; Varsha Bhatt-Mehta
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  14     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-07     Completed Date:  2013-09-16     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  194-202     Citation Subset:  IM    
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MeSH Terms
Age Factors
Anticonvulsants / pharmacokinetics*,  therapeutic use
Body Temperature
Body Weight
Hypothermia, Induced*
Hypoxia-Ischemia, Brain / complications,  therapy*
Infant, Newborn
Phenobarbital / pharmacokinetics*,  therapeutic use
Retrospective Studies
Seizures / complications,  drug therapy
Grant Support
Reg. No./Substance:
0/Anticonvulsants; YQE403BP4D/Phenobarbital
Comment In:
Pediatr Crit Care Med. 2013 Feb;14(2):228-9   [PMID:  23388572 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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