Effect of prophylactic phenobarbital on seizures, encephalopathy and mortality in neonates with perinatal asphyxia

Abstract

Background. Seizures after an asphyxial insult may result in brain damage in neonates. Prophylactic phenobarbital may reduce seizures.
Objective. To determine the e€ect of prophylactic phenobarbital on seizures, death and neurological outcome at hospital discharge.
Methods. Neonates with base de.cit >16 mmol/l and Apgar score at 5 minutes <7 or requiring resuscitation for >5 minutes at the time of
birth were randomised to prophylactic phenobarbital 40 mg/kg (n=50) or placebo (controls) (n=44) within the .rst 6 hours of life. .ey were
monitored for clinical seizures, hypoxic ischaemic encephalopathy (HIE) and mortality.
Results. Seizures developed in 30.0% of the phenobarbital group as opposed to 47.7% of the control group (relative risk 0.63; 95% con.dence
interval -0.37 - 1.06; p=0.083). .e proportions of patients who had died and/or had HIE II or III at time of discharge from hospital were
similar in the two groups (42.0% v. 45.5%). .ere were no di€erences in mortality between the two groups (14.0% v. 15.9%).
Conclusion. In infants with asphyxia, prophylactic phenobarbital does not reduce the incidence of seizures, HIE and mortality.