Clinical experience with phenobarbitone in icterus neonatorum

Phenobarbital and Phototherapy Combination Enhances Decline of Total Serum Bilirubin and May Decrease the Need for Blood Exchange Transfusion in Newborns with Isoimmune Hemolytic Disease

OBJECTIVE

The objective of this study was to evaluate the effect of phenobarbital and phototherapy combination on the total serum bilirubin of the newborn infants with isoimmune hemolytic disease (IHD) and its impact on blood exchange transfusion rates.

PATIENTS AND METHOD

This single-blinded, prospective, randomized, controlled trial was conducted between March 2013 and December 2014 at the pediatric ward of two Military Hospitals in Jordan. A total of 200 full-term neonates with IHD were divided randomly into two groups: (1) the phenobarbital plus phototherapy group (n = 103), and (2) the phototherapy-only group (n = 97). Infants in group 1 received an oral dose of 2.5 mg/kg phenobarbital every 12 hours for 3 days in addition to phototherapy. The total serum bilirubin was observed.

RESULTS

Of the total 200 included newborn infants, 186 infants completed the study: 97 infants were included in group 1 and 89 infants in group 2. The difference between the mean total serum bilirubin levels at 24, 48, and 72 hours after starting the trial was clinically and statistically significant at P < 0.05. The differences between the two groups were also statistically significant at P < 0.05. Of the total 186 who completed the study, only 22 underwent blood exchange transfusion [7 from group 1, and 15 from group 2 (P = 0.0478)].

CONCLUSION

In a limited-resources setting, phenobarbital in combination with phototherapy may be helpful to newborn infants with IHD, as it results in a faster decline in total serum bilirubin, thus decreasing the need for blood exchange transfusion than phototherapy alone.

Interactions of CNS drugs--hypnotics and sedatives

The physicochemical properties of the barbiturates and a brief review of microsomal enzyme induction introduces this literature review of the interactions of sedative and hypnotic drugs. Food has been shown to delay absorption of barbiturates; barbiturates, in turn, may interfere with the absorption of griseofulvin, dicumarol, and folic acid. Barbiturate-produced enzyme induction may result in interactions with the oral anticoagulants, the anticonvulsants, vitamin D, bilirubin, digitoxin, doxycycline, and perhaps other drugs. The problem of additive central nervous system depression and the relative lack of documented evidence is considered. Finally, the interactions of nonbarbiturate hypnotics, such as glutethimide, chloral hydrate, and others are reviewed.

Relative roles of phototherapy and phenobarbitone in treatment of nonhaemolytic neonatal jaundice

Trials were carried out on 61 infants with plasma bilirubin over 15 mg/100 ml to compare effects of phototherapy alone, phenobarbitone by injection, and both treatments combined. Infants above 2·5 kg birthweight treated with phenobarbitone only behaved like untreated controls up to 60 hours, and only at 84 hours was a significant fall seen. Infants of 2·5 kg birthweight or less treated with phenobarbitone had significantly higher levels throughout the 84 hours of study. Phototherapy, either alone or combined with phenobarbitone, had its expected significant effect from 24 hours onwards in both groups of infants. Combined phototherapy and phenobarbitone treatment showed no difference from phototherapy alone. Phenobarbitone has no place in the management of established jaundice. Risks of phenobarbitone therapy and a possible explanation of contradictory results in previous trials are discussed. No changes were found in packed cell volumes, plasma albumin level, or residual albumin binding capacity at 48 hours from onset of treatment or between groups.

Sequential trial of effect of phenobarbitone on serum bilirubin of preterm infants

(1) Phenobarbitone in a dose of 8 mg/kg per day was given in twice-daily intramuscular doses to preterm infants with a gestational age of 36 completed weeks or less. The phenobarbitone was started within the first 24 hours after birth. (2) The peak serum bilirubin levels of these infants and matched, randomly selected, control infants were compared sequentially. A significantly lower (P [unk]0·05) peak bilirubin level was found in the treated group. (3) This lower level of serum bilirubin may be less liable to produce neurological damage in preterm infants.

Phenobarbitone in neonatal jaundice

Eighty-three jaundiced newborn infants were studied, 41 received phenobarbitone, and 42 served as controls. 48 hours after starting treatment the mean serum bilirubin level of the group of normal birthweight infants was significantly lower than that of controls. Exchange transfusions were required in 6 of the 32 control cases and in none of the 28 treated cases. There were no significant differences in the mean serum bilirubin levels or in the exchange transfusion rates between treated and control low birthweight infants.

Controlled trial of phenobarbitone in neonatal jaundice

A single-blind controlled trial of phenobarbitone in the treatment of non-obstructive neonatal jaundice is reported. 24 babies were given phenobarbitone by mouth for 3 days from the first appearance of jaundice. 27 babies were given placebo linctus for the same period from the appearance of jaundice. There was a small but statistically significant difference between the mean serum bilirubin levels of the two groups 24 hours after starting treatment or placebo, the mean level of the control group being the higher. There was no significant difference in the mean serum bilirubin levels for the two groups initially or at 48 and 72 hours. The maximum recorded levels of serum bilirubin did not differ significantly between the two groups. It is concluded that phenobarbitone has no place in the management of established neonatal jaundice.