[Determinants of diphemanil methylsulfate (Prantal) utilization: a survey of practice in the French neonatal and intensive care units].
Diphemanil methylsulfate (Prantal) is a quaternary ammonium with parasympathicolytic properties. It is used in premature and term neonates with bradycardias related to vagal hyper reflectivity (HRV).


OBJECTIVE
To assess the use of Prantal in the French neonatal and intensive care units: its indications, its modalities of use, its side effects and the number of patients treated during 1 year (2004) in France.


METHODS
A questionnaire was electronically sent to all neonatology units and all neonatal intensive care units in France.


RESULTS
Among 202 units, 121 (60%) answered the questionnaire. Prantal was reported to be used in 51 (42.1%) units. Among them, 38 (31.4%) actually treated 169 patients in 2004 with a mean number of patients treated by unit of 4. The diagnostic of HRV was supported by: a history of malaise (84.3%), bradycardia (94.1%), oculocardiac reflex (74.5%), cardiac Holter (76.4%), cardiorespirographic recording (19.6%), esophageal pHmetry (35.2%) and esophageal fibroscopy (21.5%). The mean starting dosing was 4.7 mg/kg/d, the mean maximal dosing was 9 mg/kg/d and the mean daily intakes were initially 2.3 and secondary 2.9. Prantal dosing was adjusted to weight in 54.9%, every month in 85.7%. Treatment was stopped at the mean post-natal age of 6 months, mostly in a progressive manner and without monitoring help.


CONCLUSIONS
Prantal was seldom used in 2004 in France for different reasons: HRV is an uncertain entity, the efficacy of Prantal has not been validated and atropinic side effects can be encountered.
Biran-Mucignat
V
V
Service de néonatologie, faculté de médecine Pierre-et-Marie-Curie-Paris-VI, Assistance publique-Hôpitaux de Paris, hôpital d'enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France. valerie.biran@trs.aphp.fr
Flamant
C
C
Lachtar
M
M
Perrot
C
C
Chauty
A
A
Novakova
J
J
Lavallée
I
I
Mitanchez
D
D
Aujard
Y
Y
Gold
F
F
D004363:Drug Utilization / Q000706:statistics & numerical data; D005602:France; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D010276:Parasympatholytics / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
D010276:Parasympatholytics; D010880:Piperidines; C028209:diphemanil methylsulfate