title: Can we safely administer the recommended dose of phenobarbital in very low birth weight infants?
abstract: OBJECTIVE
  We investigated whether the recommended phenobarbital loading dose of 15-20 mg/kg with maintenance of 3-4 mg/kg/day can safely be administered to very low birth weight preterm newborns with seizures.
  
  
  METHODS
  Twenty-four convulsive preterms of <1,500 g were enrolled in the study. Phenobarbital was administered intravenously with a loading dose of 15 mg/kg in approximately 10-15 min. After 24 h, the maintenance dose of 3 mg/kg/day was administered as a single injection. Blood samples were obtained 2, 24, 48, 72, and 96 h after the phenobarbital loading dose was administered, immediately before the next phenobarbital dose was injected.
  
  
  RESULTS
  None of the cases had plasma phenobarbital concentrations above the therapeutic upper limit of 40 μg/mL on the 2nd hour; one case (4.7%), on the 24th; 11 cases (45.8%), on the 48th; 15 cases (62.5%), on the 72nd; and 17 cases (70.8%), on the 96th hour. A negative correlation was detected between the serum concentrations of phenobarbital and gestational age on the 72th (p, 0.036; r, -0.608) and 96th hour (p, 0.043; r, -0.769).
  
  
  CONCLUSIONS
  We suggest that particular attention should be done while administering phenobarbital in preterms, as blood levels of phenobarbital are higher than the reference ranges that those are often reached with the recommended doses in these groups of babies.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Akdeniz University Medical School, 07070, Antalya, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Oztekin
authors.forename: Salih
authors.initials: S
authors.lastname: Kalay
authors.forename: Gonul
authors.initials: G
authors.lastname: Tezel
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akcakus
authors.forename: Nihal
authors.initials: N
authors.lastname: Oygur
mesh_terms: D000367:Age Factors; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000097:blood; D007223:Infant; D019102:Infant, Very Low Birth Weight; D008297:Male; D010634:Phenobarbital / Q000008:administration & dosage* / Q000097:blood; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D010634:Phenobarbital
references.citation: Clin Pharmacol Ther. 1978 Mar;23(3):346-50
references.pmid: 627141
references.citation: Pediatr Neurol. 2012 Feb;46(2):111-5
references.pmid: 22264706
references.citation: Pediatr Neurol. 2011 Jun;44(6):439-42
references.pmid: 21555055
references.citation: Eur J Pharm Sci. 2000 Dec;12(2):111-6
references.pmid: 11102738
references.citation: J Child Neurol. 2009 Feb;24(2):148-54
references.pmid: 19182150
references.citation: Seizure. 2010 Apr;19(3):185-9
references.pmid: 20133173
references.citation: Pediatr Neurol. 2007 Aug;37(2):85-90
references.pmid: 17675022