Does phenobarbital improve the effectiveness of therapeutic hypothermia in infants with hypoxic-ischemic encephalopathy?

Abstract

Objective: To determine whether phenobarbital (PB) given before therapeutic hypothermia to infants with hypoxic-ischemic encephalopathy (HIE) augments the neuroprotective efficacy of hypothermia.Study Design: Records of 68 asphyxiated infants of X36 weeks' gestation, who received hypothermia for moderate or severe HIE were reviewed. Some of these infants received PB prophylactically or for clinical seizures. All surviving infants had later brain magnetic resonance imaging (MRI). The composite primary outcome of neonatal death related to HIE with worsening multiorgan dysfunction despite maximal treatment, and the presence of post-hypothermia brain MRI abnormalities consistent with hypoxic-ischemic brain injury, were compared between the infants who received PB before initiation of hypothermia (PB group, n ¼ 36) and the infants who did not receive PB before or during hypothermia (No PB group, n ¼ 32). Forward logistic regression analysis determined which of the pre-hypothermia clinical and laboratory variables predict the primary outcome.Result: The two groups were similar for severity of asphyxia as assessed by Apgar scores, initial blood pH and base deficit, early neurologic examination, and presence of an intrapartum sentinel event. The composite primary outcome was more frequent in infants from the PB group (PB 78% versus No PB 44%, P ¼ 0.006, odds ratio 4.5, 95% confidence interval 1.6 to 12.8). Multivariate analysis identified only the PB receipt before initiation of hypothermia (P ¼ 0.002, odds ratio 9.5, 95% confidence interval 2.3 to 39.5), and placental abruption to be independently associated with a worse primary outcome.Conclusion: PB treatment before cooling did not improve the composite outcome of neonatal death or the presence of an abnormal post-hypothermia brain MRI, but the long-term outcomes have not yet been evaluated.

Cooling and seizure burden in term neonates: an observational study

“…It has been shown to augment the neuroprotective effect of hypothermia 27. However, phenobarbitone has been shown to be ineffective in controlling electrographic seizures in non-cooled neonates;28 29 this reduced efficacy has been linked to the altered neuronal chloride transport in the developing brain 30. In our study, plasma phenobarbitone levels were not routinely measured.…”

Low back pain around retirement age and physical occupational exposure during working life

“…However since common LBP is associated with disability rather than with mortality this should not be an important source of bias. In addition, we did not consider people living in nursing home or retirement home but few people at these ages currently live in these situations in France [18]. Active workers above 60 years of age were also not studied in order to minimize selection bias.…”

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

“…Hypoxic-ischemic lesions either in the basal nuclei (basal ganglia and thalamus) or in the cortex were considered "less extensive. " The categorization of the brain injury into "less extensive" and "more extensive" represent scores 1 or 2; and scores 3 or 4, respectively, of the basal ganglia/watershed scoring system described by Barkovich et al, and we have used this scoring system previously to assess the severity of posthypothermia brain MRI abnormalities (23,24,26,27).…”