Predictors of Duration of Phenobarbitone Therapy in Seizures of Neonates with Hypoxic-Ischemic Encephalopathy

Abstract

Objective: Perinatal asphyxia with hypoxic-ischemic encephalopathy associated with seizures is one of the leading cause of neonatal mortality and morbidity in Bangladesh. Phenobarbitone remains the drug of choice in treatment of neonatal seizures. This study was conducted to determine the predictors of duration of Phenobarbitone therapy in seizures of neonates with Hypoxic-Ischemic Encephalopathy (HIE). Methodology: The study was conducted in Neonatal Intensive Care Unit (NICU) of East West Medical College Hospital from 1st february 2016 to 31st january 2017 on fifty neonates with HIE and seizures. The dose and duration of phenobarbitone therapy for initial control of seizure was noted. Total duration of phenobarbitone therapy after control of seizure to prevent further recurrences was also noted. Follow up was given up to 3 months of age to see any recurrence of seizures. Results: Out of the 50 neonates,25 cases (50%) responded well within 24 hours. Mean duration of phenobarbitone therapy after initial control of seizure was 4.70 ± 2.93days and Mean total duration of therapy was 6.89 ± 3.58 days in cases who responded well within 24 hours.. 3 (6%) cases had recurrence of seizures. The recurrence cases required more than 72 hours for initial control of seizure (p 0.006) and had poor primitive reflexes and activity after initial control of seizure (p 0.0002). Mean duration of phenobarbitone therapy after initial control of seizures was 6.33 ± 6.11 days and Mean total duration of phenobarbitone therapy was also longer 9.67 ± 7.37 days. Conclusion: Neonates who have good initial response and have better reflexes required short duration of phenobarbitone therapy. It should be discontinued soon after control of seizure. Neonates with HIE III, those requiring more than 72 hours for initial response and poor reflexes after initial control of seizure may require longer duration of phenobarbitone therapy (more than 7 days) to prevent recurrence of seizures. Thus, judicious use of phenobarbitone will minimize the unnecessary non-specific treatment.