Justification of Phenobarb therapy in Stage I HIE.

[Sutirtha Roy]

Hi Stefan,

How are you?

I would like to share your view regarding the use of Phenobarbital in Hyper-alert and irritable state with transient increase of tone and presence of rigidity in the first 24 hours of postnatal life [not to mention if clinically a case of Stage I HIE but where, there is no possibility of documentation to demonstrate the presence of any Electroencephalographic seizure].

Would also like to request you if possible for the citation of reference in this regard.

Will be looking for your kind reply and further discussion.

Best,

Roy.

[Stefan Johansson]

Dear Roy,

despite the fact that I would advocate diagnostics of seizures first, I have commonly found that phenobarbital is started (10-20 mg/kg) on clinical grounds before CFM/EEG is available. So, if there´s no equipment to diagnose seizures, I would argue that symptomatic treatment of clinically evident irritability and seizures is appropriate.

One can debate whether this phenobarbital and similar drugs really changes long-term outcome, but short-term it is usually well tolerated and may result in less irritability.

I found these two papers, both from the same research group:

http://www.ncbi.nlm.nih.gov/pubmed/16390805

http://www.ncbi.nlm.nih.gov/pubmed/15188805

They do not address your specific question, but give some light of the use of phenobarbital.