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.

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.