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.

Dear Stefan, How are you? This is Roy again. I am putting the question in the open forum for discussion as you suggested regarding the use of adequate [?better] maintenance therapy for PHENOBARBITAL. Which I think is very essential for the use of this classical anti-convulsanat. I would like to know what recommendations will you [or our other forum members]suggest to follow regarding the management of neonatal seizures [chiefly Post asphyxial] if quality EEG facilities are not available? And how to withdraw the maintenance PHENOBARBITAL? My specific question is: I.How long should we continue the medication and how to omit in a set up with limited resources and II.Considering the long half life in the early neonatal period what regimen do you follow as the PHENOBARB maintenance Therapy once daily [OD]or twice [bID]? [** I rose the the question because as far the current recomendations of the Clinacal Paediatric Neurology by Fenichel andNeonatal Formulary [The Nothern Neonatal Pharmacopoeia, BMJ] the plama half life in early neonatal period is so long [48-up to 200 Hrs] the maintenance therapy once a is perfectly all right. As as the drug is largely metabolized by liver considering the initial immaturity and inability in the early conjugation process should also come in to account.Therapeutic level in the Neonatal Period is 20-40 mg/l [1 mg/l=4.42 micro mole/l]. This is higher than the range generally quoted for use in later childhood.] Looking for the reply. Warm Regards, Roy.

[With Reference to John P Cloherty, Manual of Neonatal Care, Fifth Edition,Pp547,Lippincott W&W]: "For unexplained reasons even refractory seizures in HIE ultimately burn themselves out and cease after approximately 48 hours". WHY DO THEY?

Dear Stefan, How are you? Even after extensive search we could not find any evidence based answer for the scenario mentioned below. [except "Discontinuation of Neonatal Resuscitation In Term > Babies",Rollo D Clifford, Fetal Neonatal Ed. Online, 22 May 2007]. I would like to know if is there Standard Guideline/Protocol/ Recommendation/Recent Study regarding the ongoing management of Term/ Post Term Neonates* having persisting HR more than 120/m but with no Spontaneous Respiration even after 20 minutes after the initiation of Resuscitation? *Newborn with Severe Perinatal Asphyxia but no maternal narcotic history. In a Set up where no Basic Mechanical Ventilatory Support is available what should be the line of further management? What should be the ethical,moral, medico-legal [irrespective of country of origin,religious,colour,class,cast and creed] point of view? Looking for your kind Reply. My Best Regards, Dr .Sutirtha Roy.