1380 REDUCED INCIDENCE OF HYPERBILIEDBINEMIA IN LOW BIRTHWEIGHT BABIES RECEIVING PHENOBAHBITAL

Abstract

A clinical trial to evaluate phenobarbital (PB) prophylaxis of germinal matrix hemorrhage recruited 280 babies with birth-weight <1,750g who were intubated and mechanically ventilated within 12 hours of birth, and who had a normal cranial ultrasound at that time. The 34 babies who died during the clinical trial are not included in these analyses.Participants were randomly assigned to receive either placebo or IV PB (10 mg/kg at 12 hours, and 2.5 mg/kg every 12 hours X 9). Mean serum PB level of treated babies was 26.9 meg/ml on day 5.Hyperbilirubinemia (serum total bilirubin >10 mg% on d 5-7) occurred in 7% of 128 babies who received PB, and in 13.6% of 118 babies who received placebo. Exposure to phototherapy lights and use of exchange transfusion were based on decisions of physicians who were naive to the babies' drug assignment. Duration of phototherapy was similar in babies who received PB (5.7±2.6d) and those who received placebo (6.3±2.4d). The babies who received placebo were more than twice as likely than PB receivers to have an exchange transfusion (3.6% vs. 1.6%). We conclude that in LBW infants requiring ventilatory assistance, receipt of PB is associated with a lower incidence of hyperbilirubinemia. Whether the effect of PB is a direct one on hepatic function, is secondary to an effect on germinal matrix hemorrhage, or to a combination of these effects remains to be determined.