부산대학교 도서관

Approximately one-fourth of infants who weigh less than 1,500 grams (3.3 pounds) at birth develop periventricular-intraventricular hemorrhage (PVH-IVH; bleeding around or within the ventricles, fluid-filled chambers buried deep in the brain). When extensive bleeding occurs, the infant often suffers permanent developmental and neurological handicaps. Since one cause of PVH-IVH is the reduced oxygen available to the brain (hypoxia) around the time of delivery, it is possible that drugs that protect the brain against hypoxia also protect it against PVH-IVH. Barbiturates, such as phenobarbital, exert such a protective effect in animal experiments, but do not appear protective when given after birth. Administration before birth, however, may be more effective. To test this, a randomized, controlled trial of 121 premature infants (born at ages younger than 31 weeks' gestation) was carried out. One hundred ten women (the infants' mothers) were assigned to receive either phenobarbital or placebo intravenously, starting at the point when delivery was about to occur. Apgar scores (a measure of physical functioning in the newborn) were lower for the phenobarbital group than the placebo group, and more phenobarbital infants needed mechanical ventilation for respiratory distress. The groups did not differ with respect to certain other variables, such as the severity of respiratory disease, incidence of pneumothorax (entry of air into the chest cavity), or blood acidity. Although the two groups had similar incidences of PVH-IVH (28 percent in the phenobarbital group; 20 percent in the placebo group), this complication was more severe for babies who received placebo. Thus, 15 percent of these infants had grade 3 or 4 hemorrhage (the most extensive), while under 4 percent of the phenobarbital infants suffered such extensive hemorrhage. The results, plus results from two other published studies, show that administration of phenobarbital before delivery ameliorates PVH-IVH in the premature newborn. However, the drug's effects on respiration should be carefully evaluated before it can be recommended for general use. (Consumer Summary produced by Reliance Medical Information, Inc.)