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《Journal of Clinical Pediatrics》 2008-11
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Multicenter investigative report for the effect of prophylactic phenobarbital on intraventricular hemorrhage in premature infants in China

CHEN Hui-jin1,WEI Ke-lun2,YAO Yu-jia3,YANG Yu-jia4,ZHOU Cong-le5,FANG Xiu-fang6,GAO Xi-rong7,JIANG Lian8,LIU Xiao-hong9,QIAN Ji-hong1,WANG Li10,WU Ben-qing11,WU Gao-qiang12,ZHANG Qing-mei13,ZHANG Xiao-lan14,ZHOU Xiao-yu15(1.Shanghai Institute for Pediatric Research,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;2.Second Hospital Affiliated to China Medical University,Shenyang 110004,Liaoning,China;3.West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan,China;4.Xiangya Hospital,Central South University,Changsha 410008,Hunan,China;5.Peking University First Hospital,Beijing 100034,China;6.Jinan Women &Children Hospital,Jinan 250014,Shandong,China;7.Hunan Children Hospital,Changsha 410007,Hunan,China;8.The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China;9.Shenzhen Childern's Hospital,Shenzhen 518026,Guangdong,China;10.The First Hospital of Xinjiang Medical Univcersity,Ulumuqi 830111,Xinjiang,China;11.Shenzhen City People's Hospital,Shenzhen 518020,Guangdong,China;12.Ulumuqi Women & Children Hospital,Ulumuqi 830001,Xinjiang,China;13.Shenyang Women Hospital,Shenyang 110014,Liaoning,China;14.Shenzhen Maternity and Child Healthcare Hospital,Shenzhen 518028,Guangdong,China;15.Nanjing Children's Hospital,Nanjing Medical University,Nanjing 210029,Jiangsu,China)  
Objectives Prophylactic phenobarbital therapy is much controversial all the time with either positive or negative appraisal for the prevention of intraventricular hemorrhage(IVH) in premature infants.It is recently no longer routinely used clinically.In order to assess objectively the effect of phenobarbital on IVH,sponsored by the Subspecialty Group of Neonatology of Pediatric Society,China Medical Association,more than ten large-scale hospitals joined the near two-year multicenter investigation named Brain Injuries in Premature Infants in China.The present study presents the inves-tigative result for the effect of prophylactic phenobarbital on IVH in premature infants in 5 big hospitals that all belong to the Third Class and A Level licensed.Methods All premature infants with gestation less than 34 weeks in three hospitals and less than 37 weeks in other two hospitals received phenobarbital intravenously on loading,doses of 20 mg / kg as early than 6 hours of age as possible.Twenty-four hours after loading,a maintenance dose of 5 mg / kg daily was followed for 5 days.All premature infants were routinely examined by cranial ultrasound within seven days after birth,and then repeated every another 3 ~ 7 days till the discharge from the hospital during Jan.2005 to Aug.2006.Results A total of 3007 pre-mature infants were admitted to 9 hospitals during the investigation.Among them,1 754 cases in five hospitals received phenobarbital early after birth as the prophylactic group,other 1 433 cases in four hospitals did not receive phenobarbital as control group including 37 cases in 5 hospitals without the use of phenobatbital due to neglect.No significant differences in gestational age,birth weight,sex,Apgar scores and delivery mode were found between two groups.The incidences of IVH and severe IVH were 9.8%(154 / 1574) and 2.0%(32 / 1574) in the prophylactic group,and 14.1%(202 / 1433) and 3.6%(52 / 1433) in control group,respectively.There were very significant differences in the incidences of IVH and severe IVH between the two groups(χ2 = 13.364,P = 0.000;χ2 = 7.034,P = 0.008) .The transformation rate from se-vere IVH to mild IVH in the prophylactic group was significantly higher than that in the control group(62.5% vs 1.9%,、 continuity correction χ2 = 21.201,P = 0.000) .It was shown that the aggravating phenomenon of intraventricular hemor-rhage induced by mechanical respiration clinically could be significantly improved with the use of prophylactic phenobarbi-tal.Conclusions The data of the multicenter investigation basically reflects the effect of prophylactic phenobarbital on IVH in premature infants in major big cities of China.It is confirmed that there is a positive effect of phenobarbital for the prevention of IVH,in particular on the stabilization of clinical status and the alleviation of IVH extent.The multicenter in-vestigative results can be helpful to establish the protocol for the prevention and treatment of brain injuries in premature in-fants in China.Prophylactic phenobarbital used routinely early after birth in premature infants may be recommended based on the multicenter investigative results.
【Fund】: 中华医学会儿科分会新生儿学组立项课题
【CateGory Index】: R722.6
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