Anemia of Prematurity - Portal Neonatal

Precautions
Associated with other risks accompanying administration of other human
blood products (eg, transmission of infection, allergic reaction); unknown
if administration of IVIG places the neonate at a theoretically increased
risk of susceptibility to infection; check serum IgA before IVIG (use an
IgA-depleted product, eg, Gammagard S/D); infusions may increase
serum viscosity and thromboembolic events; infusions may increase risk
of migraine attacks, aseptic meningitis (10%), urticaria, pruritus, or
petechiae (2-30 d postinfusion)
Drug Category: Anticonvulsant agents -- Phenobarbital may increase hepatic conjugation and
excretion. Decreased hepatic conjugation caused by normal delay in enzyme induction increases the
amount of unconjugated bilirubin in the blood stream. Conjugated bilirubin does not pose a threat of
neurotoxicity. Once conjugated, this nontoxic form of bilirubin proceeds toward intestinal excretion.
Drug Name
Pediatric Dose
Contraindications
Interactions
Phenobarbital (Luminal, Solfoton) -- Induces the hepatic enzymes
involved in bilirubin conjugation and increases biliary excretion.
Do not administer intra-arterially. Dosing can be enteral or parenteral.
Maximum IV administration rate of 1 mg/kg/min IV; not to exceed 30
mg/min for infants.
Hyperbilirubinemia: 3-8 mg/kg/d PO/IV initially; may increase up to 12
mg/kg/d
Documented hypersensitivity; severe respiratory disease; marked
impairment of liver function; nephritis
May decrease effects of chloramphenicol, digitoxin, corticosteroids,
carbamazepine, theophylline, verapamil, metronidazole, and
anticoagulants (patients stabilized on anticoagulants may require dosage
adjustments if added to or withdrawn from their regimen);
coadministration with alcohol may cause additive CNS effects and death;
chloramphenicol, valproic acid, and MAOIs may increase phenobarbital
toxicity; rifampin may decrease phenobarbital effects; induction of
microsomal enzymes may result in decreased effects of PO
contraceptives in women (must use additional contraceptive methods to
prevent unwanted pregnancy; menstrual irregularities may also occur)
Pregnancy D - Unsafe in pregnancy
Precautions
Use with caution in patients with renal impairment, hepatic impairment, or
both; abrupt withdrawal may precipitate status epilepticus; high doses
may cause respiratory depression or failure
FOLLOW-UP Section 8 of 11
Further Outpatient Care:
• To help insure that infants may reach their maximum neurodevelopmental potential, referring
babies with chronic bilirubin encephalopathy to a neurodevelopmental pediatrician skilled in
caring for these patients is important. Early identification of and intervention for
neurodevelopmental deficits has been shown to positively impact an infant's long-term
neurodevelopmental prognosis.
• The numerous areas of uncertainty surrounding the diagnosis and treatment of
hyperbilirubinemia in the infant, coupled with the infrequency of sequelae, make it easy to
become cavalier about the evaluation of a jaundiced infant. However, remember that
physiologic hyperbilirubinemia is a diagnosis of exclusion, and kernicterus, when it occurs, is a
devastating and legally indefensible sequela.
• Sepsis must always be excluded in the jaundiced infant. Uncommon, but treatable, metabolic
causes of jaundice include hypothyroidism and galactosemia. The first sign of occult immune
or nonimmune hemolytic disease may be hyperbilirubinemia.