Effect of high-dose phenobarbital on oxidative stress in perinatal asphyxia: An open label randomized controlled trial

Objective To evaluate the effect of high dose phenobarbital on lipid peroxidation and antioxidant enzymes in perinatal asphyxia. Design Open label, Randomized controlled trial. Setting Neonatal intensive care unit of a tertiary care teaching hospital. Participants 72 full term inborn neonates with severe birth asphyxia. Methods Neonates were randomized to Study (phenobarbital) group and Control group. The infants in the study group received phenobarbital infusion (40mg/kg) within first two hours of life while babies in the control group did not receive any phenobarbital. Rest of the management in both the groups was as per the unit protocol for the management of hypoxic ischemic encephalopathy. A cerebrospinal fluid examination was done at 12 ± 2 hours of life to determine the levels of superoxide dismutase, glutathione peroxidise and malonyldialdehyde. 60 neonates were followed up at 1 month of age when a detailed neurological examination was done. Results Four neonates in the study group and six neonates in the control group died during the study. Two neonates in the study group were lost to follow up. The cerebrospinal fluid lipid peroxides and antioxidant enzymes were significantly lower in the phenobarbital group as compared to the control group. The neurological outcome at one month follow up was found to be comparable between the two groups. Conclusion Phenobarbital (40mg/kg) given in the first two hours of life in term neonates with perinatal asphyxia led to a decrease in CSF levels of lipid peroxides and antioxidant enzymes at 12 ± 2 hours of life.