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Subject:
From:
Tom Hale <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 6 Nov 1996 11:27:54 -0600
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To      : Lisa Logan
Re      : Phenobarb and Phenytoin in premature neonate

The phenobarb and phenytoin levels found in this infant are a reflection of two
problems,  one,  a significant maternal supply combined with  poor excretion in
the premi infant.  As to whether these will adversely effect the infant,  the
neonatologists will have to answer that,  based on clinical symptoms.  Although
these levels are not terribly high (Phenobarbitol 4.6mg (therapeutic range
15-40) and dilantin 5.1mg (range 10-20)) they will probably fluctuate depending
on the infants condition, hepatic and renal output,  and oral input.

I have two suggestions,  see if the neonatologists will continue to monitor the
infant over the next week.  If the renal output increases as it should,  these
levels may drop off,  but they will probably be somewhere around 3-5 ug/mg for
PB.  A lot of term infants have done just fine with this level.  It is unlikely
that the postnatal exposure to low levels of these drugs will provide long-term
neurobehavioral delays in this infant.

Secondly,  in the first weeks postpartum,  ALL moms on anticonvulsants should
be closely monitored and their drug levels dropped back somewhat as their
plasma kinetics change in the first several weeks.  Early postpartum,  the
maternal plasma volume and plasma protein levels change dramatically.    So,
see if mom's doseage can be dropped back somewhat according to her plasma
levels.

But ultimately, the neurodevelopment of this premi will determine just how
dangerous moderate exposure to these drugs will be.  Signs of apnea, poor
feeding, etc.  may dictate withdrawal from the breast.

Best of Luck
Tom Hale, Ph.D.
Associate Professor of Pediatrics

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