Phenobarbital is a first-line treatment of various seizure types in newborns. Dosage individualization maximizing the proportion of patients with drug levels in therapeutic range or sufficient treatment response is still challenging. The aim of this review was to summarize the available evidence on phenobarbital pharmacokinetics in neonates and to identify its possible covariates suitable for individualization of initial drug dosing. Several covariates have been considered: body weight and height, body surface area, gestational and postnatal age, laboratory parameters of renal and hepatic functions, asphyxia, therapeutic hypothermia, extracorporeal membrane oxygenation (ECMO), drug interactions, and genetic polymorphisms. The most frequently studied and well-founded covariate for the estimation of phenobarbital dosing is actual body weight. Loading dose of 15–20 mg/kg followed by a maintenance dose of 3–5 mg/kg/day seems to be accurate. However, the evidence for the other covariates with respect to dosing individualization is not sufficient. Doses at the lower limit of suggested range should be preferred in patients with severe asphyxia, while the upper limit of the range should be targeted in neonates receiving ECMO support.

中文翻译：

---

新生儿初次服用苯巴比妥药代动力学的最佳预测是什么？

苯巴比妥是新生儿各种惊厥类型的一线治疗。使药物水平在治疗范围或充分的治疗反应中的患者比例最大化的剂量个体化仍具有挑战性。这篇综述的目的是总结有关新生儿苯巴比妥药代动力学的现有证据，并确定其可能适合个体化初始药物剂量的协变量。已经考虑了几个协变量：体重和身高，体表面积，妊娠和产后年龄，肾和肝功能的实验室参数，窒息，治疗性体温过低，体外膜氧合（ECMO），药物相互作用和遗传多态性。估计苯巴比妥剂量的最常研究且有充分根据的协变量是实际体重。负载剂量为15–20 mg / kg /天，然后维持剂量为3–5 mg / kg /天，似乎是准确的。但是，关于剂量个体化的其他协变量的证据不足。重度窒息患者应首选建议范围的下限剂量，而接受ECMO支持的新生儿应针对该范围的上限。