1. Spectroscopic detection of brain propylene glycol in neonates: Effects of different pharmaceutical formulations of phenobarbital
- Author
-
Inge A. Zonnenberg, Laura A. van de Pol, Petra J. W. Pouwels, Bregje C.M. Witjes, Monique van de Lagemaat, Radiology and nuclear medicine, Amsterdam Neuroscience - Brain Imaging, Pediatric surgery, Clinical pharmacology and pharmacy, Amsterdam Reproduction & Development (AR&D), General Paediatrics, Neonatology, and Pharmacy
- Subjects
In vivo magnetic resonance spectroscopy ,Male ,medicine.medical_specialty ,newborns ,Magnetic Resonance Spectroscopy ,Drug Compounding ,Population ,phenobarbital ,Gastroenterology ,Pediatrics ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Neonatal convulsions ,medicine ,Neonatal brain ,Humans ,Radiology, Nuclear Medicine and imaging ,Lactic Acid ,education ,Original Research ,Retrospective Studies ,education.field_of_study ,lactate ,business.industry ,MR spectroscopy ,Infant, Newborn ,Brain ,medicine.disease ,Magnetic Resonance Imaging ,Propylene Glycol ,propane‐1,2‐diol ,Spectrophotometry ,Lactic acidosis ,Intensive Care, Neonatal ,Solvents ,Phenobarbital ,Acidosis, Lactic ,Female ,Spectroscopic detection ,business ,medicine.drug - Abstract
BACKGROUND: The first choice for treatment of neonatal convulsions is intravenous phenobarbital, which contains propylene glycol (PG) as a solvent. Although PG is generally considered safe, the dosage can exceed safety thresholds in neonates. High PG levels can cause lactic acidosis.PURPOSE/HYPOTHESIS: To investigate a relationship between brain PG concentration and medication administered to neonates, and to study if a correlation between spectroscopically detected PG and lactate was present.STUDY TYPE: Retrospective.POPULATION: Forty-one neonates who underwent MRI/MRS.FIELD STRENGTH/SEQUENCE: Short echo time single voxel MRS at 1.5T.ASSESSMENT: Spectra were quantified. Concentrations of PG were correlated with medication administered, because intravenously administered phenobarbital solutions contained 10, 25, or 50 mg phenobarbital per ml, all containing 350 mg PG per ml. The interval between medication and MRI/MRS was determined.STATISTICAL TESTS: Chi-square test, Student's t-test, Mann-Whitney U-test and Spearman correlation.RESULTS: Eighteen neonates had brain PG >1 mM (median 3.4 mM, maximum 9.5 mM). All 18 neonates with high brain PG and 14 neonates with low brain PG (DATA CONCLUSION: These MRS findings may increase awareness of potentially toxic PG concentrations in the neonatal brain due to intravenous phenobarbital administration and its dependence on the phenobarbital formulation used.LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018.
- Published
- 2019