A Cochrane review [Abstract] 1 included 7 studies with a total of 385 patients. Two studies may be sequential reports that include some identical patients. Most studies had methodological concerns. Phenobarbital compared to supportive care alone did not reduce treatment failure or time to regain birthweight (one study). However, the duration of supportive care required to be given to infants each day was significantly reduced (MD -162.1 minutes/day, 95% CI -249.2 to -75.1). Comparing phenobarbital to diazepam, meta-analysis of two studies found that phenobarbital produced a significant reduction in treatment failure (typical RR 0.39, 95% CI 0.24, 0.62). There was no significant difference in duration of treatment or duration of hospital stay. Comparing phenobarbital with chlorpromazine, one study found no significant difference in treatment failure rate.
In infants treated with an opiate, one study reported addition of clonidine resulted in no significant difference in treatment failure, seizures or mortality. In infants treated with an opiate, one study reported addition of phenobarbitone significantly reduced the proportion of time infants had a high abstinence severity score, duration of hospitalisation and maximal daily dose of opiate.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (limited study size for each comparison).
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