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PEDIATRICS Vol. 108 No. 2 August 2001, pp. 482-484

EXPERIENCE AND REASON:
Treatment of Pain With Gabapentin in a Neonate

The first 300 words of the full text of this article appear below.

Gabapentin (GBP) is a gamma-aminobutyric acid (GABA) analog approved for the treatment of partial seizures with and without generalization in patients 12 years of age and older. The precise mechanism of action for GBP in the central nervous system is not known. Although it was originally designed to mimic the effects of GABA, it has been found to be inactive at GABA binding sites.1 Recently, GBP has been shown to be effective in the treatment of neuropathic pain in adults2 and children.3 We report the case of a neonate with amyoplasia congenita resulting in severe contractures and dislocated joints who was successfully and safely treated with GBP to relieve pain.

    CASE REPORT

D. L. was a 3-week-old male born at 36 5/7 weeks' gestation and weighing 2475 g to a 20-year-old G1/P0 mother who received late prenatal care. The pregnancy was remarkable for oligohydraminos and substance abuse including marijuana, tobacco, alcohol, crack cocaine, and ecstasy, the mother's self-reported drug of choice. The neonatal toxicology screen was positive for marijuana (Delta 9-THC) and opiates. The infant received routine resuscitation at birth and the Apgar scores were 4 and 7, respectively. At birth the infant was noted to have an extended neck and contractures of the extremities. Radiographs were remarkable for cervical spine in severe extension contracture, bilateral shallow acetabula with probable dislocated hips, bilateral clubfeet, fingers with severe flexion contractures, and dysplastic shoulders with probable dislocation. A head ultrasound obtained on day of life (DOL) 2 was unremarkable. Physical therapy was also instituted on DOL 2. Although the infant was noted to lie peacefully at rest, the slightest movement produced significant pain associated with a loud, shrill high-pitched cry. The infant was initially started on as needed acetaminophen (10 mg/kg) which was quickly converted to a regular (Q4 hour) dosing interval.

Symptomatic assessment on DOL 4 illustrated apparent failure of acetaminophen, . . . [Full Text of this Article]