• Samson A Gwer, Richard I Idro, Gregory Fegan, Eddie M Chengo, Ayub Mpoya, Esther Kivaya, Jane Crawley, Simon N Muchohi, Michael N Kihara, Bernhards R Ogutu, Fenella J Kirkham, and Charles R Newton.
• Department of Medical Physiology, School of Health Sciences, Kenyatta University, Nairobi, Kenya; Clinical Research, Afya Research Africa, Nairobi, Kenya. Electronic address: samgwer@gmail.com.
• J Crit Care. 2013 Dec 1; 28 (6): 108610921086-92.

PurposeWe conducted a double-blind trial to determine whether a single intramuscular injection of fosphenytoin prevents seizures and neurologic sequelae in children with acute coma.MethodsWe conducted this study at Kilifi District Hospital in coastal Kenya and Kondele Children's Hospital in western Kenya. We recruited children (age, 9 months to 13 years) with acute nontraumatic coma. We administered fosphenytoin (20 phenytoin equivalents/kg) or placebo and examined the prevalence and frequency of clinical seizures and occurrence of neurocognitive sequelae.ResultsWe recruited 173 children (median age, 2.6 [interquartile range, 1.7-3.7] years) into the study; 110 had cerebral malaria, 8 had bacterial meningitis, and 55 had encephalopathies of unknown etiology. Eighty-five children received fosphenytoin and 88 received placebo. Thirty-three (38%) children who received fosphenytoin had at least 1 seizure compared with 32 (36%) who received placebo (P = .733). Eighteen (21%) and 15 (17%) children died in the fosphenytoin and placebo arms, respectively (P = .489). At 3 months after discharge, 6 (10%) children in the fosphenytoin arm had neurologic sequelae compared with 6 (10%) in the placebo arm (P = .952).ConclusionA single intramuscular injection of fosphenytoin (20 phenytoin equivalents/kg) does not prevent seizures or neurologic deficits in childhood acute nontraumatic coma.© 2013.

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