Pantogam syrup 10% 100 ml fl t/st/pack cards x1

Pediatrician, physiotherapist, head of the pediatric medical department

Neonatal jaundice is a change in the color of the skin, conjunctiva and sclera (whites of the eyes) in newborns to a yellowish tint due to increased levels of bilirubin (a pigment that is formed when hemoglobin breaks down) in the blood plasma during the newborn period. Neonatal jaundice is usually mild and transient. However, it is important to monitor newborns with severe jaundice or whose jaundice does not resolve naturally, as this may lead to long-term negative consequences. Severe neonatal hyperbilirubinemia is associated with a neurological dysfunction known as bilirubin-induced neurological dysfunction (BIND). In severe hyperbilirubinemia, unconjugated bilirubin crosses the blood-brain barrier, binds to the basal ganglia and brainstem nuclei, leading to acute bilirubin encephalopathy, or progresses to permanent neurological dysfunction that manifests as cerebral palsy, seizures, buckling, and sensorineural hearing loss.

Indications for use

Pantogam has the following indications for use:

• excessive nervous excitability;
• epilepsy;
• diseases leading to damage to the nervous system (cerebral palsy, dropsy of the brain);
• tremor caused by organic damage to brain structures;
• urinary disorders caused by neurological disorders;
• condition caused by brain injury or neuroinfection;
• birth injuries of the baby or neurological disorders resulting from pregnancy pathologies;
• nervous tic;
• Parkinson's disease;
• Huntington's chorea;
• schizophrenia. For schizophrenia, Pantogam can be prescribed as an addition to antipsychotic drugs;
• hypoxia, or oxygen starvation, of the brain;
• disorders of speech, motor or mental development.

Pantogam also helps maintain emotional balance during long-term stressful situations. This explains why this drug is prescribed to preschoolers and schoolchildren during the period of mastering writing and reading skills, as well as during adaptation to school education: in order to stimulate the functioning of the brain. Although such an appointment is rare.

What is the nature of jaundice in newborns?

Jaundice or, scientifically speaking, unconjugated hyperbilirubinemia in newborns occurs due to physiological or pathological reasons. More than 75% of cases of neonatal jaundice are due to physiological reasons. Physiological jaundice is also called non-pathological jaundice because it is mild and disappears spontaneously. This occurs due to the peculiarities in the metabolism of bilirubin in the neonatal period. Increased bilirubin load in newborns occurs due to its increased production, which is caused by a higher mass of red blood cells (RBCs) with a decrease in the duration of their existence in newborns. At the same time, a newborn’s liver is still very inactive, and it processes water-soluble bilirubin into conjugated bilirubin, which is water-insoluble, 100 times slower than in an adult.

Physiological jaundice usually occurs between days 2 and 4 of life, peaks between days 4 and 5, and resolves within 2 to 3 weeks. Physiological jaundice never occurs in the first 24 hours of a newborn's life.

Pantogam®

Inside, 15-30 minutes after eating.

A single dose for adults is usually 0.25-1 g (1/2-2 tablets), for children - 0.25-0.5 g (1/2-1 tablet); daily dose for adults - 1.5-3 g (3-6 tablets), for children - 0.75-3 g (1.5-6 tablets). The course of treatment is from 1 to 4 months, in some cases up to 6 months. After 3-6 months, a second course of treatment is possible.

For cognitive impairment with organic brain lesions, including the consequences of neuroinfections and traumatic brain injuries, and neurotic disorders

: 0.25 g (1/2 tablet) 3-4 times a day.

For extrapyramidal hyperkinesis in patients with hereditary diseases of the nervous system in combination with ongoing therapy:

in a dose of 0.5 to 3 g (1-6 tablets) per day. The course of treatment is up to 4 months or more.

As a corrector for the side effects of neuroleptic drugs, for neuroleptic extrapyramidal syndrome (hyperkinetic and akinetic), as part of complex therapy for cerebral organic failure in patients with schizophrenia:

adults - in a dose of 0.5 to 1 g (1-2 tablets) 3 times a day; children - in a dose of 0.25 to 0.5 g (1/2-1 tablet) 3-4 times a day. The course of treatment is 1-3 months.

For epilepsy with slowing of mental processes in complex therapy with anticonvulsants:

adults - in a dose of 0.5 to 1 g (1-2 tablets) 3 times a day; children - in a dose of 0.25 to 0.5 g (1/2-1 tablet) 3-4 times a day. The course of treatment is up to 6 months.

For psycho-emotional overload, decreased mental and physical performance, to improve concentration and memory:

0.25 g (1/2 tablet) 3 times a day.

For neurogenic urinary disorders:

adults - in a dose of 0.5 to 1 g (1-2 tablets) 2-3 times a day; children - in a dose of 0.25 to 0.5 g (1/2-1 tablet) 3 times a day (daily dose is 25-50 mg/kg). The course of treatment is 1-3 months.

Children with various pathologies of the nervous system

Depending on age, it is recommended to take the drug up to 3 g per day (6 tablets). Tactics for prescribing the drug: increasing the dose over 7-12 days, taking the maximum dose for 15-40 days and gradually reducing the dose until Pantogam® is discontinued over 7-8 days. The break between courses of Pantogam®, as for any other nootropic drug, ranges from 1 to 3 months.

For children with developmental delay:

0.5 g (1 tablet) 3-4 times a day. The course of treatment is 2-3 months.

Children with attention deficit hyperactivity disorder

Depending on body weight, the drug is prescribed at an average therapeutic dose of 30 mg/kg per day, morning and afternoon, with dose titration over the first 5-7 days. The course of treatment is 3-4 months.

Children with neurosis-like conditions (tics; stuttering, mainly in the tonic form)

: in a dose of 0.25 to 0.5 g (1/2-1 tablet) 3-6 times a day. The course of treatment is 1-4 months.

Taking into account the nootropic effect of the drug, it is preferably taken in the morning and afternoon (up to 17:00).

The drug is used in children over 3 years of age. At an earlier age, it is recommended to take the drug in syrup form.

What is pathological jaundice of newborns?

The causes of pathological unconjugated hyperbilirubinemia are also associated with an increase in bilirubin production, a decrease in its excretion from the body and increased blood circulation in the liver and intestines. Pathological jaundice can occur in a newborn in the first 24 hours of life and is characterized by a rapid increase in bilirubin levels of more than 5 mg/dL per day.

The causes of increased bilirubin production in pathological jaundice are immune-mediated hemolysis (destruction of red blood cells) arising due to Rh conflict with the mother, blood group incompatibility or non-immune-mediated causes such as cephalhematoma, defects in red blood cell membranes (hereditary spherocytosis and elliptocytosis), defects enzyme system (glucose-6-phosphate dehydrogenase and pyruvate kinase), which most often affects boys.

Incompatibility of blood groups according to the ABO system occurs in mothers with blood group O, who have IgG antibodies to factors A and B, which penetrate the placenta into the child’s body and cause hemolysis in newborns with blood group A or B. In case of Rh incompatibility, Rh- a negative mother exposed to Rh positive blood from a previous pregnancy becomes sensitized to such blood. This leads to hemolysis in a fetus with Rh-positive blood. To prevent Rh conflicts, anti-D gamma globulin is currently used, which reduces the incidence of hemolysis.

Decreased bilirubin clearance is also observed with hereditary diseases such as Crigler-Najjar and Gilbert syndrome, as well as with diabetes in the mother or congenital hypothyroidism in the baby. For Crigler-Najjar syndrome, newborns may require liver transplantation or long-term use of phototherapy. In Gilbert syndrome, a mutation of the UGT1A1 gene is observed, causing unconjugated hyperbilirubinemia. Gilbert syndrome is usually diagnosed during adolescence, although the first manifestations may occur as early as the neonatal period. It can be diagnosed using genetic testing.

Jaundice due to breastfeeding disorders

A decrease in intestinal activity in a newborn leads to increased enterohepatic circulation. Jaundice in the absence or insufficient breastfeeding and intestinal obstruction are common conditions associated with increased enterohepatic circulation, which leads to unconjugated hyperbilirubinemia. Non-breastfeeding jaundice occurs in the first week of life and is caused by insufficient breast milk intake, which leads to dehydration and sometimes high sodium levels in the baby. Lack of breastfeeding leads to decreased intestinal motility and decreased excretion of bilirubin in feces or meconium. This jaundice occurs at the end of the first week, peaks in the second, and usually resolves by 12 weeks of age.

What may be an indication for prescribing Pantogam

Pantogam is prescribed to infants for various developmental disorders and neurological diseases.

Among the most common indications for the use of the drug are the following:

• some types of injuries and damage to the nervous system in infants received during childbirth;
• developmental abnormalities and damage to the nervous system acquired by the fetus during pregnancy;
• convulsions or epileptic seizures;
• serious disorders of the infant's nervous system, such as cerebral palsy and hydrocephalus;
• brain injury;
• frequent state of agitation, nervousness and sleep disturbances.

Jaundice resulting from impaired bile transport

Conjugated hyperbilirubinemia is always a pathology and occurs due to defects in the formation or transport of bile caused by mechanical obstructions to its outflow or systemic diseases that can affect the liver. Such conditions include biliary atresia, common bile duct cysts, idiopathic neonatal hepatitis, and Alagille syndrome. Congenital metabolic disorders such as galactosemia, tyrosinemia, antitrypsin-1 deficiency also manifest themselves in the form of conjugated hyperbilirubinemia. Biliary atresia is the most common cause of conjugated neonatal hyperbilirubinemia. It affects both intrahepatic and extrahepatic bile ducts and usually appears during the first 2–4 weeks of life along with pale stools. Initial diagnosis is by ultrasound, which may show the absence of the gallbladder. Ultrasonography can also detect cysts with normal or dilated intrahepatic bile ducts, or sclerotic ducts in biliary atresia.

Characteristics of the medicine and Komarovsky’s opinion

The pharmacological action of the drug is aimed at improving mental capacity and memory. In addition, it eliminates signs of hypoxia (oxygen starvation) in the body and reduces the occurrence of seizures. Komarovsky clarifies that, according to the annotation, Pantogam is often prescribed for neurological pathologies, delayed physical development, and deviations from the speech apparatus.

The drug is available in the form of tablets and syrup, which are usually prescribed to children. In some cases, the doctor says, syrup is prescribed during pregnancy, from the second trimester.

In certain cases, the doctor has a negative attitude regarding the prescription of this drug for children.

So, the doctor points out that the medicine is often prescribed for disorders of the speech apparatus, to stimulate it. The specialist says that in this case, taking the drug is not advisable, since there are no means to stimulate speech as such. With such a deviation, drug therapy will not help; you need to talk to the baby and do it correctly.

Also, notes Dr. Komarovsky, Pantogams are often recommended to children by doctors for problems with physical development. As a rule, parents complain that the baby, being 7-8 months old, cannot sit and stand on his own. Here the drug is also unlikely to have a therapeutic effect and, according to the doctor, is prescribed on the principle “something needs to be done.” To develop normal physical activity, you should resort to the right exercises, more details here.

Jaundice due to infectious diseases

Systemic infections such as toxoplasmosis, syphilis, varicella, rubella, cytomegalovirus and herpes simplex, and systemic conditions such as sepsis, shock and birth asphyxia may also present as jaundice caused by conjugated hyperbilirubinemia. Neonatal urinary tract infections and long-term use of parenteral nutrition in preterm infants are also known causes of conjugated hyperbilirubinemia.

How common is jaundice in newborns?

Almost all newborns will have a total bilirubin level above the upper limit of normal for adults and older children of bilirubin of 1.5 mg/dL with less than 5% total conjugated bilirubin. Up to 60% of full-term infants and 80% of newborns at 35 weeks' gestation or more will have jaundice, which occurs when plasma bilirubin levels exceed 5 mg/dL. Neonatal jaundice is more common in people living at high altitudes and in people living around the Mediterranean Sea, especially in Greece.

How is jaundice diagnosed?

Diagnosis of a newborn with jaundice begins with a detailed history, including birth history, family history, and onset of jaundice. A complete examination of the newborn should include general appearance, eye examination, abdominal assessment for hepatomegaly, splenomegaly or ascites, neurological examination and assessment of skin rashes. Bilirubin levels can be assessed using a transcutaneous measurement device or blood draw to determine total serum or plasma bilirubin levels. Transcutaneous measurement reduces the frequency of bilirubin blood tests, but is not possible after phototherapy. In addition, if the transcutaneous bilirubin level is greater than the 95th percentile on the transcutaneous nomogram or the 75% of the total serum bilirubin nomogram for phototherapy, the total serum bilirubin level should be measured.

Ultrasound and additional tests such as antibody titers for infection, urine culture, viral culture, serologic titers, amino acids, and α-antitrypsin phenotype may be added to the list of investigations in the case of a suspected diagnosis of conjugated hyperbilirubinemia.

Laboratory testing of the mother's blood will also be required to distinguish between unconjugated and conjugated jaundice. The American Academy of Pediatrics recommends universal screening of all newborns for jaundice and identification of risk factors for severe hyperbilirubinemia. Major risk factors in newborns over 35 weeks include high bilirubin levels, jaundice observed in the first 24 hours of life, blood type incompatibility, gestational age between 35 and 36 weeks, previous siblings who have received phototherapy, cephalhematoma or significant bruising, absence of breastfeeding feeding and East Asian race. Prematurity is also a known risk factor for the development of severe hyperbilirubinemia.

Minor risk factors include maternal diabetes, polycythemia, male gender, and maternal age over 25 years.

How is jaundice treated?

To prevent acute bilirubin encephalopathy and kernicterus, severe hyperbilirubinemia is treated with phototherapy, intravenous immunoglobulin, or exchange transfusion. There are nomograms for determining bilirubin levels at which phototherapy and replacement blood transfusion are indicated.

Phototherapy is initiated taking into account risk factors and serum bilirubin levels on a nomogram. Bilirubin optimally absorbs light in the blue-green range (460 to 490 nm) and is either photoisomerized and excreted in bile or converted to lumirubin and excreted in urine. During phototherapy, the newborn's eyes should be protected and as much of the body's surface area should be illuminated as possible. It is important to maintain hydration and urine output because most bilirubin is excreted in the urine as lumirubin. The use of phototherapy is not indicated for conjugated hyperbilirubinemia and may result in “bronze baby syndrome” with grayish-brown skin discoloration.

After cessation of phototherapy, there is an increase in total serum bilirubin levels, known as “reverse bilirubin.” The level of "reverse bilirubin" is usually lower than the level at the beginning of phototherapy and does not require restarting phototherapy.

Intravenous immunoglobulin is recommended if bilirubin levels increase as a result of isoimmune hemolysis despite phototherapy. Intravenous immunoglobin is started when bilirubin levels are between 2 and 3 mg/dL.

Replacement blood transfusion is indicated if there is a risk of neurological dysfunction, either with or without phototherapy. It is used to remove bilirubin from the bloodstream and, in isoimmune hemolysis, also removes circulating antibodies and sensitized red blood cells. Blood transfusions are performed in neonatal or pediatric intensive care units. A double exchange blood transfusion (from 160 to 180 ml/kg) is performed to replace the newborn’s blood. Phototherapy should be restarted and continued after blood transfusion until bilirubin reaches a safe level.

Helpful information

Instructions for use of Pantogam for infants state that the drug belongs to the group of nootropics. Nootropics have a mild effect on brain tissue, improving their blood supply, and therefore trophism. Thanks to this, cognitive abilities are restored, the emotional background is normalized, and memory is improved. However, it has not yet been possible to establish accurately enough exactly how nootropics affect nerve tissue. This information can be found on forums where parents share their experiences. Some young mothers, due to the fact that the mechanism of action of Pantogam has not been precisely established, refuse to give their child the medicine prescribed by the doctor. This should not be done: the consequences of using the product recommended for babies have been studied thoroughly, and Pantogam does not pose any danger to the health of the newborn.

It is important to remember that nootropics should not be abused, despite the fact that they have a rather gentle effect on the body. Therefore, it is strictly prohibited to give Pantogam to newborns for preventive purposes. This is especially true in cases where the baby is taking other drugs that affect the nervous system.

Prognosis for jaundice

With timely diagnosis and treatment, the prognosis is positive. In patients with delayed treatment, brain damage is a serious complication. Until now, many doctors (and parents) do not fully understand that jaundice (or as it is sometimes disparagingly called “jaundice”) in newborns is not a benign disease, and requires close attention. The fact is that jaundice in a newborn is a serious disease that can cause irreversible brain damage. All physicians caring for newborns should be aware of this fact. Although many conditions that cause jaundice cannot be immediately diagnosed, the key to preventing complications is to educate parents. Parents should be informed by nurses, pediatricians, obstetricians and the attending physician that if the child's skin, stool or urine color changes, the child should be examined immediately at the clinic. Today, there are smartphone apps that help parents identify jaundice. The main thing is to ensure that the baby is examined in a clinic to rule out any malignant cause of jaundice. Only through the cooperation of parents and doctors can the incidence of jaundice in newborns be reduced.

Pantogam for the little ones

In what cases can a doctor prescribe Pantogam for infants? Here are the main indications:

• the baby received some kind of injury during its birth;
• During childbirth, the child experienced hypoxia, that is, oxygen starvation. This can occur during protracted labor, during a long anhydrous period, etc.;
• during pregnancy, the woman suffered from a disease that can affect the development of the baby’s nervous system;
• the child has seizures;
• the baby suffers from cerebral palsy or has been diagnosed with hydrocephalus;
• an infant has suffered a brain injury;
• the child sleeps poorly and is often in an excited state. In this case, the baby may be prescribed this medicine.

Pantogam is prescribed to infants if they develop a neurological disease