Efficacy of levetiracetam in pharmacoresistant continuous spikes and waves during slow sleep.

OBJECTIVE: To evaluate the efficacy of levetiracetam (LEV) in continuous spikes and waves during slow sleep (CSWS). Despite first description dates back to 1971, no agreement exists about CSWS treatment. The condition is rare and controlled clinical trials are very difficult to perform, so the reports about efficacy of different drugs are anecdotal. PATIENTS AND METHODS: We introduced LEV in three children affected by symptomatic focal epilepsy and pharmacoresistant CSWS and evaluated clinical, neuropsychological and electroencephalographic outcome. RESULTS: Two cases responded completely, one case showed only a mild reduction of spikes and waves during slow sleep. CONCLUSION: Even if our report is anecdotal, LEV expands the spectrum of antiepileptic drugs that can be used for the treatment of CSWS. LEV efficacy should be confirmed in larger series.

Risk factors of hypoglycemia in premature infants.

Hypoglycemia is a frequent complication of preterm birth and may lead to later CNS damage. The hypoglycemia incidence and the relative risk factors for the affected preterm infants were assessed. We examined 1,500 preterm infants (<37 weeks of gestational age) consecutively admitted between January 1994 and December 1996 at the Department of Pediatrics of Padua University, and screened for hypoglycemia by Dextrostix within the first hour of life. Hypoglycemia was defined as blood glucose levels <40 mg% at Dextrostix. Among study prematures, 35% had hypoglycemia; while the incidence was 9% at levels of Dextrostix <20 mg%. The relative risk for hypoglycemia (odds ratio, OR) was computed assuming a 99% confidence interval (CI). We found 5 risk factors for hypoglycemia: cesarean section (OR 2.24, CI 1.66-3.03), intrauterine malnutrition (SGA) (OR 1.65, CI 1.08-2.53), NICU hospitalization (OR 1.45, CI 1. 09-1.93), gestational age between 30 and 33 weeks (OR 1.93, CI 1. 34-2.78), and twinning (OR 2.49, CI 1.77-3.56). At levels of Dextrostix <20 mg%, 3 more risk factors were found: cardiopulmonary resuscitation at birth (OR 4.06, CI 2.52-6.54), neonatal respiratory distress syndrome (OR 2.21, CI 1.34-3.36) and gestational age between 26 and 29 weeks (OR 2.16, CI 1.02-4.25). The identification of relative risk factors could be useful in improving the hypoglycemia prophylaxis, and in reducing related later CNS abnormalities.

Prenatal theophylline and necrotizing enterocolitis in premature newborn infants.

To determine whether prenatal theophylline therapy would increase the incidence of neonatal necrotizing enterocolitis (NEC) we studied bowel dysfunction in 59 consecutive premature infants (g.s. < 34 weeks), whose mothers were treated with theophylline as a tocolytic during the last trimester, or as surfactant synthesis inductor, for at least three days prior to premature labor (Group A). As case-control we considered the premature, matched for gestational age born immediately before, and whose was untreated with theophylline (Group B). NEC occurred in one patient from group A during the second postnatal week, and surgery was performed. First passage of meconium and start of enteral feeding were comparable in groups A and B, while gastric residuals lasting more than 4 days were found statistically increased (p < 0.03) in antenatally treated group A prematures. Furthermore, 18 out of 49 prematures postnatally treated with theophylline had gastric residuals (36%) with respect to 5 out of 69 untreated (7%) (p < 0.001). Also the premature infants treated ante and postnatally with theophylline showed a statistically significant increase of lasting gastric residuals with respect to the untreated, 13/16 vs 5/7, respectively (p < 0.03). Antenatal theophylline administered to high risk mothers, when maternal diseases do not allow the use of steroids, does not appear to later increase the risk of NEC in premature infants, and provides a chance to avoid the risks related to premature birth. Inhibitory activity on gut motility and gastric irritability are only detectable during the first postnatal days, enhanced by gut immaturity of preterm infants.

Factors associated with neonatal hypoglycemia in premature twins and singletons.

Twin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix < 40 and < 20 mg%) was found in twins vs singletons (54% vs 32%, OR 2.49, CI 1.77-3.56; 19% vs 8%, OR 2.65, CI 1.59-4.19, respectively). Gestational age of 34-37 weeks increased hypoglycemia risk for the premature twins (77% vs 51%, OR 3.20 CI 1.49-6.88). Twin deliveries statistically differed from those of singletons in several perinatal characteristics. More twins were born by cesarean section (85% vs 55%, OR 4.15, CI 2.48-6.95), and the birth weight of twins was much lower related to prematures with BW < 1.0 kg (12% vs 6%, OR 2.06, CI 1.11-3.82) and SGA (20% vs 10%, OR 2.41, CI 1.46-3.98). The risk of twin deliveries was increased at 30-33 weeks gestational age (25% vs 15%, OR 1.84; CI 1.17-2.90). Twins were found to have higher rates of hospitalization (50% vs 40%, OR 1.52, CI 1.04-2.23) and showed an increased risk of cardiorespiratory resuscitation (51% vs 31%, OR 2.36, CI 1.61-3.47), hypothermia (11% vs 4%, OR 3.02, CI 2.33-3.91), BPD (25% vs 19%, OR 2.55, CI 1.10-5.91), and PVL (4% vs 1%, OR 4.08, CI 1.23-13.5). Mortality was found more often (not significant) in premature twins. The risk for intrapartum and early neonatal morbidity was however, mostly reduced in hypoglycemic twins, while it was comparable between smaller or smaller weight discordant twins and larger twins. Similarly, SGA twins, and smaller or smaller weight-discordant twins did not show increased hypoglycemia risk. In conclusion, our findings suggest that the multiple gestation per se is the single most important relative risk factor of hypoglycemia in premature twins.

[Study of the reliability of a parenteral questionnaire used in a pediatric follow-up of 18-month-old children]. / Studio di validazione di un questionario ai genitori di bambini con età intorno ai 18 mesi utilizzato nei follow-up pediatrici.

We are conducting a validation study of questionnaire to the parents according to the Griffiths Mental Developmental Scale, used in pediatric follow-up of obstetric studies among the Italian population. The questionnaire concerns the child's gross and fine motor and language development, swallowing, respiratory, hearing and vision problems, and hospital admissions within the first 18 months of life. The purpose of this study is to examine the degree of agreement between parental and professional assessment of normal and high-risk infants development at 18 months of life.