Phenytoin administration in the newborn and infant

To evaluate the efficacy and safety of phenytoin (PHT) in the treatment of situation-related seizures and epilepsies in the newborn and infant; the clinical histories of 82 patients were retrospectively reviewed. Sixty patients received for status epilepticus (SE), intravenous PHT followed by long-term oral administration for 27 of them. The other 22 patients had oral treatment only. Intravenous administration made 55% of these patients seizure-free, whereas oral administration produced lasting seizure control in only 9.1%. During chronic oral treatment, it was most difficult to obtain adequate plasma concentrations in 69.1% of the patients, and 43.6% had side effects, most of which were related to very high plasma concentrations. In conclusion, in the first 2 years of life, intravenous administration of PHT is useful for SE, but oral treatment is poorly effective with difficulty to achieve appropriate and stable therapeutic plasma concentrations, and with frequent side effects.     

Immunoglobulins in the cerebrospinal fluid of the newborn infant

Immunoglobulins IgG, IgA and IgM were studied in serum and cerebrospinal fluid (CSF) samples from 36 newborn infants in the second day of life. According to parameters previously established in the same laboratory for normal newborn infants, serum proteins were normal in all samples and CSF composition was normal as to blood pigments, cells, total proteins and protein fractions in all samples. Immunoglobulins concentrations were determined by two methods: radial immunodiffusion (RID) and nephelometry. Concentrations found (mean +/- standard deviation) were as follows (mg/dl). Serum: through the RID method IgG 1346 +/- 299.1, IgM 10.4 +/- 2.26, IgA 1.1 +/- 1.06; through nephelometry IgG 1372 +/- 319.7, IgM 10.6 +/- 4.10, IgA 1.5 +/- 0.31. Cerebrospinal fluid: IgA and IgM were not detected by the methods employed; IgG was detected by both methods, and values were 11.1 +/- 2.52 by RID and 9.6 +/- 7.04 by nephelometry. IgG relations and IgG index were also evaluated; values of the IgG index (0.5 +/- 0.14) are emphasized. Considerations are made in order to point out data obtained as to characterize normal values for immunoglobulins in the cerebrospinal fluid of normal newborn infants.     

Significance of discontinuous traces in the full-term newborn infant

This article is devoted to a consideration of the clinical prognostic significance of "tracé discontinu". The authors first distinguish "tracé discontinu" from the "tracé paroxystique" and tracé alternant" patterns in the newborn. The distinction is very important. The bad prognosis of the "tracé paroxystique" is well known, but prognosis of the "tracé discontinu" seems to be different. If the "tracé discontinu" is permanent, there was a 50% favourable outcome in our 22 newborn babies brought to the reanimation department. If some continuous activity can be observed: beginning of sleep organisation, then the prognosis seems to be better: 61% of our cases. As blood levels of anticonvulsants are rarely measured it seems difficult, given our present knowledge, to appreciate anticonvulsive drug effects on EEG recordings. Thus 3 aims should be pointed out: --Measurements of anticonvulsant blood level each time a "tracé discontinu" is observed in a treated newborn. --Early EEG recordings of sufficient duration to obtain eventually some continuous tracing. --Correct differentiation between "tracé paroxystique" and "tracé discontinu" for the clinician: "tracé discontinu" in a full-term newborn should never allow the paediatrician to stop treatment.     

Seizures in the newborn infant; value of polygraphy

Recordings were made from 20 newborns during seizures in their first days of life, using a polygraphic study enabling observation of electro-clinical seizures, electric seizures, and seizures with no EEG transfer. The interictal EEG as well as the duration of status epilepticus are discussed. An estimation of the prognosis from the EEG clinical criteria is envisaged. CT scans and ultrasound scans were performed in serious cases of neonatal distress responsible for status epilepticus; these showed diffused or localized oedema of the white matter, either isolated or associated with intracranial hemorrhagic lesions.     

Therapeutic hypothermia for hypoxic-ischaemic encephalopathy in the newborn infant

PURPOSE OF REVIEW: This review examines recent findings from experimental models and clinical trials of induced hypothermia as treatment after cerebral hypoxia-ischaemia in term newborn infants. RECENT FINDINGS: Experimental hypothermia inhibits many steps in the biochemical cascade that produces severe brain injury after hypoxia-ischaemia. This is in contrast to pharmacological agents, which tend to target only one step in the process that leads to brain injury. In adult humans hypothermia initiated immediately after cardiac arrest has improved outcomes. Delayed cooling after brain trauma has also been effective in a subgroup of adult patients. Seventy-two hours of selective head cooling with mild systemic hypothermia (rectal temperature 34.5 degrees C) in term infants with hypoxic-ischaemic encephalopathy (HIE) reduced death or disability in the infants with less severe electroencephalographic changes at entry (no benefit in those with advanced electroencephalographic changes). Cooling had no apparent adverse effects. A smaller randomized clinical trial of 48 h whole body cooling (rectal T 33 degrees C) found a reduction in death and neurological impairment. SUMMARY: In term infants with HIE there is emerging evidence that both selective head cooling and whole body cooling are neuroprotective and safe. This is consistent with a wealth of experimental animal data and adult trials. Neuroprotection seems to be lost if cooling is started after 6 h. The challenge now is to complete ongoing trials. If meta-analysis confirms a therapeutic effect, then this may lead to selection criteria and treatment protocols for very early hypothermia in HIE at term.     

Cyanide insensitive oxidase in platelets of newborn infant

The authors studied the behaviour of neonate platelet O2 consumption after the addition of pyridine nucleotide compared to adult controls. O2 consumption of neonate platelets after NADH addition was 103,2 millimicronmol O2/10(9)/hr (SE = 24,74) and in adult controls 188,8 millimicronmol O2/10(9)/hr (SE = 36,46). After the addition of NADPH O2 consumption was, respectively, 233,5 millimicronmol (SE = 46,29) and 218,3 millimicronmol (SE = 30,01).     

Subcortical visual function in the newborn

Early behavioral visual function in infants may not depend upon the geniculocalcarine pathway but may be mediated through more primitive subcortical pathways. This subcortical visual system may exist in early life and be responsible for visual pursuit and perhaps fixation. In some infants with damage to the visual cortex, the subcortical pathway may persist beyond the neonatal period. Three infants with major defects in the visual cortex are reported. These infants displayed persistent preservation of visual pursuit movements without evidence of visual recognition. Limited behavioral expressions of vision in the infant with damage to the visual cortex may not always be an indicator of preserved function of the visual cortex.     

Neurologic evaluation of the newborn infant: definition and psychometric properties

The neonatal neurologic assessment is an evaluation of neurologic function in the newborn infant. This paper provides an overview of the construct, content, and purpose of the neonatal neurologic examination. Furthermore, the reliability and validity of nine standardized neonatal assessments are reviewed.     

Outcome of electroclinical, electrographic, and clinical seizures in the newborn infant

Three seizure types have been described in the neonate: electroclinical, electrographic, and clinical only. Controversy still exists about whether the episodic abnormal movements seen in some infants, which are not accompanied by simultaneous ictal discharges on the EEG, are true seizures. Twenty-four infants with seizures were studied, 17 had purely electrographic and/or electroclinical seizures, seven had clinical-only seizures; six of these seven had clonic seizures, without facial manifestations or autonomic change. The three seizure types were investigated using video-EEG and a Griffiths neurodevelopmental assessment was performed in each seizure group. Of the seven infants with clinical-only seizures, six had clonic seizures with a normal background EEG, neuroimaging studies and neurodevelopmental follow-up assessment were normal in five. In the remaining 17 infants with electrographic and/or electroclinical seizures, seizure discharges were often associated with ocular phenomena, apnoea, or tonic posturing, and the background EEG was abnormal in all but one subject. Neurodevelopmental follow-up assessments revealed a poor outcome (14 of 17) in this group. In otherwise healthy infants, purely clonic seizures involving only the limbs may be a benign phenomenon and an EEG should be obtained to avoid unnecessary treatment. Infants with seizures superimposed on an abnormal background EEG pattern had a poor outcome.