Efficacy and tolerability of levetiracetam in children aged 10 years and younger: a clinical experience.

Levetiracetam is a new anti-epileptic drug that is currently not licensed for use in children. Studies in adults suggest that it may be a useful adjunctive treatment both in partial onset and generalised epilepsy. A retrospective case notes review of 26 children age 10 years and under with refractory epilepsy was undertaken to evaluate the efficacy and safety of the drug.

Effects of feeding on gastric tonometric measurements in critically ill children.

Objective: To determine the effect of gastric feeding on the measurement of gastric intramucosal PCO2 (PiCO2) and its derived gastric intramucosal PCO2-arterial PCO2 difference (PiCO2-PaCO2 difference) and gastric intramucosal pH (pHi) in a group of critically ill children using recirculating gas tonometry.

Design: Prospective clinical pilot study.

Setting: Sixteen bed pediatric intensive care unit.

Bronchopulmonary foregut malformations: embryology, radiology and quandary.

Bronchopulmonary foregut malformations (BPFM) are a heterogeneous group of pulmonary developmental anomalies that present at varying ages and with overlapping symptoms, signs and radiology. This article discusses the embryology of these lesions with reference to possible common origins and the link between aetiology and radiological appearance. The radiology of each lesion, both antenatally and postnatally, is described and illustrated.

Diaphragmatic hernia and preaxial polydactyly in spondylothoracic dysplasia.

We report on two cases (male twins), and a female sib terminated at 20 weeks, whose autopsy revealed features of spondylothoracic dysplasia (STD) and also a diaphragmatic hernia and preaxial polydactyly. We present the findings and review STD and the closely related spondylocostal dysostosis. On the basis of the discussion we suggest that our cases are possibly the first report of preaxial polydactyly in spondylothoracic dysplasia and that STD and spondylocostal dysostosis may be allelic.

Adverse events associated with intravenous phenytoin in children: a prospective study.

A prospective study was undertaken to assess the type and frequency of adverse side-effects following the use of intravenous phenytoin in children. Twenty-two children received a total of 100 doses over a 10-month period. Six patients (27%) experienced one or more side-effects, including extravasation of the drug, hypotension and cardiac arrhythmia.

Octreotide for treatment of chylothorax after repair of congenital diaphragmatic hernia.

Chylothorax is a recognized cause of morbidity after repair of congenital diaphragmatic hernia (CDH). Management may include prolonged hospitalization with cessation of enteral feedings, repeated aspiration, chest tube drainage, total parenteral nutrition, and introduction of a medium chain triglyceride (MCT) diet as the effusion resolves. The authors report that the successful deployment of octreotide, a somatostatin analogue, hastened resolution of a postoperative chylothorax in a newborn infant with CDH.

Motor, cognitive, and behavioural disorders in children born very preterm.

Children born preterm have been shown to exhibit poor motor function and behaviour that is associated with school failure in the presence of average intelligence. A geographically determined cohort of two-hundred and eighty preterm children (151 males, 129 females) born before 32 weeks' gestation and attending mainstream schools were examined at 7 to 8 years of age together with 210 (112 males, 98 females) age- and sex-matched control participants were tested for motor, cognitive, and behavioural problems. Tests applied were the Movement Assessment Battery for Children (MABC), Clinical Observations of Motor and Postural Skills (COMPS), Developmental Test of Visual-Motor Integration (VMI), Wechsler Intelligence Scale for Children, and Connors' Teacher Rating Scale for attention-deficit-hyperactivity disorder (ADHD).

Paediatric epistaxis: Alder Hey experience.

Referrals for epistaxis management constitute a significant proportion of paediatric ENT consultations. A prospective audit of all new referrals to our paediatric ENT department for epistaxis management yielded 88 patients over four months. Parents completed a questionnaire with particular reference to the duration of history and frequency of epistaxis.

Mortality in severe meningococcal disease.

Aim: To evaluate mortality of critically ill children admitted with meningococcal disease.

Methods: Prospective study of all children admitted to a regional paediatric intensive care unit (PICU) between January 1995 and March 1998 with meningococcal disease. Outcome measures were actual overall mortality, predicted mortality (by PRISM), and standardised mortality ratio.

Normal values for distortion product otoacoustic emissions in children: a study using primary levels previously demonstrated to be optimum for identification of hearing loss.

No published data exist for normal values of distortion product otoacoustic emissions (DPOAE) in children at primary levels f1 = 65 dB and f2 = 55 dB SPL. These primary levels have been previously demonstrated to be optimal for identification of hearing impaired ears in adults. A total of 102 normal children underwent audiological assessment, including exclusion of middle ear disease, pure tone audiometry and DPOAE DP-grams (primaries L1/L2 = 65/55 dB SPL, f1:f2 = 1.

The persistently irritable joint in childhood an orthopaedic perspective.

Persistent joint or periarticular irritability and pain in children can have numerous explanations. This overview explores the diverse range of orthopaedic conditions, both acquired and congenital, that may lead to such a presentation.

Cranial magnetic resonance imaging and school performance in very low birth weight infants in adolescence.

Aim: To determine whether neurological deficits are associated with structural anomalies of the brain in very low birthweight (VLBW) infants with subsequent learning disorders but without cerebral palsy, or whether other factors, such as poor early growth, are responsible.

Methods: Eighty seven VLBW infants and eight term controls who had been examined at school between the ages of 12 and 13 years, had cranial magnetic resonance imaging (MRI) scans at 15-17 years of age.

Results: Thirty seven (42.

Apparent life-threatening events presenting to a pediatric emergency department.

Objective: To review the etiology, clinical decision-making process, and outcomes of apparent life-threatening events (ALTEs) presenting to a children's hospital emergency department (ED).

Design: Retrospective patient record review.

Subjects: One hundred thirty infants under the age of 1 year fulfilling the diagnostic definition of an apparent life-threatening event.

Intraaortic balloon pumping in children.

Background: Intraaortic balloon pump (IABP) usage in young children remains a rarity because, first, there is a widespread misconception that the greater elasticity of the aorta in children may prevent effective augmentation, and second, children in low cardiac output states are more likely to have associated right ventricular failure and pulmonary problems. We report our experience with the use of IABP in children undergoing cardiac surgery in whom mechanical support was necessary for the treatment of refractory cardiac failure.

Methods: Over a 3-year period, 14 children were identified as requiring IABP support after cardiac surgery.

The removal of metalwork in children.

The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent.

Combined use of titanium mesh and biocompatible osteoconductive polymer in the treatment of full thickness calvarial defects.

Restoration of bony defects is a common problem in craniofacial surgery. This article describes a versatile approach using a combination of titanium micromesh or midimesh and biocompatible osteoconductive polymer to restore calvarial bone loss.

Congenital diaphragmatic hernia--does the side of the defect influence the incidence of associated malformations?

Background/purpose: Patients with congenital diaphragmatic hernia (CDH) frequently have associated anomalies. Experiments in the nitrofen CDH model have shown differential embryonic cell death patterns in rodents suggesting unique mechanisms in the formation of right-sided (RCDH) or left-sided (LCDH) diaphragmatic hernia. These findings provide insight into the pathogenesis of CDH and may aid our understanding on the spectrum of associated anomalies commonly observed in humans.

Recent developments in the management of Peutz-Jeghers syndrome in childhood.

A combined surgical and endoscopic approach for managing extensive polyposis in a child with Peutz-Jeghers syndrome (PJS) is presented. Application of this technique offers the following advantages over conventional surgical practice -- 1) an accurate assessment can be made of the extent of intestinal polyposis; 2) small polyps can be easily removed endoscopically; 3) endoscopy can direct the operating surgeon to selected enterotomy sites for open excision of larger polyps and 4) multiple laparotomy, extensive intestinal resection(s) and the potential threat of short-gut syndrome in PJS patients may be avoided.

Intraaortic balloon pump after treatment of anomalous origin of left coronary artery.

The same system of intraaortic balloon pumping has been used in 2 infants after surgical repair of anomalous origin of the left coronary artery from the main pulmonary artery. Intraaortic balloon pumping was started in the first patient on the second postoperative day, whereas in the second patient it was started before the patient was weaned from cardiopulmonary bypass. Both patients survived.

Sudden, unexpected death in epilepsy in children.

Sudden, unexpected death in epilepsy (SUDEP) remains a controversial and enigmatic syndrome, particularly in children where the incidence, prevalence and risk factors may, and probably do, differ from adults. This study demonstrates (and further reinforces) the difficulties and inability of retrospective and coroner/death certificate-derived data in identifying the frequency of SUDEP in children.

Managing the teenager with epilepsy: paediatric to adult care.

Epilepsy starting in childhood frequently persists through adolescence and into adult life, and an onset in adolescence itself is common. The management of the teenager with epilepsy is important but often inadequate. In 1991, a specific clinic for teenagers with epilepsy was established in Liverpool to address the unique needs and concerns of this age group and, importantly, to facilitate a smooth hand-over of specialist epilepsy care from paediatric to adult services.

The management of epilepsy in children: the role of the clinical nurse specialist.

Epilepsy in children is frequently accompanied by learning, behavioural and psychological difficulties. These difficulties may be compounded by the ignorance and stigma which exists within the community health care and education services. The management of epilepsy in children therefore extends far beyond the use of antiepileptic drugs and must address these additional problems.

Immunohistochemical evaluation of the developing outflow tract in the rat: achieving aortic to mitral fibrous continuity.

Objectives: To study the development of aortic to mitral fibrous continuity in the normal rat heart.

Methods: The hearts and great vessels of normally developed rat embryos and fetuses aged between 13.25 and 19.