The etiology and outcome of cerebrovascular diseases in Northeastern Thai children.

OBJECTIVE: To review the etiology and outcome of cerebrovascular diseases among children in Northeastern Thailand. STUDY DESIGN: Retrospective, descriptive study. SETTING: Srinagarind Hospital, Khon Kaen, Thailand. MATERIAL AND METHOD: The authors studied 109 pediatric patients admitted between April 1995 and 2006. RESULTS: The mean age was 11.6 years and the male-to-female ratio was 1.06:1. The ages at onset ranged from 6 months to 15 years, while the most commonly affected age group were children between 10 and 15 years. The authors identified 74 hemorrhagic strokes (65%) and 35 ischemic strokes (31%). The most common etiologic factor in hemorrhagic and ischemic strokes was arteriovenous malformations and cardiac diseases respectively. The five most common presenting symptoms were headache, alteration of consciousness, hemiparesis, vomiting, and seizures. The mortality rate was 22%. CONCLUSION: Knowledge of the etiologies and outcomes of cerebrovascular disease in children should improve diagnosis and management.

Treatment of infantile spasms with sodium valproate followed by benzodiazepines.

OBJECTIVE: To review the result of the infantile spasms' treatment with sodium valproate followed by nitrazepam or clonazepam. STUDY DESIGN: Descriptive retrospective study. SETTING: Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. MATERIAL AND METHOD: Twenty-four infantile spasms admitted between January 1994 and December 2003 were analyzed. The inclusion criteria were the patients with infantile spasms clinically diagnosed by the pediatric neurologist, having hypsarrhythmic pattern EEG, and receiving sodium valproate with or without nitrazepam or clonazepam. The patients who had an uncertain diagnosis, incomplete medical record, or that were incompletely followed up were excluded. Data were collected on sex, age at onset of seizure, type of infantile spasms, associated type of seizure, predisposing etiological factor, neuroimaging study, and the result of treatment including cessation of spasms, subsequent development of other seizure types, quantitative reduction of spasms, relapse rates of spasms, psychomotor development, and adverse effects of AEDs. RESULTS: The mean age at onset was 177 days. The male-to-female ratio was 1:1.2. There were 13 cryptogenic (54.2%) and 11 symptomatic (45.8%) infantile spasms. The most common predisposing etiological factors in symptomatic cases were hypoxic ischemic encephalopathy (45.5%) and microcephaly (36.4%), respectively. Ten patients received sodium valproate (41.7%), another 10 received sodium valproate with clonazepam (41.7%), and four received sodium valproate with nitrazepam (16.7%). Both, the complete cessation rate and the 50% reduction of spasms rate were 45.8%. The duration to complete cessation was 70 days. The relapse rate was 18.2%. The rate of delayed psychomotor development was 83.3%. The mean duration of follow-up was 49.6 months. CONCLUSION: The authors propose to use sodium valproate concomitantly with benzodiazepines, especially clonazepam, in situations such as unavailability, intolerability, or adverse effects of ACTH or vigabatrin, or in a patient who does not respond to ACTH or vigabatrin.

Once-daily gentamicin dosing of 4 Mg/Kg/dose in neonates.

Since gentamicin is one of the most commonly prescribed antibiotics for culture-proven or suspected sepsis in neonates, interest has increased in refining dosing regimens for improved efficacy and decreased toxicity. Usually, 2.5 mg gentamicin/kg is infused twice daily, but its large volume of distribution, slow renal clearance and concentration-dependent character, suggests longer dosing intervals would be more appropriate. From a previous study, 22% of neonates who received a once-daily gentamicin dosage of 5 mg/kg/day had unacceptably high trough levels (i.e. > 2 microg/mL). The authors studied 105 neonates (of > or = 34 wk gestational age or > or = 2, 000 g body weight) admitted to the Neonatal Unit, Srinagarind Hospital, Khon Kaen University; at risk, or with clinical features of sepsis, receiving a once-daily gentamicin dosing of 4 mg/kg intravenously. Peak (i.e. efficacy) and trough (i.e. toxicity) serum gentamicin concentrations were collected on day 3 of therapy. On days 1 and 3, nephrotoxicity was evaluated from serum creatinine and ototoxicity by a hearing test. Neonates treated with 4 mg gentamicin/kg once-daily had a mean steady-state peak vs trough concentration of 7.33 (+/- 2.77) vs 0.99 (+/- 0.57) microg/mL, respectively. The peak serum concentration achieved a therapeutic level > 4 microg/mL in 102 neonates (97%), while 7 (6.67%) had an undesirable trough level (viz. > 2 microg/mL); notwithstanding, no nephrotoxic or ototoxic effects were identified. Gentamicin once-daily at 4 mg/kg/dose in neonates at > or = 34 wk gestation achieved appropriate trough levels. the regimen was convenient and did not increase renal or ototoxicity.