Preterm infant with necrotizing enterocolitis and arteritis secondary to streptococcus gallolyticus subspecies pasteurianus.

 Streptococcus gallolyticus subspecies pasteurianus is a subtype of Streptococcus bovis (S. bovis) that has become increasingly recognized as a sepsis-causing pathogen in neonates. It is well documented that S. bovis species have a predilection to both cardiac and gastrointestinal tissue, and in adult populations, isolating these organisms in the bloodstream often triggers further evaluation for co-morbid complications such as colon cancer or endocarditis. However, no such guidance currently exists in neonatal literature. We present a case of a preterm infant with S. gallolyticus subsp. pasteurianus bacteremia presenting as necrotizing enterocolitis (NEC) not previously described in the literature. Furthermore, through a complete diagnostic evaluation, including an echocardiogram, our patient was found to have the rare complication of endocarditis.

Pharmacokinetics of lamotrigine in children in the absence of other antiepileptic drugs.

We evaluated the pharmacokinetics of lamotrigine in 12 children with epilepsy who were receiving no other antiepileptic drugs. Each patient received a single oral dose of lamotrigine 2 mg/kg. Plasma concentrations of the drug were measured up to 48 hours after dosing. Pharmacokinetic parameters were calculated using noncompartmental methods. After rapid absorption, the lamotrigine concentration declined monoexponentially. Oral clearance was 0.64 +/- 0.26 ml/min/kg. The apparent volume of distribution was 1.50 +/- 0.51 L/kg. Weight-normalized clearance and volume were higher in children than in adults. The mean half-life was 32 hours, similar to that in adults. Should similar plasma lamotrigine concentrations in adults and children be desirable, children will likely require higher weight-normalized doses at the same dosing frequency.