Meropenem decreases serum level of valproic acid.

Concomitant administration of meropenem has been reported to decrease serum level of valproic acid both in humans and in animals. This report describes three children who required simultaneous administration of valproic acid and meropenem. Meropenem rapidly decreased serum valproic acid concentration to subtherapeutic levels in all three children, and serum valproic acid levels were returned to therapeutic levels in a short time after discontinuing simultaneous meropenem therapy. Valproic acid was not changed to another antiepileptic agent, because no seizure activity was observed. To our knowledge, this is the first case report on the simultaneous administration of meropenem and valproic acid in childhood. In conclusion, it is clear that concomitant meropenem administration decreases serum valproic acid concentration, and we believe that there may be no need to change the antiepileptic drug during this period, provided that the patient has no seizure. More detailed studies are required.

Lateral pectoral nerve conduction.

The aim of this study was to measure the motor conduction time (MCT) and velocity of the lateral pectoral nerve (LPN) in normal subjects and patients with neuropathy. For the LPN, we determined thus the average MCT was 3.9 m/s using Erb stimulation with needle recording, and the average motor conduction velocity was 70.6 m/s using Erb stimulation and axilla stimulation with needle recordings in normal subjects. In patients, prolonged MCT in LPN was found in 3 of 6 patients with unilateral plexopathy and 3 of 4 patients with polyneuropathy. It was determined that MCT and motor conduction velocity in LPN was as sensitive as biceps brachii MCT in patients with unilateral plexopathy. Furthermore, the motor conduction velocity in the LPN may be beneficial to elucidate the localization of involvement in polyneuropathies, such as distal or proximo-distal.

Risk factors for intraventricular haemorrhage in very low birth weight infants.

OBJECTIVE: In a prospective study at Uludag University Hospital, 120 premature infants with birthweights of 1500 g or less were screened for intraventricular hemorrhage (IVH) using cranial ultrasound. With the purpose of studying the incidence of IVH, the associated risk factors for these neonates were considered. METHODS: We studied all the very low birth weight infants admitted in our neonatal unit. We examined the following variables as risk factors for IVH: sex, birth weight, gestational age, Apgar score, mechanichal ventilation, hypercapnia, use of antenatal steroids, tocolytic drugs, vaginal versus cesarean section delivery, and inborn versus outborn status, vasopressor infusion (any vasoactive drug such as dopamine, dobutamine, or epinephrine) not associated with resuscitation, and surfactant administration. RESULTS: The incidence of IVH was 15% (18/120), 50% grade I (9/18), 17% grade II (3/18), 11% grade III (2/18), and 22% grade IV (4/18). IVH occurred mainly in the first week of life (78%; 14/18). The significant risk factors for IVH were found to be prematurity, outborn status, low 5 minute Apgar score, vaginal delivery, hypercapnia, mechanical ventilation, hypotension, and use of vasopressors on the day of admission. Significant protective factors against IVH included antenatal steroid therapy, cesarean section, magnesium sulfate tocolysis, increasing gestational age, and increasing birth weight. CONCLUSION: Our results concur with the notion that a tertiary center is the optimal location for delivery of the high risk neonate. Transportation of infants in utero to a perinatal center specializing in high risk-deliveries results in a decreased incidence of IVH when compared to infants transported postnatally. Aggressive resuscitation, with avoidance of hypercarbia, and rapid restoration of hypovolemia could potentially reduce the incidence of PVH/IVH.

Evaluation of the need for routine preoperative latex allergy tests in children.

BACKGROUND: Recently, there was a great increase in allergic reactions to latex and this brought relatively more concern to the latex allergy. In this prospective study we aimed to identify the frequency of latex allergy in preoperative patients, and tried to clarify whether it is necessary to perform latex allergy tests routinely in the preoperative period or not. METHODS: A total of 188 children, aged 1-14, who were admitted for various operations, were randomly included in this study and of them, 181 completed the study. Latex specific history was taken from all patients. Latex skin prick tests, challenge tests with latex gloves, total IgE and latex specific IgE measurements were performed. RESULTS: Of 181 children, two (1.1%) had positive latex skin prick tests. Latex challenge tests were negative in all children. Latex specific IgE was positive in 12 children (6.6%) as class II or higher, but no patient had allergic reactions in operations. History of repeated operations was a risk factor for latex sensitization. The risk was higher in the presence of both history of repeated operations and history of allergic disease. However, the risk was not higher in patients with the history of only allergic disease, compared to ones who had a history of neither repeated operations nor allergic disease. CONCLUSION: We conclude that routine preoperative latex allergy tests seem to be not necessary because of no allergic reactions during operation in spite of the sensitization of 6.6% detected by latex specific IgE. However, this should be investigated in larger studies.