Neonatal seizures are often refractory to treatment with initial antiseizure medications. Consequently, clinicians turn to alternatives such as levetiracetam, despite the lack of published data regarding its safety, tolerability, or efficacy in the neonatal population. We report a retrospectively identified cohort of 23 neonates with electroencephalographically confirmed seizures who received levetiracetam. Levetiracetam was considered effective if administration was associated with a greater than 50% seizure reduction within 24 hours. Levetiracetam was initiated at a mean conceptional age of 41 weeks. The mean initial dose was 16 ± 6 mg/kg and the mean maximum dose was 45 ± 19 mg/kg/day. No respiratory or cardiovascular adverse effects were reported or detected. Levetiracetam was associated with a greater than 50% seizure reduction in 35% (8 of 23), including seizure termination in 7. Further study is warranted to determine optimal levetiracetam dosing in neonates and to compare efficacy with other antiseizure medications.

We describe the first use of cinacalcet as monotherapy for severe hypercalcemia in a newborn with NSHPT. The rapid and durable response to cinacalcet suggests that a trial of calcimimetic therapy should be considered early in the course of NSHPT.

Tracheostomy was associated with improved proportional growth and increased participation in activities promoting developmental skill acquisition and reduced daily sedation requirements in preterm infants with severe BPD.

ObjectiveNeonates are at high risk for significant morbidity and mortality from medication prescribing errors. Despite general awareness of these risks, mistakes continue to happen. Alerts in computerised physician order entry intended to help prescribers avoid errors have not been effective enough. This improvement project delivered feedback of prescribing errors to prescribers in the neonatal intensive care unit (NICU), and measured the impact on medication error frequency.MethodsA front-line multidisciplinary team doing multiple Plan Do Study Act cycles developed a system to communicate prescribing errors directly to providers every 2 weeks in the NICU. The primary outcome measure was number of days between medication prescribing errors with particular focus on antibiotic and narcotic errors.ResultsA T-control chart showed that the number of days between narcotic prescribing errors rose from 3.94 to 22.63 days after the intervention, an 83% improvement. No effect in the number of days between antibiotic prescribing errors during the same period was found.ConclusionsAn effective system to communicate mistakes can reduce some types of prescribing errors.

Objective-Intravenous (IV) levetiracetam (LEV) is approved for use in patients older than 16 years and may be useful in critically ill children, although there is little data available regarding pharmacokinetics. We aim to investigate the safety, an appropriate dosing, and efficacy of IV LEV in critically ill children.Design-We describe a cohort of critically ill children who received IV LEV for status epilepticus, including refractory or nonconvulsive status, or acute repetitive seizures.Results-There were no acute adverse effects noted. Children had temporary cessation of ongoing refractory status epilepticus, termination of ongoing nonconvulsive status epilepticus, cessation of acute repetitive seizures, or reduction in epileptiform discharges with clinical correlate.Conclusions-IV LEV was effective in terminating status epilepticus or acute repetitive seizures and well tolerated in critically ill children. Further study is needed to elucidate the role of IV LEV in critically ill children. Keywordslevetiracetam; status epilepticus; seizure; pediatric Intravenous (IV) levetiracetam (LEV) has been approved for use by the U.S. Food and Drug Administration in patients aged 16 years and older (1), but there is little data available regarding pharmacokinetics, tolerability, or efficacy in younger children. Additionally, LEV has not been approved by the Food and Drug Administration for treatment of acute seizures. LEV is a broadspectrum anticonvulsant and can be administered rapidly as a loading dose over 15 minutes, although adult studies suggest infusion times of 5 minutes are well tolerated (2). Pharmacokinetically, LEV completely avoids hepatic metabolism, which may prove beneficial in complex patients with liver dysfunction or metabolic disorders or those patients at risk for major drug interactions. In comparison with other IV anticonvulsants, LEV has few known adverse effects, including a low risk of sedation, cardiorespiratory depression, or coagulopathy, and thus is potentially useful in critically ill pediatric patients. We present data on a cohort of critically ill children who received IV LEV for status epilepticus or acute repetitive seizures. MethodsThis is a retrospective case series of critically ill children who received IV LEV for status epilepticus or acute repetitive seizures at The Children's Hospital of Philadelphia between For information regarding this article, abend@email.chop.edu. NIH Public Access ResultsTen children were identified who received IV LEV for status epilepticus or acute repetitive seizures in the pediatric ICU (Table 1). The median age was 5 years and range was 0.08-14 years. Loading dose of LEV ranged from 6.5 to 31 mg/kg. Indications for therapy included nonconvulsive status epilepticus refractory to other anticonvulsant medications in three children, nonconvulsive status epilepticus with LEV as the first-line anticonvulsant in two children, acute repetitive seizures in four children (nonconvulsive in two patients, clinical in two patients), and periodic epileptifo...

Acute AEs related to ZA infusion in youths are common, occur principally after the first ZA infusion in bisphosphonate-naive patients, and are typically mild and easily managed. Future prospective studies are needed to determine the potential long-term risks, as well as benefits, of ZA therapy in the pediatric population.

Objective: To identify the number of cumulative medication exposures and most frequently used medications in infants with severe BPD. Study Design: We performed a retrospective cohort study in infants with severe BPD admitted to United States children’s hospitals. We measured cumulative medication exposures in individual subjects and between-center variation after adjustment for infant characteristics. We then identified the specific medications and therapeutic classes with the highest rates of use. Results: In 3252 subjects across 43 hospitals, we identified a median (interquartile range) of 30 (17– 45) cumulative medication exposures per infant. The adjusted mean number of medication exposures varied between centers (p < 0.0001), with a range of 22 – 50. Diuretics and furosemide were the most frequently prescribed therapeutic class and specific medication for the management of severe BPD. Conclusions: Infants with severe BPD are exposed to alarming number of medications of unclear efficacy and safety, with marked variation between center.

The implications of absorption site should be considered for all patients receiving medications via postpyloric feeding tubes. Several medications cannot be administered through alternative routes because gastric acid is needed for their absorption, the medications may bind to the tubing, or drug absorption is altered at the intestinal site.