Topiramate for drug-resistant epilepsies.

Topiramate is a new anti-epileptic drug with proven efficacy against partial seizures in adults. A retrospective assessment of the use of topiramate in drug-resistant childhood epilepsy was undertaken. Thirty-four children (median age of 10 years; range 2-18 years) were treated for a median of 9 months (range 6-18 months). The starting dose was 0.25-2.0 mg/kg/day increasing to a maximum of 13 mg/kg/day. Generalized seizures occurred in 27 patients, partial seizures in 15 and infantile spasms in two. Epilepsies were localization-related in 15 patients and generalized in 18. One patient had severe myoclonic epilepsy in infancy. Two patients had Lennox-Gastaut syndrome, five (two currently and three previously) had West syndrome and one had epilepsy with myoclonic absences. Twenty patients had a substantial (> 50%) reduction in seizure frequency; two of whom became seizure-free. Two-patients had an increase in seizures. Efficacy was seen against simple and complex partial seizures, generalized tonic-clonic seizures (primarily generalized), atonic and tonic seizures, myoclonic seizures and infantile spasms. There was no response in the one patient with myoclonic absence seizures. Adverse effects were reported in nine patients; appetite suppression occurred in five patients, behaviour disturbances in three, somnolence in two and poor concentration in one patient. Topiramate is efficacious in a wide spectrum of childhood epilepsies and is well tolerated.     

促皮质素与生酮饮食治疗新发婴儿痉挛症的随机对照研究

目的 通过促皮质素(ACTH)与生酮饮食(KD)治疗新发婴儿痉挛症(IS)的随机对照研究,比较二者的疗效、安全性、耐受性,证实KD能否作为IS的首选治疗方法.方法 将不同时间收治的30例IS新发病例随机分为2组,每组15例.分别给予KD及ACTH治疗,于治疗2周及1、3、6、12个月观察和对比二者的疗效、脑电图改善情况、不良反应及治疗保留率情况.结果 治疗2周,ACTH组与KD组无发作比例分别为71.4%(10/14例)与33.3%(5/15例),ACTH组优于KD组(P=0.039),ACTH治疗有效病例起效时间为(6.00±4.10) d,而KD治疗有效病例起效时间为(9.31±3.59) d,ACTH组起效快于KD组(P<0.05),但治疗3、6、12个月,ACTH组无发作比例分别为50.0%、35.7%、28.6%;KD组无发作比例分别为85.7%、81.8%、75.0%.KD组均优于ACTH组(P=0.045,0.025,0.043),同时脑电图的高峰节律紊乱背景的改善情况与发作控制情况基本平行.1 a后,ACTH组与KD组治疗保留率分别为26.7%(4/15例)及40%(6/15例),二者差异无统计学意义(P=0.227).观察期间,ACTH组与KD组分别出现19例次与16例次的不良反应,但经对症处理后均能很快好转.结论 ACTH治疗IS起效较KD快,近期疗效优于KD治疗,但其停药后复发率逐渐增高,远期疗效不及KD治疗,提示KD可考虑作为IS的首选治疗方案.     

Prospective study of outcome of infants with infantile spasms treated during controlled studies of ACTH and prednisone

We report the long-term outcome of 64 infants with infantile spasms, followed prospectively, using controlled treatment schedules and objective techniques (24-hour EEG and video monitoring) to determine response. Average age at follow-up was 50 months. Of the 64 infants, three (5%) died; of the others, 41 (67%) had developmental retardation of 50% or more or an IQ of 50 or less. Eight patients (13%) composed our cryptogenic study group and were so classified on the basis of normal CT scan, normal development prior to onset of infantile spasms, and undetermined cause. These patients had the better outcome; 38% had normal development or were only mildly retarded. Both the responders and nonresponders in our symptomatic group had a poor outcome; only 5% had normal development or mild impairment. Outcome was not significantly influenced by short versus long treatment lag or by response to therapy. Other types of seizures occurred in 34 patients (53%). In summary, the overall prognosis for long-term outcome in these 64 patients with infantile spasms was poor.     

Growth hormone and body composition in children younger than 2 years with Prader-Willi syndrome

OBJECTIVES: To assess body composition of infants with Prader-Willi syndrome (PWS) by using deuterium dilution and investigating the efficacy of early institution of growth hormone (GH) therapy in increasing lean mass (LM) and preventing massive obesity. STUDY DESIGN: One group of 11 children with PWS <2 years before and during 30-month GH therapy (GH group) was compared with 6 infants administered only coenzyme Q(10) for 1 year (Q10 group). LM adjusted for height (LM(Ht)) and relative fat mass (%FM(Age)) standard deviation scores (SDS) were calculated from data of 95 healthy children. RESULTS: Initially, LM(Ht) of all patients was below the normal average. LM(Ht) decreased by -0.46 +/- 0.3 SD (P=.03) per year in the Q10 group but rose by 0.25 +/- 0.3 SD (P=.02) per year during GH therapy, normalizing after 30 months (-0.70 +/- 1.0 SD). Despite low to normal weight for height (WfH), %FM(Age) was above the normal average (GH group, 31.0% +/- 4.5%, Q10 group, 32.4% +/- 9.5%). In the Q10 infants, %FM(Age) increased by 0.71 +/- 0.7 SD per year, whereas in the GH group, %FM(Age) remained more stable up to 30 months. CONCLUSIONS: Diminished LM(Ht) found in infants with PWS further declines during the early years. Early institution of GH therapy lifts LM(Ht) into the normal range and delays fat tissue accumulation.     

Intrathecal immunoglobulin production and minor motor seizures

Five infants with idiopathic infantile minor motor seizures had an elevated immunoglobulin G (IgG) index ((cerebrospinal fluid IgG/serum IgG):(cerebrospinal fluid albumin/serum albumin)). The infants had prolonged prodromal symptoms, and bad prognosis. It is suggested that immunological mechanisms may contribute to the pathophysiology in certain cases of infantile spasms.     

36例婴儿痉挛患儿血清孕酮与硫酸脱氢表雄酮表达及药物影响的研究

目的 探讨婴儿痉挛患儿血清中孕酮（progesterone,Prog）、硫酸脱氢表雄酮（dehydroepiandrosterone sulfate,DHEAS）水平及丙戊酸钠（sodium valproate,VPA）、拉莫三嗪（lamotrigine,LTG）对患儿Prog和DHEAS水平的影响.方法 以36例未经治疗的婴儿痉挛患儿（病例组）与40例健康婴儿（对照组）为研究对象,应用电化学发光免疫法测定血清Prog及DHEAS水平,并分别对21例单药服用VPA（VPA治疗组）、13例添加LTG（LTG添加治疗组）治疗4个月前后对比,观察各治疗组女婴患儿和男婴患儿性激素的变化.结果 病例组与对照组女婴患儿与男婴患儿血清Prog和log（DHEAS）（经对数转换）水平差异均无统计学意义（P均＞0.05）.VPA治疗组治疗后女婴患儿和男婴患儿血清Prog水平均明显低于治疗前（t=2.603、3.146,P=0.003、0.008）;LTG添加治疗组治疗后女婴患儿和男婴患儿血清log（DHEAS）水平均明显高于治疗前（t=3.185、2.663,P=0.007、0.041）.结论 婴儿痉挛可能并不影响患儿激素代谢,VPA、LTG可影响婴儿激素水平,在治疗期间应该监测患儿血清激素水平.     

Intrathecal Immunoglobulin Production and Minor Motor Seizures

ABSTRACT. Five infants with idiopathic infantile minor motor seizures had an elevated immunoglobulin G (IgG) index ((cerebrospinal fluid IgG/serum IgG): (cerebrospinal fluid albumin/serum albumin)). The infants had prolonged prodromal symptoms, and bad prognosis. It is suggested that immunological mechanisms may contribute to the pathophysiology in certain cases of infantile spasms.     

婴儿痉挛症首次促肾上腺皮质激素治疗相关因素与痉挛控制时间的Cox比例风险回归模型分析

目的 探讨婴儿痉挛症患儿首次行促肾上腺皮质激素（ACTH）治疗中的相关因素对痉挛控制时间的影响,为临床治疗提供参考依据。方法 选择2008年1月至2013年10月收治的72例婴儿痉挛症患儿为研究对象,收集临床资料,选取婴儿痉挛症相关暴露因素,以痉挛控制时间分别对各因素进行Cox比例风险回归模型分析,评估各因素对痉挛控制时间的影响。结果 有无明确病因（已知病因或不明原因）、治疗前痉挛发作频率、是否联合治疗（ACTH单用或联合硫酸镁）3个因素对婴儿痉挛症患儿的痉挛控制时间具有显著性影响（P < 0.05）。已知病因的婴儿痉挛症患儿痉挛控制时间较短,而治疗前痉挛发作频率较低以及ACTH联合硫酸镁治疗的患儿痉挛控制时间较长（均P < 0.05）。结论 对于首诊的婴儿痉挛症患儿,应尽可能明确病因,有助于评估预后;及早应用ACTH联合硫酸镁治疗,可能改善预后。     

Iron status at 9 months of infants with low iron stores at birth

OBJECTIVE: To determine the 9-month follow-up iron status of infants born with abnormally low serum ferritin concentrations.Study design: Ten infants of >34 weeks' gestation with cord serum ferritin concentrations <5th percentile at birth (<70 microg/L) and 12 control infants with cord serum ferritin concentrations >80 microg/L had follow-up serum ferritin concentrations measured at 9 +/- 1 month of age. The mean follow-up ferritins, incidences of iron deficiency and iron-deficiency anemia, and growth rates from 0 to 12 months were compared between the two groups. RESULTS: At follow-up, the low birth ferritin group had a lower mean ferritin than the control group (30 +/- 17 vs 57 +/- 33 microg/L; P =.03), but no infant in either group had iron deficiency (serum ferritin <10 microg/L) or iron-deficiency anemia. Both groups grew equally well, but more rapid growth rates were associated with lower follow-up ferritin concentrations only in the low birth ferritin group (r = -0.52; P =.05). Both groups were predominantly breast-fed without iron supplementation before 6 months. CONCLUSIONS: Infants born with serum ferritin concentrations <5th percentile continue to have significantly lower ferritin concentrations at 9 months of age compared with infants born with normal iron status, potentially conferring a greater risk of later onset iron deficiency in the second postnatal year.     

应用多项神经电生理技术对婴儿痉挛临床发作特征的综合研究

目的应用多项电生理技术观测婴儿痉挛（IS）的临床发作特征,探索痉挛、肌阵挛和强直性发作的临床．电生理鉴别要点。方法应用视频脑电一肌电多导记录及抽搐逆向锁定的脑电平均技术（ierk-locked back averaging,JLA）,对8例1岁以下IS婴儿的681次临床明显发作（包括经测试最后被摒除的20次非皮层性肌阵挛）,进行临床和多项电生理的实时联合记录分析。同时以其中1例Aicardi综合征Is临床发作前2个月的58次肌阵挛发作为对照。结果8例IS共记录到3种发作形式,包括痉挛、肌阵挛和强直性发作,分别占94．4％（624／661次）、4．5％（30／661次）和1．1％（7／661次）。痉挛发作多为轴性肌群收缩,具有丛集性及“渐强-渐弱”特征,85．7％（535／624次）的痉挛发作时间在0．4—3.0s间,14．3％（89／624次）持续3—7S。此外,还根据发作期EEG认定273次微小痉挛发作。发作期脑电图多为全脑性高幅慢波或低-中幅快波活动（89．1％）,经JLA叠加后发作期脑电与肌电间未见明确锁时关系。肌阵挛为闪电样的肌肉收缩,发作时间〈400ms,发作期脑电图或为痫性放电,或无明显改变。经JLA叠加后证实痈性肌阵挛有皮层放电波,且与肌电之间有恒定锁时关系。强直性发作持续3s以上,脑电图为低幅快波及中幅θ活动。此外,根据强直痉挛的强直达峰时间〈2s、发作期EEG及轴性发作与IS一致等特点,可与强直性发作区别。结论IS临床以痉挛发作为主,借助多导电生理记录及JLA等电生理技术,能满意地对痉挛、强直性痉挛、肌阵挛和强直性发作等婴幼儿期常见癫痫发作进行鉴别,从而有助对婴儿期癫痫的正确诊断、分类与治疗。     

Long-term outcome of peritoneal dialysis in infants

Debate continues concerning the treatment of infants with end-stage renal disease. We evaluated progress and outcome of 20 infants with a mean age of 0.34 year (range, 0.02-1 year) in a long-term peritoneal dialysis program at a single center. Mean weight at the start of dialysis was 4.8 kg (range, 1.7-11.4 kg), and the duration of dialysis was 17.3 months (range, 1-59 months). Eleven infants received renal transplants, 4 were switched to hemodialysis and then received transplants, 4 died, and 1 continues to receive peritoneal dialysis. There was significant co-morbidity in 6 infants who died or required hemodialysis. Catheter interventions were frequent, with 12 infants requiring at least one replacement. There were 1.1 episodes of peritonitis per patient-year; 70% of infants had 0 to 1 episode. Mean weight standard deviation score (SDS) was -1.6 at the start, -0.3 at 1 year (P =.0008), and 0.3 at 2 years (P =.0008). Height SDSs were -1.8 at the start, -1.1 at 1 year (P =.046), and -0. 8 at 2 years (P =.06). Head circumference SDSs were -1.9 at the start, -1.3 at 6 months (P =.003), and -0.9 at 1 year (P =.015). Fourteen of 16 survivors are achieving normal developmental milestones or attend mainstream school. Peritoneal dialysis in infancy is a demanding treatment, but outcome for growth, development, and transplantation justifies this intensive approach. When parents are counseled, the importance of non-renal co-morbidity must be emphasized.     

生酮饮食添加治疗儿童癫痫性痉挛临床和随访研究

目的：初步了解生酮饮食（ ketogenic diet,KD）添加治疗对儿童癫痫性痉挛的短期疗效、不良反应及依从性。方法对2012年7月至2014年12月在我院接受KD添加治疗的20例癫痫性痉挛患儿,总结其临床特点,并临床随访。结果20例癫痫性痉挛患儿,男14例,女6例,年龄10个月至8岁2个月,＜1岁2例,～3岁10例,～6岁5例,＞6岁3例。隐源性癫痫12例,围生期脑损伤6例,先天性脑发育畸形及重症病毒性脑炎后遗症各1例。20例患儿均以痉挛发作为主要发作形式,其中7例患儿同时伴随其他发作形式,包括部分性发作泛化全身、阵挛发作、强直发作、不典型失神、不典型失神持续状态。19例患儿诊断为婴儿痉挛症或晚发性癫痫性痉挛,1例诊断为Lennox-Gaustaut综合征。20例患儿病程最短11 d,最长7年9个月。1例患儿因口服抗癫痫药物后短期（11 d）出现较严重肝功损害,予KD治疗,余患儿均为难治性癫痫。20例患儿中6例完全缓解,占30％,1例患儿癫痫发作明显改善,达Engel分级Ⅱ级。12例患儿大运动能力进步,6例患儿同时出现语言能力进步。主要不良反应为消化道症状和代谢紊乱,均较轻微,无严重不良反应。治疗疗程＞6个月者8例,其中4例仍继续治疗,其余12例因短期治疗无效、饮食不耐受、腹泻、治疗过程中饮食控制欠佳及复发等原因终止治疗。结论 KD添加治疗对癫痫性痉挛治疗有效,短期内尚未观察到严重不良反应。还需要加强长期管理,改善饮食配方,提高优质脂肪比例,对更大样本进行更长时间临床观察,为癫痫性痉挛患儿提供更好的治疗方案及更多治疗选择。     

Clinical Study of Epileptic Children with Frequent Seizures

The subjects were 98 children with an average age of 5.8 years. The frequent seizures were categorized into the following three modes: (1) seizures occur more than five times a day; (2) 1 -4 seizures occur every day for one week or more; (3) 1 -4 seizures a day occur weekly for one month or more. The incidence of each mode was as follows: (1) 15.3%; (2) 16.3% (3) 173% (1) + (2) 43.9% etc. We observed frequently the cases of tonicclonic seizures in mode (l), infantile spasms (IS) in mode (2), simple partial seizures (SPS) in mode (3), and minor seizures, IS, and Lennox-Gastaut syndrome (LCS) in mode (1) + (2). Abnormal CT findings were observed in 37.8%. Of all the patients, 33.7% indicated a developmental quotient (DQ) or intelligence quotient (IQ) above 80, and 31.6% showed a DQ or IQ under 30. Of 96 patients followed for the past one year or more, 32.3%, consisting mainly of the cases with absence seizures and IS, had been seizure-free for at least one year; 60.4% including the cases with LGS, SPS, etc., still had seizures.     

Maternal postpartum behaviors and mother-infant relationship during the first year of life

OBJECTIVE: To assess the hypothesis that maternal postpartum behaviors toward the newborn may predict the quality of the maternal-infant relationship during the first year. DESIGN: Prospective, non-randomized, longitudinal cohort study of 174 maternal-infant dyads. METHODS: A Postpartum Parenting Behavior Scale (PPBS) was formulated to measure clearly defined observed maternal behaviors toward the infant shortly after birth. The quality of the maternal-infant relationship was assessed at 6 months after birth with the Nursing Child Assessment Satellite Training (NCAST) Feeding Scale and at 12 months after birth with the NCAST Teaching Scale and Ainsworth Strange Situation. RESULTS: The PPBS score correlated significantly with the Feeding Scale score (r =.27, P <.005) and with the Teaching Scale score (r =.23, P <.01). Mothers whose infants were later classified as securely attached in the Ainsworth Strange Situation had higher PPBS scores than mothers of infants classified as insecurely attached (mean +/- SD: 5.18 +/- 1.51 vs 4.63 +/- 1.69, respectively, P <.05). In regression models adjusting for social and demographic factors, the PPBS remained a significant predictor of the Feeding Scale score, the Teaching Scale score, and security of attachment. CONCLUSIONS: Maternal behaviors in the immediate postpartum period may aid in predicting quality of the maternal-infant relationship during the subsequent 12 months, suggesting the potential for early identification of suboptimal parenting.     

Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants

OBJECTIVE: To test the efficacy and safety of long-chain polyunsaturated fatty acid (LCPUFA) supplementation with gamma-linolenic acid, a precursor of arachidonic acid, and docosahexaenoic acid in preterm infants. STUDY DESIGN: Preterm (<35 weeks, < or =2000 g birth weight) infants (n=238) randomly assigned to unsupplemented or LCPUFA-supplemented formula to 9 months after term. The main outcome measure was the Bayley Mental and Psychomotor Indexes (MDI, PDI) at 18 months after term. Safety outcome measures were anthropometry (9 and 18 months), feed tolerance, infection, and clinical complications. RESULTS: There were no significant differences in neurodevelopment between groups overall. In preplanned subgroup analyses, LCPUFA-supplemented boys had significantly higher Bayley MDI than did control boys (difference, 5.7 points; 95% CI, 0.3 to 11.1; P=.04). LCPUFA-supplemented infants showed significantly greater weight gain (difference, 310 g; 95% CI, 30 to 590 g; P=.03) and length gain (difference, 1.0 cm; 95% CI, 0.02 to 1.9; P=.05) between birth and 9 months, with greater effect in boys (weight difference at 9 months, 510 g; 95% CI, 80 to 930 g; P=.02; length difference at 18 months, 1.8 cm; 95% CI, 0.1 to 1.8; P=.03). CONCLUSIONS: This trial, using the strategy of providing gamma-linolenic acid as a source of arachidonic acid, showed efficacy for growth and for neurodevelopment in boys, with no adverse effects. These data have important implications for LCPUFA-supplementation strategy in preterm infants.     

Infants with colic have a normal sleep structure at 2 and 7 months of age

OBJECTIVE: To compare nighttime sleep structure between infants with colic and a control group. STUDY DESIGN: Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age. RESULTS: Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003). CONCLUSION: Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.     

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目的探讨晚发型癫痫性痉挛患儿的临床和脑电图(EEG)特征、治疗反应及预后。方法对北京大学第一医院儿科2000年6月至2007年8月59例晚发型癫痫性痉挛患儿的临床和EEG资料进行回顾性研究,其中37例有随访,随访时间13～90个月,末次随访年龄为2岁6个月至12岁2个月(中位数60个月)。结果59例患儿癫痫起病年龄为12～98个月,中位年龄22个月。以痉挛发作起病36例(61.0%),以其他发作类型起病23例(39.0%)。17例(28.8%)在病程中有部分性发作,22例(37.3%)合并其他全面性发作形式,20例(33.9%)病程中仅有痉挛发作。EEG14例(23.7%)为典型高度失律;2例(3.4%)为一侧性高度失律;43例(72.9%)无典型的高度失律。总计22例(37.3%)表现为局灶性或一侧性临床、影像学和(或)EEG异常。44例(74.6%)为症状性癫痫,围生期脑损伤、中枢神经系统感染、脑结构异常为主要病因。14例(23.7%)符合晚发型West综合征,7例(11.9%)符合Lennox-Gastaut综合征。促肾上腺皮质激素(ACTH)治疗后近期无发作率32.0%,有效率58.0%,复发率为61...     

Efficacy of albendazole and short-course dexamethasone treatment in children with 1 or 2 ring-enhancing lesions of neurocysticercosis: a randomized controlled trial

OBJECTIVE: To determine the efficacy of albendazole plus dexamethasone in children with 1 or 2 ring-enhancing lesions (by computed tomography scan) on resolution of lesions and recurrence of seizure. STUDY DESIGN: Randomized controlled open trial. METHODS: Children of either sex, 1 to 14 years of age, with seizures and 1 or 2 ring-enhancing lesions <20 mm in diameter on computed tomography scan, likely to have neurocysticercosis, were assigned to treatment l groups. Children assigned to the treatment group (n=61) were given 0.15 mg/kg per day dexamethasone for 5 days plus 15 mg/kg per day albendazole for 28 days, starting on the third day of dexamethasone. Control group (n=62) children were given neither dexamethasone or albendazole. Anti-epileptic therapy was given to both the study groups. RESULTS: The lesions resolved completely or partially in more children in the treated group compared with the control group (79% versus 57%; P=.02). The proportion of children who had seizures was significantly lower in the treated group compared with the control group at 3 months (10% versus 32%; P=.006) and 6 months (13% versus 33%; P=.03). CONCLUSIONS: Albendazole plus dexamethasone increased complete or partial resolution of lesions and reduced the risk of subsequent recurrence of seizures among children with neurocysticercosis who had with seizures and 1 or 2 ring-enhancing lesions on computed tomography.     

Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy

Aim: To study the difference between pyridoxine (PN) and its active form, pyridoxal phosphate, (PLP) in control of idiopathic intractable epilepsy in children. Methods: Among 574 children with active epilepsy, 94 (aged 8 months to 15 years) were diagnosed with idiopathic intractable epilepsy for more than six months. All received intravenous PLP 10 mg/kg, then 10 mg/kg/day in four divided doses. If seizures recurred within 24 hours, another dose of 40 mg/kg was given, followed by 50 mg/kg/day in four divided doses. For those patients whose seizures were totally controlled, PLP was replaced by the same dose of oral PN. If the seizure recurred, intravenous PLP was infused followed by oral PLP 50 mg/kg/day. Results: Fifty seven patients had generalised seizures (of whom 13 had infantile spasms) and 37 had focal seizure. Eleven had dramatic and sustained responses to PLP; of these, five also responded to PN. Within six months of treatment with PLP or PN, five of the 11 patients were seizure free and had their previous antiepileptic medicine tapered off gradually. Two were controlled with pyridoxine and the other three needed PLP to maintain seizure freedom. The remaining six responders needed PLP exclusively for seizure control. Six of the 11 responders to PLP had infantile spasms (46%); four of them needed PLP exclusively. The other five responders were in the remaining 81 patients with other seizure type. Conclusions: PLP could replace PN in the treatment of intractable childhood epilepsy, particularly in the treatment of infantile spasms.     

Lower concentration of pulmonary hepatocyte growth factor is associated with more severe lung disease in preterm infants

OBJECTIVES: Hepatocyte growth factor (HGF) participates in normal lung development and in regeneration after lung injury in animals. We studied the role of HGF during the perinatal period and in the development of bronchopulmonary dysplasia (BPD). STUDY DESIGN: HGF was measured in 172 tracheal aspirate fluid samples (TAF) from 17 preterm infants in whom BPD subsequently developed (gestational age, 27.2+/-1.7 weeks; body weight, 828+/-210 g) and from 15 who survived without BPD (gestational age, 26.8+/-1.9 weeks; body weight, 994+/-265 g) during the first 2 postnatal weeks. RESULTS: Infants with subsequent development of BPD had lower HGF in TAF (45+/-9 pg/mL per IgA-sc) than those surviving without BPD (102+/-32 pg/mL per IgA-sc; P=.028). Lower HGF in TAF were seen in infants with more severe acute respiratory distress as defined as requirement for surfactant therapy (50+/-14 vs 146+/-50 pg/mL per IgA-sc in infants requiring no surfactant; P=.0001), for higher number of surfactant doses (r=-0.16, P=.06), and for mechanical ventilation >1 week (167+/-51 vs 51+/-14 pg/mL per IgA-sc in infants intubated <1 week; P=.0012). CONCLUSIONS: These data show an association between lower HGF concentration in TAF and more severe lung disease in human preterm infants in the early neonatal period.