Severe Apnea in a Premature Infant after Accidental Vancomycin Overdose Responsive to Treatment with Exchange Transfusion

Background: Mostly seen toxicities following vancomycin are ototoxicity and nephrotoxicity. We here report a very low birth weight preterm neonate who developed severe episodes of apnea after accidental iatrogenic vancomycin overdose, responsive to treatment with double volume exchange transfusion. Case report: A preterm neonate weighing 1380 grams received two doses of 10-fold of the normal dose of vancomycin per kg in this age group. She developed sudden onset of frequent and severe episodes of apnea, which required noninvasive ventilation. Using fluorescence polarization immunoassay, serum vancomycin level was found to be 84 μg/mL 10 hours after the last dose. The patient underwent exchange transfusion. Apnea episodes terminated 12 hours after exchange transfusion. The blood level of vancomycin decreased from 84 μg/mL before exchange to 67 μg/mL immediately post-exchange and eventually to less than 1 μg/mL in 36th hour after exchange. Discussion: Target peak concentration of vancomycin in neonates is between 20 and 40 μg/mL and trough concentration ranges from 5 to 10 μg/mL. Peak serum concentration of our patient can be back extrapolated to be about 336 μg/mL which was higher than the target level. This high plasma levels of vancomycin might be the cause of apnea in our patient as evidenced in similar reports. Conclusion: Apnea is a potential sign of vancomycin overdose in neonates and infants treated with this antibiotic. Exchange transfusion is a potential effective treatment to rapidly resolve this unwanted complication

Refractory Pseudotumour Cerebri in a Pediatric Case

Pseudotumour cerebri (PTC) is traditionally defined as increased intracranial pressure (ICP) >200 mmH(2)O with non-focal neurological findings, except the sixth-nerve palsy, and normal cerebrospinal fluid (CSF) composition without brain pathology or evidence of venous thrombosis. A 6-years-old girl was referred to our clinic for blurred vision in her left eye and a progressive headache. Her history was positive for a progressive vision loss in the left eye. Both optic disks were blurred and swollen. The opening pressure of CSF was 310 mm/ H2O. Despite the repeated lumbar punctures (LP) and medical treatment, the patient had to undergo the optic nerve sheath fenestration. A consequent shunt procedure had to be performed due to a persistently high CSF level. In this report, we emphasize that if surgical procedures can be applied earlier in refractory PTC cases, better results of visual improvement may be observed. In this report, we emphasize that early surgical treatment in refractory PTC cases results in better visual improvement

Association of CYP3A5 Expression and Vincristine Neurotoxicity in Pediatric Malignancies in Turkish Population

Pinarli, Faruk Guclu/0000-0002-3241-2478; Albayrak, Meryem/0000-0003-2711-5150WOS: 000406231400018PubMed: 28697165Vincristine is a widely used chemotherapeutic agent in the treatment of childhood malignancies. Neuropathy is the most common adverse effect. CYP3A4 and CYP3A5 enzymes of cytochrome p450 enzyme system are responsible in vincristine metabolism. Genetic polymorphism may alter the vincristine metabolism and the neurotoxicity rate. In this study, distribution of CYP3A5 alleles among Turkish children with malignancies, relation between CYP3A5 genotype and neurotoxicity rates, as well as severity and duration of neuropathy and total vincristine doses were investigated. Patient group consisted of 115 patients (age, 1 to 17 y) with acute lymphoblastic leukemia and solid tumors, who were treated with vincristine consisting chemotherapy protocols. Control group consisted of 50 children without any neurological symptom or disorders. All patient files were reviewed for presence and severeness of neurotoxicity symptoms. Blood samples were obtained and CYP3A5 genotypes were analyzed. Neurotoxicity occurred in 20.8% of patients. Although it was found to occur more frequently after 4 doses of vincristine, and rates were higher in the low-dose vincristine group suggesting other contributing factors. Although neurotoxicity rate in the CYP3A5*1/*3 genotype was 17.6%, it was 21.6% in the CYP3A5*3/*3 genotype and the difference was not statistically significant (P<0.05). This study suggested that vincristine-related neurotoxicity is dose-independent and genotype is not the only causative factor in the occurrence of neurotoxicity in these patients.Gazi University Scientific Research Projects UnitGazi University [SBE-01/2011-72]Supported by Gazi University Scientific Research Projects Unit with a project number of SBE-01/2011-72

Retrospective analysis of children with myelin oligodendrocyte glycoprotein antibody-related disorders

Background: Knowledge has been expanding on myelin oligodendrocyte glycoprotein (MOG) antibody-associated central nervous system disorders. We delineate the clinical and paraclinical findings and outcome of our pediatric patients with MOG antibody seropositive disease