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Summary Purpose: To assess the advantages of the 2001 ILAE proposed diagnostic scheme for classification of newborns with epileptic seizures over the 1989 ILAE classification. Method: Clinical features, seizure semiology and duration, neurological evaluation, ictal and interictal EEG, brain imaging and outcome at the end of the neonatal period (44 weeks post-conceptional age) of 94 newborns with EEG confirmed seizures were analyzed. The 2001 ILAE classification was applied where possible. Results: Twenty patients died before the end of the neonatal period. In the remaining patients, applying axis 3, we classified 54 newborns as having epileptic seizures that do not require a diagnosis of epilepsy; 14 as symptomatic partial epilepsy; 5 within the neonatal epileptic syndromes and one as benign neonatal seizures (NS). Axis 4 in all newborns provided a valuable tool in order to better define the individual patient. Conclusions: Compared to the 1989 ILAE classification, which allowed a syndromic diagnosis in only 6/94 patients, the remaining being classified as Epilepsies and Syndromes undetermined whether focal or generalized, the 2001 ILAE diagnostic scheme, applied at the end of the neonatal period, offers a variety of approaches to classification, allowing an early distinction between epilepsy and single or isolated clusters of seizures, with therapeutic and prognostic implications.

The early symptoms of brain dysfunction in infants born to heroin-addicted mothers were studied during the first month of life by a multimethod approach. Neurological examination and polygraphic EEG studies of sleep patterns were performed; concomitantly plasma levels of beta-endorphin and met-enkephalin were measured. Whenever possible, these parameters were correlated with each other and with the severity of the withdrawal syndrome. While the neurological examination of addicted newborns was almost negative, altered sleep cycles with a decrease in active sleep and an increase in quiet sleep were noted together with a marked increase in the plasma concentration of the endogenous opioid peptides. Furthermore, instead of reverting to the adult values (as for normal babies), the peptides remained at high levels up to the 40th day of life.

A comparative study of blood levels, kinetics of distribution in body fluids, and urinary excretion of a tetracycline derivative in newborn infants, older infants, and children is reported. Additional direct tissue measurements of the same compound in newborn and adult rabbits were also obtained. It was found that newborn differ from adult subjects in many respects as far as tetracycline pharmacology is concerned. In the early periods of life comparable doses of tetracycline on a per kilogram basis results in much higher blood levels, in lower urinary excretion, and in different concentrations in various tissues. Clinical implications of these studies are briefly discussed.

THEOPHYLLINE has been recently introduced as a treatment for apnea in premature newborn infants." Preliminary studies have revealed that in premature neonates theophylline disposition differs from that in older infants? The number of reported cases, however, is too few, and the range of pathologic conditions which may occur is too brcad to allow general deductions which could confidently be applied in clinical practice. In this study we were interested in the measurements of blood theophylline concentrations in three premature newborn infants before and after exchange transfusions. Microsamples of blood (200 to 300 t~l) were collected for theophylline assay from the umbilical artery in hepa- rinized test tubes before and 15 minutes after the exchange transfusion; all of the blood exchanged was also collected for determination of total blood theophylline. Theophylline blood levels were measured by a recently developed micromethod that consisted of a single step extraction at pH 6.0 in chloroform, evaporation, and determination of the underivatized drug on a gas-liquid chromatographic apparatus equipped with an OV-17 column and a nitrogen-phosphorus selective detector. =' The total amount of the drug cleared from the body during the procedure was calculated as the difference of the amount of theophylline in the body after transfusion substracted from that which was present before. The total amount (A,,) of theophylline in the body was calculated using the expression of Gibaldi and associates, '~ A,, = C  V~/~, where C (blood concentration) was measured and Vda was assumed to be 0.69 l/kg as reported by Aranda and associates :~ for the premature neonate. RESULTS The blood levels of theophylline before and after the exchange transfusion and the total amount exchanged are shown in Table I. Neonates 1 and 2, who had received 1 and 4 doses, respectively, had much lower theophylline blood levels than neonate 3 who had been treated for four days; it appears that the drug accumulates at this dosage schedule. The percentage of drug exchanged by the procedure ranged from 16.9 to 29.9; this is similar to the percentage estimated on theoretical calculations as being cleared from the body.