Topiramate
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Necrotising enterocolitis: case report A 32-day-old male neonate developed necrotising enterocolitis (NEC) during treatment with topiramate for seizure. The neonate, who was born by caesarean section after 35 weeks of gestation. He was intubated due to meconium aspiration and hypoxic-ischaemic encephalopathy. He received hypothermia treatment for three days. At 11 days of age, he was started on unspecified antibiotic treatment due to sepsis. At 14 days of age, he developed seizure and hence, phenobarbital was given and later, at 18 days of age, he was sent to hospital for nasal continuous positive airway pressure support. An EEG showed epileptiform activity. Therefore, due to the persistence of epileptiform activity on EEG, phenobarbital was stopped, and on postnatal day 23, he was started on treatment with topiramate 1 mg/kg/day [route not stated]. Three days later, it was increased to 2 mg/kg/day, then 3 mg/kg/day on day 28, and on day 29, it was increased to 4 mg/kg/day. On the following day, he was intubated due to respiratory depression and apnoea. In view of sepsis, broad spectrum antibiotic treatments comprising meropenem, vancomycin, amikacin were given. He was fed enterally. On day 32, enteral feeding was stopped due to abdominal distension and bloody stool (prediagnosis of NEC). Subsequently, total parenteral nutrition was started. A standing abdominal radiography showed dilated bowel loops and an abdominal ultrasonography revealed mild intestinal wall thickening. In view of persistence of bloody stools, it was suspected that topiramate may cause NEC. Hence, the neonate was treated with levetiracetam, and topiramate was tapered and eventually, discontinued on day 42. Then, levetiracetam dose was increased. On postnatal day 46, his condition improved and enteral feeding was restarted. His antibiotic treatment was completed. On day 60, a repeat EEG showed no epileptiform activity. Laryngoscopic examination showed no stenosis in the respiratory tract. With the diagnosis of chronic lung disease, the mechanical ventilator remained continued, and subsequently, tracheostomy was performed. Later, he was switched to home-type mechanical ventilation and was discharged on day 73. Kayki G, et al. Yenidoganda topiramat kullanimi sonrasi nekrotizan enterokolit: Bir vaka takdimi. Cocuk Sagligi ve Hastaliklari Dergisi 62: 14-16, No. 1, 2019. Available 803498638 from: URL: http://www.cshd.org.tr/abstract.php?id=1586 [Turkish; summarised from a translation]
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Reactions 29 Aug 2020 No. 1819
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