Neonatal Meningitis: Risk Factors, Causes, and Neurologic Complications

How to Cite This Article: Khalessi N, Afsharkhas L. Neonatal Meningitis: Risk Factors, Causes and Neurologic Complications.Iran J Child Neurol. 2014 Autumn;8(4): 46-50.AbstractObjectiveNeonates are at greater risk for sepsis and meningitis than other ages and in spite of rapid diagnoses of pathogens and treatments, they still contribute to complications and mortality. This study determines risk factors, causes, andneurologic complications of neonatal meningitis in  ospitalized neonates.Material & MethodsIn this descriptive, cross sectional study, we evaluated 415 neonates with sepsis and meningitis admitted to the neonatal intensive care unit at our center between 2008 and 2012. The data that was recorded was age, sex, birth weight, prenatalrisk factors, clinical features, blood and cerebrospinal fluid analysis, and brain sonographic findings and outcomes.Results Twenty patients had meningitis. Eleven cases (55%) were male. The mean age was 8. 41 days and mean birth weight was 2891.5±766 grams. Poor feeding, seizures, and tachypnea were detected in 12 (60%), 11 (55%), and 6 (30%)patients, respectively. Prenatal risk factors were prolonged rupture of membranes, maternal vaginitis, asymptomatic bacteriuria, prematurity, low birth weights, and asphyxia. Four patients had positive cerebrospinal fluid cultures with klebsiella pneumoniae 2 (50%), Enterococcus spp. 1 (25%), and Group B streptococcus 1 (25%) cases, respectively. Two cases had positive blood cultures with klebsiella pneumoniae. Neurologic complications were brain edema, subdural effusion,and brain abscesses with hydrocephaly. One neonate (5%) died.ConclusionOur study provides some information about risk factors, pathogens, and neurologic complications for neonatal meningitis. Prenatal assessments help to diagnose and reduce risk factors of this hazardous disease. ReferencesVolpe JJ. Bacterial and fungal intracranial infections. In:Neurology of the Newborn. 5th. Edition. Philadelphia, Pa: Saunders Elsevier.2008. Pp:916-56.Aletayeb M, Farajzadeh S, Dehdashtian M. Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, Iran Pediatrics International 2010; 52, 463–466.Edwards MS, Baker CJ. Sepsis in the newborn. In:  Gershon A, Hotez PJ, Katz SL, editors. Krugman’s Infectious Diseases of Children, 11th edition. Philadelphia: Mosby. 2004. Pp: 545-561Hristeva L, Booy R, Bowler I, Wilkinson AR. Prospective surveillance of neonatal meningitis. Arch. Dis. Child. 1993; 69: 14–8.Klein JO. Bacterial meningitis and sepsis. In: Remington JS, Klein JO (eds.). Infectious Diseases of the Fetus and Newborn Infant. 4th edition WB Saunders, Philadelphia, PA. 2006.Pp: 943–98.Klinger G, Chin CN, Beyene J, et al. Predicting the outcome of neonatal bacterial meningitis. Pediatrics. Sep 2000; 106(3):477-82.Tiskumara R, Fakharee SH, Liu C-Q, Nuntnarumit P, Lui K-M, Hammoud M, et al. Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed. March 2009; 94: 144-8.Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J. 2009 Jan; 28(1Suppl):S10-8.Muhe L, Tilahun M, Lulseged S et al. Etiology of pneumonia, sepsis, and meningitis in infants younger than three months of age in Ethiopia. Pediatric. Infect. Dis. J. 1999; 18(Suppl. 1): 56–61.Garges HP, Moody MA, Cotten CM, et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics. Apr 2006; 117(4):1094-100.Edwards MS. Neonatal sepsis. In Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin’s Neonatal-Perinatal Medicine. Diseases of the fetus and infant, 9th edition. Philadelphia: Elsevier Mosby.2010. Pp:806- 09.Laving AM, Musoke RN, Wasunna AO, Revathi G. Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital. East Afr. Med. J. 2003; 80:456–62.Chang Chien HY, Chiu NC, Li WC, Huang FY. Characteristics of neonatal bacterial meningitis in a teaching hospital in Taiwan from 1984–1997. J. Microbiol. Immunol. Infect. 2000; 33: 100–4.Kavuncuoglu S, Gursoy S, Turel O, Aldemir E, Hosaf E. Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis J Infect Dev Ctries 2013; 7(2):073-081.Gerdes JS Diagnosis and management of bacterial infections in the neonate. Pediatr Clin Nam. 2004; 51: 939-959.Yikilmaz A and Taylor AG. Sonographic findings in bacterial meningitis in neonates and young infants. Pediatric Radiology 2008; 38: 129-137.

Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome

How to Cite This Article: Afsharkhas L, Khalessi N, Karimi Panah M. Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome. Iran J Child Neurol. Summer 2015;9(3):34-39. AbstractObjectiveIntraventricular hemorrhage (IVH) occurs in preterm infants; however, theoccurrence of this event is less frequent in term neonates. The present studyevaluated clinical characteristics, pathophysiological features, and earlyoutcome of term neonates with IVH in a referral neonatal center in Iran.Materials & MethodsThis study was performed on 30 full-term neonates admitted to the NeonatalIntensive Care Unit (NICU) of Ali-Asghar Hospital, Tehran, Iran betweenMarch 2005 and April 2011. IVH was diagnosed using cranial ultrasonography,or brain magnetic resonance imaging (MRI).ResultsThe mean age at onset of symptoms was 3.9 days. Seizure was the commonestclinical symptoms followed by poor feeding and fever. The sources ofbleeding in the brain were choroid plexus (60%), germinal matrix (20%) andparenchyma (6.7%). Severity of bleeding included 33.3% grade I, 30.0% gradeII, 36.7% grade III to IV. Fifteen (50%) cases had coagulopathy. Twenty-five(83.3%) cases were discharged with a good condition, three (10%) cases werereferred to surgical ward and two cases (6.7%) died in NICU.ConclusionThe main source of IVH in term neonates is choroid plexus; the most commonclinical symptoms include seizure and poor feeding, and one-third of IVHevents are graded as III to IV. Most affected neonates are discharged fromNICU without CNS complication, about 10% need to refer to surgicalinterventions, and death was occurred in a few of neonates

Plasma Ammonia Levels in Newborns with Asphyxia

How to Cite This Article: Khalessi N, Khosravi N, Mirjafari M, Afsharkhas L. Plasma Ammonia Levels in Newborns with Asphyxia. Iran J Child Neurol. Winter 2016; 10(1):42-46.AbstractObjectivePerinatal asphyxia may result in hypoxic damage in various body organs, especially in the central nervous system. It could induce cascade of biochemical events leading to the cell death and metabolic changes, eventually may increase plasma ammonia levels. The purpose of this study was to determine the prevalence of hyperammonemia in neonates with asphyxia and to find the relationship between ammonia levels and severity of asphyxia.Material & MethodsIn this cross-sectional study, we included 100 neonates with perinatal asphyxia in the Neonatal Intensive Care Unit of Ali-Asghar Hospital, Iran University of Medical Science, Tehran, Iran in 2010-2011. All full term patients diagnosed of asphyxia were enrolled. The relationship between plasma ammonia levels and sex, gestational age, birth weight and severity of asphyxia were determined.Data were analyzed using SPSS software.ResultsFifty six percent of neonates were male. The mean gestational age was 38.0± 1.2 wk. Mean plasma ammonia level was 222 ± 100 μg/dl and 20% of the neonates had hyperammonemia. It was not associated with gender, gestational age, birth weight, and asphyxia severity. Six patients died and mean plasma ammonia levels was 206±122 μg/dl. In this group, there was no significant relation between plasma ammonia levels and severity of asphyxia. No significant different was seen between plasma ammonia in dead and lived neonates.ConclusionAccording to high prevalence of hyperammonemia in neonatal asphyxia, measurement of plasma ammonia levels, is suggested to improve management of asphyxia

The Prevalence of Acute Kidney Injury in Neonates with Asphyxia

Introduction: Asphyxia is a common cause of mortality and morbidity among neonates. Following severe asphyxia and ischemia, reperfusion occurs which damages vital organs like the kidneys. This study was conducted to determine the prevalence of AKI based on the definition of a serum creatinine level higher than 1.5 mg/dL, in neonates with asphyxia.Materials and Methods: This retrospective study was performed in Ali-Asghar and Shahid-Akbar-Abadi Hospitals, Tehran, Iran in a period of one year. The medical documents of all newborns diagnosed with asphyxia were studied. The asphyxia grade was determined according to the asphyxia Sarnat criteria. The kidney function was evaluated based on the serum creatinine level.Results: Thirty-eight cases met the inclusion criteria. There were 13 Sarnat grade-1 cases (34.2%), 19 grade 2 cases (50%), and 6 grade 3 patients (17.6%).  Three (7.8%) patients (2 patients in grade 3 and one patient in grade 2 of the Sarnat grading scale) developed AKI. AKI was detected in 33% of the patients in grade 3 and 5.2% of the patients in grade 2 of the Sarnat grading scale. Nine patients (23%) died, of whom 83% were in grade 3 and 16.9% in grade 2 of asphyxia.Conclusions: AKI developed in 7.8% of the cases, of whom 33% were in grade 3 and 5.2% were in grade 2 of the Sarnat grading scale. The low rate of AKI development in our study might be duo to the small sample size and patient mortality in the first 3 days of life.Keywords: Acute kidney injury; Neonates; Asphyxia

The Relationship between Maternal Vitamin D Deficiency and Low Birth Weight Neonates

Objective:Maternal hypovitaminosis D may impair fetal growth and cause adverse pregnancy outcomes including intrauterine growth restriction and neonatal low birth weight. The aim of this study is to evaluate the relationship between maternal vitamin D status and neonate’s birth weight. Materials and methods:A cross-sectional, descriptive analytical study was carried out in the nursery ward of 2 hospitals (Tehran-Iran) during one year (January 2011- January 2012). One hundred and two neonates were categorized into two groups, neonates with birth weight2500 gr (n=50). Data regarding medical history, physical examination and anthropometric measurements of neonates were noted in a questionnaire. Birth time blood samples of their mothers were analyzed for serum 25-(OH)-vitamin D by ELISA method. Maternal vitamin D status was compared in two groups. Results:Mean maternal vitamin D (vit D) level was 31.46 nmol/L. Forty eight percent of mothers had vitamin D deficiency, 27.5% had vit D insufficiency and 24.5% were normal. Mean maternal vitamin D level of LBW neonates was lower than other group; 25.05 vs. 38.13 (p= 0.001). All mothers of neonates with head circumference ≤ 33 cm also had vitamin D deficiency (p= 0.007). Conclusion:Maternal Vitamin Ddeficiency may increase the risk of low birth weight neonate and modifying maternal nutrition behavior and their vit D level could be beneficial on pregnancy outcome

Risk Factors of Intracranial Hemorrhage in Premature Neonates

Intraventricular hemorrhage (IVH) is an important cause of brain injury in premature neonates. Current study tries to define associated risk factors of IVH in preterm neonates in Aliasghar Children Hospital during 2008 to 2011. In this study, the risk factors have been evaluated in premature neonates with IVH, who had at least one brain sonography since their admission in NICU. A total of 63 premature neonates with IVH were assessed. Mean gestational age was 29.81 (24-34) weeks and mean birth weight was 1290.83±382.96 gr. Other risk factors such as sex, mode of delivery, history of using infertility drugs, maternal disease, maternal hypertension and preeclampsia, lumbar puncture, ventilator therapy and pneumothorax were considered. Because no absolute treatment for IVH is available, identifying risk factors is important in prevention and management of IVH

The Effects of Pre-feeding Oral Stimulations and Non-nutritive Sucking on Physical Growth and Independent Oral Feeding of Preterm Infants

Background: Breastfeeding failures and oral feeding problems in preterm infants result in long-term health complications. In this study, therefore, we aimed to evaluate the effect of oral stimulation along with non-nutritive sucking (NNS) on independent oral feeding initiation and weight gain in preterm infants. Methods: This prospective randomized clinical trial was carried out at Aliasghar Hospital in Tehran, Iran, 2014. A total of 50 26-32 weeks gestational age hospitalized infants, who were fed through tubes, were recruited in the study. The newborns were randomized into A, B and C groups. In the A and B groups, the neonates were stimulated through oral stimulation as well as non-nutritive sucking for 5 or 10 days, while in the group C, no especial intervention was performed. Infants' mean daily weight gain, the number of days until initiation of oral feeding, oral feeding progression, the number of days until reaching full oral feeding and date of discharge were recorded. The obtained data were analyzed and compared in the three groups using SPSS version 16.0. Results: Of all the participants, 25 cases (55.55%) were male. Mean gestational age at birth and mean birth weight were 28.64±1.93 weeks and 1337.11±185.07 grams, respectively. In the group A, newborns' weight at reaching four and eight oral feedings per day and their weights at discharge were significantly higher than the other two groups (P=0.016, 0.001 and 0.001, respectively). Mean daily weight gain in the group A was higher (84.2850 g) than the other groups (69.5814 vs. 64.2677 g). However, ANOVA results showed that this difference was not significant (P=0.108). Moreover, independent samples t-test indicated that this difference between groups A and C was significant (P=0.049). Conclusion: In clinically stable preterm neonates, oral stimulation and should be implemented to increase their weight; however, further studies are required to address this issue

Prevalence of Meningitis among Hospitalized Neonates with Urinary Tract Infection

Background: Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI.Methods: This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged Results: A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54% of the neonates were male. Out of all neonates, 23 (14.1%) cases had positive blood culture. The positive CSF culture was observed in only two (1.2%) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50% of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50% and 24.2%, respectively; P=0.432).Conclusion: The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2%. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results