Comparing the Efficacy and Safety of Levetiracetam Versus Phenytoin for Treating the Acute Phase of Neonatal Seizures

  Objectives Neonatal seizure is a significant problem in this life course, and its timely and effective treatment is crucial. In this study, we compared the efficacy of levetiracetam versus phenytoin for treating the acute phase of neonatal seizures. Materials & Methods In this single-blind case-control study, 60 consecutive children with neonatal seizures referred to the Children’s medical center in Tehran, Iran, in 2018 were studied. Those neonates who had at least 30 minutes of seizure after Phenobarbital treatment were assigned to receive either phenytoin (20 mg/kg) or levetiracetam (initial dose of 40-60 mg/kg) through block randomization. The efficacy and safety of the two drugs were compared between the groups. Results The response rate was 83.3% and 86.7% in phenytoin and Levetiracetam groups, respectively, which was not significantly different between groups (P=1.000). Adverse effects were nearly similar between groups (6.7% in the phenytoin group and 3.3% in the Levetiracetam group, P=1.000). ConclusionLevetiracetam and phenytoin are both practical and safe for treatingneonatal seizures

Comparison of 2 Methods of Light Reduction on Preterm Infants" Sleep Pattern in NICU: A Randomized Controlled Trial

Objectives: Growth and development of preterm infants may be negatively affected by constant bright light in neonatal intensive care units ( NICUs ). It may also contribute to sleep pattern disorders commonly seen in in this group of infants. Reducing exposure to light by covering the incubators is recommended by guidelines of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP). Materials and Methods: This randomized clinical trial study was performed on 60 preterm infants with gestational age of 28-32 weeks admitted at NICU of Al-Zahra Teaching Hospital of Tabriz University of Medical Sciences in 2014. Preterm infants were divided randomly in 2 groups: In the first group (intervention), incubators were covered with a thick cover and the face was covered with a cloth (face cover). In the second group (observation), incubators were covered with a thick cover but the face was not covered. We darkened the environment of NICU by closing the curtain and turning off additional florescent lights from 19:30 pm till 7:30 am in both groups, then we compared sleep pattern in 2 groups of infants by using sleep diagram. Results: In the intervention group (face cover), the mean frequency of sleep during the 6 days increased by 2.96 times/observations and the mean amount of sleep increased by 59 minutes. Conclusion: This study showed that light reduction with incubator covers and eye shield, increases the frequency and sleep duration in premature infants

Clinical Risk Factors for Early-Onset Sepsis in Neonates: An International Delphi Study

Background: Despite growing evidence, there is still uncertainty about potentially modifiable risk factors for neonatal early-onset sepsis (EOS). This study aimed to identify potential clinical risk factors for EOS based on a literature review and expert opinions. Methods: A literature search was conducted in PubMed (MEDLINE), Cochrane, Embase, and Scopus databases. Articles in English, published up to May 2021, on clinical risk factors for neonatal EOS were included. Initially, a questionnaire on risk factors for EOS was developed and validated. The fuzzy Delphi method (FDM) was used to formulate the final version of the questionnaire. The validity of the risk factors was assessed using the Chi square test. P<0.05 was considered statistically significant. Results: In the review phase, 30 risk factors were approved by two neonatologists and included in the FDM phase. In total, 25 risk factors met the consensus criteria and entered the validation phase. During the observational study, 114 neonates (31 with and 83 without EOS) were evaluated for two months. The results of the Chi square test showed that cesarean section was not a significant risk factor for EOS (P=0.862). The need for mechanical ventilation and feed intolerance was observed in about 70% of neonates with EOS, and therefore considered significant risk factors for EOS (P<0.001). Finally, 26 potential clinical risk factors were determined. Conclusion: Neonatal-related risk factors for EOS were birth weight, one-min Apgar score, and prematurity. Maternal-related risk factors were gestational age and urinary tract infection. Delivery-related risk factors were premature rupture of membranes, chorioamnionitis, and intrapartum fever

National Minimum Data Set for Antimicrobial Resistance Management: Toward Global Surveillance System

Background: Success of infection treatment depends on the availability of accurate, reliable, and comprehensive data, information, and knowledge at the point of therapeutic decision-making. The identification of a national minimum data set will support the development and implementation of an effective surveillance system. The goal of this study was to develop a national antimicrobial resistance surveillance minimum data set. Methods: In this cross-sectional and descriptive study, data were collected from selected pioneering countries and organizations which have national or international antimicrobial resistance surveillance systems. A minimum data set checklist was extracted and validated. The ultimate data elements of the minimum data set were determined by applying the Delphi technique. Results: Through the Delphi technique, we obtained 80 data elements in 8 axes. The resistance data categories comprised basic, clinical, electronic reporting, infection control, microbiology, pharmacy, World Health Organization-derived, and expert-recommended data. Relevance coding was extracted based on the Iranian electronic health record coding system. Conclusion: This study provides a set of data elements and a schematic framework for the implementation of an antimicrobial resistance surveillance system. A uniform minimum data set was created based on key informants’ opinions to cover essential needs in the early implementation of a global antimicrobial resistance surveillance system in Iran

A five‐day‐old child with lipid hemihypertrophy: A case report

Key Clinical Message Lipid hemihypertrophy should be considered in the differential diagnosis of neonatal asymmetry. Early recognition and further evaluation for associated disorders are important for appropriate management and surveillance of potential complications. Abstract We present the case of a 5‐day‐old female neonate who presented with a visibly enlarged right thigh, right labia majora, and below the right mandible. This case report highlights the importance of early identification, comprehensive evaluation, and multidisciplinary management in neonates with lipid hemihypertrophy to optimize their long‐term outcomes and quality of life

Causes of Neonatal Mortality in the Neonatal Intensive Care Unit of Taleghani Hospital

Background: Neonatal survival is one of the most important challenges today. Over 99% of neonatal mortalities occur in the developing countries, and epidemiologic studies emphasize on this issue in the developed countries, as well. In this study, we attempted to investigate the causes of neonatal mortality in Taleghani Hospital, Tabriz, Iran.Methods: In this cross-sectional study, we studied causes of neonatal mortality in neonatal intensive care unit (NICU) of Taleghani Hospital, Tabriz, Iran, during 2013-2014. Data collection was performed by the head nurse and treating physician using a pre-designed questionnaire. Most of the data were extracted from the neonatal records. Information regarding maternal underlying diseases and health care during pregnancy was extracted from mothers' records.Results: A total of 891 neonates were admitted to NICU of Taleghani Hospital of Tabriz, Iran, during 2013-2014, 68 (7.5%) of whom died. Among these cases, 37 (%54.4) were male, 29 (29.4%) were extremely low birth weight, and 16 (23.5%) weighed more than 2.5 kg. The main causes of mortality were congenital anomalies (35.3%), prematurity (26.5%), and sepsis (10.3%), respectively.Conclusion: Congenital anomaly is the most common cause of mortality, and the pattern of death is changing from preventable diseases to unavoidable mortalitie

Clinical outcomes of high-risk infant follow-up program in a tertiary care centre

Background: High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran. Materials and Methods: In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis. Results: From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs. Conclusions: Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development

Peritoneal Dialysis in Neonates: A Five-Year Experience

Background: Peritoneal dialysis is an applicable method for children and even neonates. Moreover, it allows the quiet excretion of fluid and soluble substances without hemodynamic instability. Peritoneal dialysis can be continued easily in hospitalized infants. However, the question is whether peritoneal dialysis is an effective procedure to replace hemodialysis in neonates or not?Methods: The population of this study included all neonates who were admitted to the Neonatal Intensive Care Unit of Children's Medical Center Hospital, Tehran, Iran, and underwent peritoneal dialysis during 2012-17. The data were collected using a questionnaire. Subsequently, the underlying diseases, complications, and laboratory changes were determined before and after peritoneal dialysis.Results: In total, 29neonates who underwent peritoneal dialysis were evaluated in this study. Peritoneal dialysis was performed on 58.6% and 41.4 % of the cases for congenital metabolic disorder and extra body fluids, respectively. Moreover, electrolyte disorders and uremia were observed in 13.7% and 13.8% of the total cases, respectively. Several indications were seen in some infants. Dialysis failure was seen in 79.3% of the cases, most of which were due to dialysis catheter obstruction; however, the mean changes in potassium, sodium, urea, creatinine, acidosis, ammonia, and phosphorus were significant72 h after dialysis.Conclusion: This study showed that peritoneal dialysis faced several failures in newborns; however, metabolic disorders, electrolyte imbalance, uremia, and extra body fluid were resolved. Moreover, it is considered a vital and effective way for the treatment of newborns, especially in low-resource countries in which hemodialysis cannot be performed easily

Relationship between serum levels of calcium, magnesium and phosphorus in infants with vitamin D deficiency

Background. The present study was conducted with the aim of investigating the relationship between vitamin D deficiency and the serum levels of calcium, magnesium and phosphorus. Methods. In this descriptive sectional study, infants who were admitted to the neonatal and NICU of Tehran Children's Medical Center Hospital with any diagnosis during 2018-2020 with vitamin D deficiency or insufficiency were included in the study. Serum levels of calcium, magnesium and phosphorus, and their relationship with vitamin D deficiency were recorded and investigated. Results. Among 400 included infants, 197 neonates (49.3%) had vitamin D deficiency and 203 (50.7%) had vitamin D insufficiency. The average serum level of vitamin D in studied infants was 11.477±3.55 ng/ml. There was no statistically significant relationship between the serum level of vitamin D in newborns and the serum levels of magnesium and phosphorus (P value = 0.118 and P value = 0.511), but there was a statistically significant relationship between the serum level of vitamin D and the serum level of calcium (P=0.0001). There was no statistically significant relationship between the level of serum vitamin D in newborns with the age and the gestational age of the newborn (P = 0.132 and P = 0.651). Still, a direct and significant statistical relationship was observed with the newborn's weight (P = 0.049). The average length of hospitalization in the examined infants was 16.39 ± 16.36 days. Pearson’s correlation coefficient indicated the presence of an inverse and significant correlation between the level of serum vitamin D in infants and the duration of hospitalization (P=0.036). In such a way with the reduction of vitamin D serum level, the time of hospitalization increased. Conclusion. This study showed a statistically significant relationship between low vitamin D serum levels with calcium serum levels. Practical Implications. In infants with low weight or hypocalcemia, there is a possibility of vitamin D deficiency. Vitamin D check is recommended to start treatment earlier and decrease the duration of hospitalization and other complications

Developing a model to predict neonatal respiratory distress syndrome and affecting factors using data mining: A cross-sectional study

Abstract Background: One of the major challenges that hospitals and clinicians face is the early identification of newborns at risk for adverse events. One of them is neonatal respiratory distress syndrome (RDS). RDS is the widest spared respiratory disorder in immature newborns and the main source of death among them. Machine learning has been broadly accepted and used in various scopes to analyze medical information and is very useful in the early detection of RDS. Objective: This study aimed to develop a model to predict neonatal RDS and affecting factors using data mining. Materials and Methods: The original dataset in this cross-sectional study was extracted from the medical records of newborns diagnosed with RDS from July 2017-July 2018 in Alzahra hospital, Tabriz, Iran. This data includes information about 1469 neonates, and their mothers information. The data were preprocessed and applied to expand the classification model using machine learning techniques such as support vector machine, Naïve Bayes, classification tree, random forest, CN2 rule induction, and neural network, for prediction of RDS episodes. The study compares models according to their accuracy. Results: Among the obtained results, an accuracy of 0.815, sensitivity of 0.802, specificity of 0.812, and area under the curve of 0.843 was the best output using random forest. Conclusion: The findings of our study proved that new approaches, such as data mining, may support medical decisions, improving diagnosis in neonatal RDS. The feasibility of using a random forest in neonatal RDS prediction would offer the possibility to decrease postpartum complications of neonatal care