Neonatal seizure and short-term outcomes in hospitalized neonates

Background: Neonatal seizure is a common problem and associated with a great mortality rate, high risk of chronic neurodevelopmental impairments, also difficult to diagnosis and treatment. The aim of this study was to determine the neurodevelopmental outcome, clinical presentation and etiology of seizures in neonates admitted to Amirkola Children's Hospital (ACH). Methods: In this cross-sectional study, 42 neonates with the initial diagnosis of seizure, aged less than 28 days, hospitalized in ACH, northern Iran, from April to September 2016 were selected using convenient sampling method. The patients' information was gathered during hospitalization period and 6 months after discharge. Data were analyzed using SPSS 22 through descriptive and chi-square tests. Results: Among preterm and term neonates with seizures, the main diagnosis in neonates with seizures was idiopathic (38.1%) and hypoxic-ischemic encephalopathy (HIE) (14.3%), hypoglycemia (9.5 %) hypomagnesaemia (7.1%) and opiate withdrawal (4.8%). Twenty-three neonates underwent brain computed tomography (CT) scan and 6 (14.3%) of them had abnormal brain imaging. Seizure control with antiepileptics (P=0.006), metabolic disturbance (P=0.002) and time of drug discontinuation (P<0.001) were significantly associated with adverse neurodevelopmental outcome. Conclusions: Since idiopathic encephalopathy and HIE were the most common cause of neonatal seizures, it should be attempted to improve care during delivery

Neonatal seizure and short-term outcomes in hospitalized neonates

Background: Neonatal seizure is a common problem and associated with a great mortality rate, high risk of chronic neurodevelopmental impairments, also difficult to diagnosis and treatment. The aim of this study was to determine the neurodevelopmental outcome, clinical presentation and etiology of seizures in neonates admitted to Amirkola Children's Hospital (ACH). Methods: In this cross-sectional study, 42 neonates with the initial diagnosis of seizure, aged less than 28 days, hospitalized in ACH, northern Iran, from April to September 2016 were selected using convenient sampling method. The patients' information was gathered during hospitalization period and 6 months after discharge. Data were analyzed using SPSS 22 through descriptive and chi-square tests. Results: Among preterm and term neonates with seizures, the main diagnosis in neonates with seizures was idiopathic (38.1) and hypoxic-ischemic encephalopathy (HIE) (14.3), hypoglycemia (9.5 ) hypomagnesaemia (7.1) and opiate withdrawal (4.8). Twenty-three neonates underwent brain computed tomography (CT) scan and 6 (14.3) of them had abnormal brain imaging. Seizure control with antiepileptics (P=0.006), metabolic disturbance (P=0.002) and time of drug discontinuation (P&#60;0.001) were significantly associated with adverse neurodevelopmental outcome. Conclusions: Since idiopathic encephalopathy and HIE were the most common cause of neonatal seizures, it should be attempted to improve care during delivery

Near-fatal drug toxicities in newborn babies: A Case Series

Background: Neonates are highly vulnerable to drug toxicities because of their age-related limitations in drug metabolisms and renal excretion. Lack of the knowledge and/or education for medical professionals about the right dose administration and the lack of neonate-specific formulations are the additional dilemmas. Cases Presentation: Here, we reported six neonates presented with severe drug toxicities, including acetaminophen, digoxin, theophyllin, lidocaine and opium and they were successfully treated in NICU at Amirkola Children’s Hospital, Babol– in the north of Iran. Most of the toxicities were originated from the lack knowledge of physician or parents for selecting the right drug and dose of drug for newborn babies. Conclusions: Better education of medical professional and parents are needed to avoid neonatal drug toxicities

Effect of Probiotics on Serum Bilirubin Level in Term Neonates with Jaundice; A Randomized Clinical Trial

Background In recent years, tendency to use drugs has been increasing in the treatment of neonatal jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL) is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of phototherapy in term neonates with hyperbilirubinemia. Materials and Methods: In this randomized clinical trial, we studied 150 term neonate with jaundice hospitalized for phototherapy in Amirkola Children’s Hospital, Babol- Iran, during October 5, 2016 till May 19, 2017. Eligible neonates were randomly divided into two; intervention (n=75), and control (n=75) groups. Both groups received standard conventional phototherapy, but the intervention group received 10 drop/day of probiotics (Pedilact Zisttakhmir. Co. Iran), until hospital discharge. The outcome variables were SBL and the duration of phototherapy. The data was analyzed by SPSS 22.0 and   the P 0.05.After 24, 48 and 72hours it decreased to 13.73±1.72, 10.92±1.87 and 10.25±1.32 in the intervention and 13.66±1.91, 11.01±1.69 and10.09 ±1.38 in the control groups, respectively but comparison of the amount of SBL reduction  between the two groups was not significant (P>0.05). The duration of phototherapy in the intervention group and the control group was 3.61±1.17 days and 3.72±1.18 days respectively (P>0.05). Conclusion Oral probiotics in neonates with jaundice has no significant effect on SBL and the duration of phototherapy. Further studies are needed to with longer time follow-up

Prophylactic oral probiotic on prevention of feeding intolerance in Very Low Birth Weight (VLBW) neonates: Randomized Clinical Trial

Background: Feeding intolerance is prevalent in very low birth weight (VLBW) neonates and is a barrier for better and faster growth in these neonates. Some studies have supported the administration of oral probiotic to decrease feeding intolerance. The aim of this study was to evaluate the effect of probiotic on feeding intolerance in VLBW neonates. Methods: This randomized clinical trial study was conducted on 60 VLBW neonates who were randomly divided into two equal groups. In the case group, the infants received probiotic in addition to routine therapy. Duration of hospitalization, time to reach to full enteral feeding and birth weight, the numbers of vomiting and defecation, c-reactive protein rising, daily weight gain were compared between two groups. Results: No significant differences were observed between two groups in regard with gender, birth weight, method of delivery and gestational age. Mean of duration of hospitalization was 42.27 and 31.6 days in control and drug groups, respectively and there was significant difference (P-value=0.005). There was no significant difference between two groups in terms of reaching full enteral feeding, the numbers of vomiting and defecation, time to reach to birth weight, CRP rising and daily weight gain but these results were better in probiotic group. Conclusions: This study showed that prophylactic administration of probiotic had significant role in reducing the duration of hospitalization of VLBW neonates and was effective in reaching full enteral feeding. It is suggested that the administration of probiotic can be helpful for feeding tolerance in VLBW neonates

Evaluation of the first day transcutaneous bilirubin (TcB) level as a predictor of hyperbilirubinemia in healthy term neonates

Background: The readmission rate for neonatal jaundice has been increased in recent years. This has been attributed to shorter length of postpartum hospital stays without comprehensive follow-up. The purpose of this study was to determine the diagnostic value of pre-discharge transcutaneous bilirubin (TcB) levels for prediction of subsequent hyperbilirubinemia in healthy term neonates. Methods: Between October and December 2013, a total of 99 healthy term neonates born at the Babol Clinic Hospital of healthy mother were enrolled in a prospective cross sectional study. The TcB levels were measured in all enrolled neonates between 12 and 24 hours of age just before discharge. All newborns were followed-up for jaundice to 10th day. Newborns with clinical jaundice were recalled and their serum bilirubin levels were measured. Appropriate treatment was performed based on the Amirkola Children's Hospital Protocol. TcB levels were compared between the non-treatment and treatment groups. Results: The mean age of the TcB measuring was 17.5±2.6 hours. A total of 18.1% neonates (18 of 99) were developed severe hyperbilirubinemia (need for treatment). The mean of cutaneous bilirubin level in the non-treatment and treatment groups was 5.2±1.6mg/dl and 6.3±0.9 mg/dl, respectively. The cutaneous bilirubin level at cut-off 6 mg/dl was associated with 80.0% sensitivity and 63.0% specificity. The negative predictive value was 94.6%. Conclusion: Single TcB measurements at the first 24 hours predict hyperbilirubinemia with a reasonably high degree of accuracy

Comparing the Hospital Costs of the Neonates Admitted to NICU of Amirkola Children's Hospital Before and After the Implementation of the Health Sector Reform in Iran

Background: The cost-effective strategies are of paramount importance in the improvement of neonatal health services. Regarding this, the present study aimed to evaluate the health sector reform of the Islamic Republic of Iran and its impact on hospital costs related to the admission of neonates in Amirkola Children's Hospital.Methods: This observational analytic study was conducted in 2015 to evaluate the hospital records of all neonates admitted to Amirkola Children's Hospital during late 2013 (before the implementation of health sector reform in Iran) and late 2014 (after the implementation of this reform).Results: According to the results, the number of the neonates admitted to this center has increased by 11% after reform. Furthermore, the mean total hospital cost and share of insurance organizations have elevated by 2.2 and 2.5 fold, respectively. Mean of the cost paid by the patients has reached to 2.7 million Rials, which has had a 33% decrease, compared to that of the pre-reform stage. Additionally, 5.8% of the total expenditures related to neonatal inpatient cares were paid out-of-pocket.Conclusion: As the findings of the present study indicated, the health sector reform in Iran has increased the rate of neonatal admission and decreased the amount of direct payment by the people

Effect of antenatal steroid before elective cesarean section on prevention of respiratory morbidities of full-term neonates

Background and Objective: Elective cesarean section (ECS) increases neonatal respiratory complications like transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS). This pilot study examined the effect of antenatal steroids on the prevention of respiratory problems in full-term neonates born via ECS. Methods: This experimental study was carried out on full-term neonates (39-42 weeks) born by ECS to the mothers admitted to Babol Clinic Hospital, northern, Iran in 2016. The intervention group received betamethasone (12 mg, intramuscular, once a day) for 2 days before ECS plus conventional care, but the control group received only conventional care. The rate of respiratory complication and the admission rate of the newborn ward and neonatal intensive care unit (NICU) were compared between two groups. Findings: Overall, 200 full-term neonates (100 neonates in the experimental group and 100 neonates in the control group) were enrolled. Nine neonates (9) in the experimental group and 8 neonates (8) in the control group had TTN (P=0. 64), and one (1) neonate in the experimental group and one neonate (1) in the control group had RDS (P=1). Conclusion: Antenatal corticosteroid administration to the mothers before ECS with gestational ages of 39-42 weeks does not reduce the incidence of respiratory complications.&#160; Thus, further studies are needed to determined its effects in gestational age group more than 39 weeks

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens