Frequency and Causes of Hypotonia in Neonatal Period with the Gestational Age of More Than 36 Weeks in NICU of Mofid Children Hospital, Tehran, Iran During 2012-2014

How to Cite This Article: Seyed Shahabi N, Fakhraee H, Kazemian M, Afjeh A, Fallahi M, Shariati M, Gorji F. Frequency and Causes of Hypotonia in Neonatal Period with the Gestational Age of More Than 36 Weeks in NICU of Mofid Children Hospital, Tehran, Iran During 2012-2014. Iran J Child Neurol. Winter 2017; 11(1):43-49. AbstractObjectiveHypotonia is a serious neurologic problem in neonatal period. Although hypotonia is a nonspecific clinical finding but it is the most common motor disorder in the newborn. The objective of this study was to determine the frequency of neonatal hypotonia then to ascertain of the most common causes.Materials & MethodsThis cross –sectional prospective study was carried out on the 3281 term infants hospitalized in conventional and NICU of Mofid Children Hospital, Tehran, Iran during 2012-2014. Diagnosis was made by history, physical & neurological examination and accessible diagnostic tests.ResultsFifty nine hypotonic neonates were identified, forty seven (79.66%) had central hypotonia (Hypoxic ischemic encephalopathy (n= 2), other causes of encephalopathy (n=2), intracranial hemorrhage (n=4), CNS abnormalities (n= 7), chromosomal disorders (n=4), syndromic–nonsyndromic (n=8), and metabolic diseases (n=8). Peripheral hypotonic recognized in 6 infants (10.17%); spinal muscular atrophy (n= 1), and myopathy (n= 5). Six cases (10.17%) remained unclassified. Twelve infants had transient hypotonia. In final study, 18 of 59 infants (30%) died, nearly 90% before one year of age. Twenty-eight (47%) infants found developmental disorders and only 13 (22%) infants achieved normal development in their follow up.ConclusionNeonatal hypotonia is a common event in neonatal period. A majority of diagnosis is obtained by history and physical examination. Neuroimaging, genetic and metabolic tests were also important in diagnosis. Genetic, syndromic–nonsyndromic, and metabolic disorders were the most causes of neonatal hypotonia.References1.Miller VS, Delgado M, Iannaccone ST. Neonatal hypotonia Seminar in neurology 1993; 13 (1):73-83.2. Laugal V, Cossee M, MJ. de Saint –Martin A, Echaniz- Laguna A, Mandel JL, Astruc D, Messer FMJ. Diagnostic approach to neonatal hypotonia: retrospective study on144neonates.Eur J Pediatr 2008; 167:517-523.3. Birdi K, Prasad C, Chodirker B, Chudly AE, The floppy infant: retrospective analysis of clinical experience (1990-2000) in a tertiary care facility. J Chlid Neurol 2005; 20: 803-808.4. Johnston HM.The floppy weak infant revisited. Brain Dev 2003; 25:55-58.5. Crawford TO. Clinical Evaluation of the Floppy infant. Pediatric Annal 1992;16:348-354.6. Richer LP, Shevell MI, Miller SP. Diagnostic profile of neonatal hypotonia; An 11 year study. Peditric Neurol 2001; 25:32-37.7. Paro–Panjan D. Congenital hypotonia is there an algorithm. J Child Neurology 2004;19 (6):439-442. 8. Griggs RC, Mendell JR, Miller RG. Cngenital myopathies.in: Evaluation and treatment of myopathies. Philadelphia:FA Davis C; 1995:211-469. Nada Zadeh and Louanne Hudgings. The Genetic Approach to hypotonia in the neonate. NeoReviews 2009; 10; e600-e607.10. Bodenstiener JB. The evaluation of the hypotonic infant Seminar in PediatricNeurology 2008;15:10-20.11. Dubowitz V. Thomas NH. The natural history of type 1(severe) spinal muscular dystrophy. Neuromuscular Disord. 1994;4:497-50212.12. Jimenez E, Garcia – Cazoria A, Colomer J, Nascimento A, Ieiondo M, Compistol J. Hypotonia in the neonatal period: 12 years experience.[Article in Spanish] Rev Neurol 2013 Jan16:56 (2):72-8

Best Strategies against Respiratory Problems in Extremely Low Birth Weight Infants

Background Neonatology has evolved with respect to the needs of premature infants for special care. One of the major problems in premature infants is that their lungs are not developed adequately to fulfill newborns’ needs. There is a broad spectrum of strategies for management of respiratory problems in premature infants. In this study, we aimed to determine the best Strategies against Respiratory Problems in Extremely Low Birth Weight Infants. Materials and Methods  In this analytical, prospective study, we recruited 79 newborns with birth weight of less than 1000 g, who were born in Mahdieh Hospital in Tehran- Iran, during September 2011-March 2013. The newborns were divided into three groups of Supportive care (n=10), the INSURE strategy (n=17), and Mechanical ventilation (n=52) based on their needs. Survival rate and complications were evaluated among these groups. Results Gestational age ranged between 23 and 34 weeks, and birth weight ranged between 420g and 1000 g. Survival rates in the supportive care, INSURE, mechanical ventilation groups were 90%, 47.1%, and 17.3%, respectively. Gestational age and birth weight in the three groups were significantly different (

Association of umbilical cord lipid profile with gestational age and birth weight in newborns in Mahdieh Hospital in 2017

BBackground and Aim: Ischemic heart diseases are the most common cause of mortality and morbidity in developed countries. The incidence of these disorders are increasing and the age of onset is on the decrease. The prevalence of risk factors such as obesity and hyperlipidemia is on the increase among children and adolescents. Various maternal and fetal factors can affect fetal fat levels. Therefore, the present study was designed to determine the relationship of the level of umbilical cord blood lipids with gestational age and birth weight in the newborns born in Mahdieh Hospital in 2017. Material and Method: In this descriptive-analytical study we measured cord blood lipids levels of 375 newborns, born in Mahdieh Hospital in 2017. Newborns with known maternal or fetal complications were excluded from the study. Demographic, clinical and paraclinical data of the newborns and mothers were recorded in the questionnaire for every newborn and the relationship of the level of umbilical cord blood lipids (total cholesterol, VLDL, HDL, LDL, and triglyceride) with gestational age, birth weight, sex of the newborn, maternal age and BMI was evaluated. We used chi-square test to compare qualitative data and T-test, ANOVA, Kruskal-Wallis and Spearman correlation coefficient to compare quantitative data. Results: This study included 375 single-birth infants (191 girls and 184 boys). The mean umbilical cord serum values for triglyceride in the preterm and term infants were 122.2±31.2 and 97.6±31.7 (p<0.001), and for VLDL were 24.2±6.0 and 19.5±6.6 (p<0.001) respectively. The respective values for mean serum triglyceride and VLDL levels in umbilical cord blood were 126.6±34.6 and 100.1±32.6 (p=0.011) in the newborns with birth weight of less than 2500 grams. Also mean serum triglyceride and VLDL levels in umbilical cord blood were 24.9±6.7 and 19.9±6.7 (p=0.020) in the newborns with birth weight of more than 2500 gram (2500-4000 grams and higher) respectively. The respective mean levels of umbilical cord blood triglyceride were 90.8±33.0, 101.6±32.8 and 110.2±31.6 (p=0.047) for SGA, AGA and LGA newborns. Newborns of the mothers with BMI≥25 had higher levels of triglyceride, VLDL and LDL compared to the newborns of the mothers with BMI < 25. The lipid levels of umbilical cord blood had no relationship with mother’s age. We used t-test, ANOVA, Kruskal-Wallis and Spearman correlation for quantitative and chi-square test for qualitative data analysis. Conclusion: The results of this study showed that mean serum levels of triglyceride and VLDL of the umbilical cord blood is higher in the preterm newborns and newborns with birth weights of less than 2500 grams. SGA newborns had lower umbilical cord blood triglyceride levels compared to the other newborns. Newborns of the mothers with pre-pregnancy obesity had higher umbilical cord blood levels of triglyceride, VLDL and LDL. We did not find any relationship between the levels of umbilical cord blood lipids and age of the mothers

Assessment of Delivery Room Resuscitation with Different Levels and Its Related Factors in Preterm Neonates

Background: There are many known risk factors related to maternal or neonatal problems which can predict the need for resuscitation. In this study, we evaluated the resuscitation process of preterm neonates and analyzed the impact of different risk factors on the level of resuscitation required in the patients.Methods: This cross-sectional descriptive study was conducted on inborn preterm infants with a birth weight of Results: In the present study, 193 preterm neonates were evaluated. In addition, 82 (42.5%) and 110 (57%) patients were female and male, respectively. The mean values of gestational age and birth weight of the patients were 29.9±2.4 weeks and 1191.6±265.2 g, respectively. The mode of delivery in 159 (82.4%) patients was cesarean section.In the assessment of different levels of resuscitation, 84 (43.5%), 35 (18.1%), 54 (28%), 10 (5.2%), 10 (5.2%), and 9 (4.7%) neonates needed initial steps, free flow of oxygen, positive pressure ventilation, endotracheal intubation, chest compression, and drug administration, respectively. The rate of neonatal mortality was 23.8% (n=46), and hypoxic-ischemic encephalopathy was recorded in 10 (21.7%) subjects. In the evaluation of mothers, 117 (60.6%) subjects had medical problems during pregnancy. The most common problem was preeclampsia in 44 (22.8%) mothers. The lower birth weight (PConclusion: According to the obtained results, it was shown that premature neonates needed more advanced resuscitation. Therefore, improving the quality of care for mothers and neonates is necessary to obtain better outcomes. Regarding the need for noninvasive positive pressure ventilation was the second most frequent intervention, the proper use of equipment is necessary for the prevention of advanced resuscitation

Effect of Enteral Administration of Granulocyte-Colony Stimulating Factor (G-CSF) on Feeding Tolerance in Very Low Birth Weight and Extremely Low Birth Weight Neonates; a Historical-Controlled Clinical Trial

Background: The current study aimed to investigate the effect of enteral Granulocyte-Colony Stimulating G-CSF(Factor) on feeding tolerance in very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates.Methods: This historical-controlled clinical trial was conducted on VLBW and ELBW neonates admitted to MahdiehHospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, between July 2016 and March 2017.In the intervention group, 81 neonates with birth weights of 710-1480 were given enteral 5 μg/kg/day of G-CSF (whichhas been approved by the US FDA) for 7 consecutive days. On the other hand, the control group included 191 neonateswho did not receive G-CSF with birth weights of 600-1490 admitted during 24 months prior to the study. The twogroups were compared in terms of adverse effects of treatment, primary and secondary outcomes.Results: The mean of gestational age and birth weight in the G-CSF group were reported as 29.96±2.47 weeks and1204.81±201.68 grams, and these values in the control group were measured at 29.77±2.13 weeks and1189.47±207.89 grams, respectively. Neonates who received G-CSF demonstrated better feeding tolerance, asreflected by the earlier achievement of 50, 75, 100, full enteral feeding of 150, and maximal enteral feeding of 180mL/kg/day (p (NEC) in the G-CSF group was measured at 3.7% that was significantly lower, as compared to the control group(P=0.005). Approximately 8.9% of the neonates in the control group expired which was higher than the G-CSFgroup (P=0.06). All neonates tolerated the treatment and there was no statistically significant difference betweenthe two groups.Conclusion: As evidenced by the obtained results, the enteral administration of G-CSF to VLBW and ELBW neonatesimproved feeding tolerance and it was well tolerated without any associated side effects

Longitudinal Changes in the Macronutrient Contents of Breast Milk in the Mothers with Preterm Delivery

Background: Contents of breast milk may change during the first weeks after childbirth, especially in preterm deliveries. The present study aimed to determine the macronutrient contents of breast milk in the mothers with preterm delivery. Methods: This prospective-descriptive study was conducted in Mahdieh Hospital in Tehran, Iran in 2015. Participants included the mothers with preterm delivery, whose infants had a gestational age o

Comparison of Vitamin D Level in Preterm and Term Infant–Mother Pairs: A Brief Study

Background: Recent studies have demonstrated the high prevalence of vitamin D deficiency in the general population. Pregnancy and preterm delivery are known as risk factors for vitamin D deficiency. Consequently, vitamin D level in women with preterm deliveries might vary from those with term pregnancies. In this study, we aimed to compare vitamin D level in term and preterm infant–mother pairs. Methods: This cross-sectional study was conducted in the neonatal intensive care unit of Mahdieh Hospital in Tehran, Iran in 2013. Serum level of 25-hydroxy vitamin D in preterm infant-mother pairs (≤ 32 weeks of gestation and birth weight ≤ 1500 g) was compared with term infant-mother pairs within the first 24 hours after delivery. Results: In total, 62 infant-mother pairs were recruited in this study, including 33 preterm (53.2%) and 29 term (46.8%) newborns; overall, 32 (51.6%) infants were male. the mean maternal age was 27.3 years in the preterm group and 26.4 years in the term group. The mean serum vitamin D level in preterm infants was 13.91 ng/ml. In the preterm group, vitamin D level was within the range of 4-59 ng/ml in newborns and 8-62 ng/ml in mothers. In the term group, the mean vitamin D level was 13.39 in infants and 13.7 ng/ml in mothers. In total, 48.5% and 65.5% of preterm and term groups had vitamin D deficiency, respectively. Among all newborns, 56% had vitamin D deficiency, although the difference between term and preterm neonates was not statistically significant. Also, there was no significant correlation between the infants’ serum vitamin D level and birth weight. Based on the findings, serum vitamin D levels in mothers and newborns were significantly correlated (

Predicting Factors of INSURE Failure in Low Birth Weight Neonates with RDS; A Logistic Regression Model

Background:Respiratory Distress syndrome is the most common respiratory disease in premature neonate and the most important cause of death among them. We aimed to investigate factors to predict successful or failure of INSURE method as a therapeutic method of RDS.Methods:In a cohort study,45 neonates with diagnosed RDS and birth weight lower than 1500g were included and they underwent INSURE followed by NCPAP(Nasal Continuous Positive Airway Pressure). The patients were divided into failure or successful groups and factors which can predict success of INSURE were investigated by logistic regression in SPSS 16th version.Results:29 and16 neonates were observed in successful and failure groups, respectively. Birth weight was the only variable with significant difference between two groups (P=0.002). Finally logistic regression test showed that birth weight is only predicting factor for success (P: 0.001, EXP[β]: 0.009, CI [95%]: 1.003-0.014) and mortality (P: 0.029, EXP[β]: 0.993, CI [95%]: 0.987-0.999) of neonates treated with INSURE method.Conclusion:Predicting factors which affect on success rate of INSURE can be useful for treating and reducing charge of neonate with RDS and the birth weight is one of the effective factor on INSURE Success in this study

Predicting Factors of INSURE Failure in Low Birth Weight Neonates with RDS; A Logistic Regression Model

Background:Respiratory Distress syndrome is the most common respiratory disease in premature neonate and the most important cause of death among them. We aimed to investigate factors to predict successful or failure of INSURE method as a therapeutic method of RDS. Methods:In a cohort study,45 neonates with diagnosed RDS and birth weight lower than 1500g were included and they underwent INSURE followed by NCPAP(Nasal Continuous Positive Airway Pressure). The patients were divided into failure or successful groups and factors which can predict success of INSURE were investigated by logistic regression in SPSS 16th version. Results:29 and16 neonates were observed in successful and failure groups, respectively. Birth weight was the only variable with significant difference between two groups (P=0.002). Finally logistic regression test showed that birth weight is only predicting factor for success (P: 0.001, EXP[β]: 0.009, CI [95%]: 1.003-0.014) and mortality (P: 0.029, EXP[β]: 0.993, CI [95%]: 0.987-0.999) of neonates treated with INSURE method. Conclusion:Predicting factors which affect on success rate of INSURE can be useful for treating and reducing charge of neonate with RDS and the birth weight is one of the effective factor on INSURE Success in this study