Causes and Factors Associated with Neonatal Seizure and its Short-term Outcome; A Retrospective Prognostic Cohort Study

AbstractBackground: Neonatal seizures are common, difficult to diagnose and treat, and associated with a great mortality rate and long-term risk of neurodevelopmental impairments. We aimed to determine the etiology, clinical presentation, and neurodevelopmental outcome of neonatal seizures.Methods: In this cross-sectional study, 88 neonates, aged < 28 days, who were admitted to Mofid Children’s Hospital, Tehran, Iran, from September 2011 to 2013 with the initial diagnosis of seizure were included by convenient sampling method. Data, including age, gestational age, birth weight, Apgar of the fifth minute, neonatal intensive care unit (NICU) admission, family history, type, cause, and age of seizure, EEG and paraclinic findings, anticonvulsant used for treatment, neurodevelopmental status, and the final outcome, were collected from medical records and the missed cases were completed by phone calls. The frequency and association of variables were analyzed using SPSS software.Results: Among neonates with seizures, 67% were male, 79.5% were born term, and 72.7% had normal birth weight. The most common type of seizure was multifocal clonic seizures (45.5%). The main diagnosis in neonates with seizures was hypoxic-ischemic encephalopathy (HIE) (23.9%) and hypoglycemia (10.22%). The mortality rate was 11.36% during a mean follow-up period of 21.4±6.4 months. Neurodevelopmental assessments showed that 64% were normal, 27% had global delay, and 9% had motor delay. Positive family history of epilepsy (P=0.006), low Apgar score (P=0.002) and epilepsy (P<0.001) were significantly associated with adverse neurodevelopmental outcome.Conclusion: Since HIE and hypoglycemia were the most common cause of neonatal seizures in the present study, efforts should be made to improve care during delivery and early breastfeeding.Keywords:  Newborn; Seizure; Etiology; Neurodevelopmental outcom

Comparison of the normal CSF values in premature neonates with term babies

Background:  Premature infants are at more risk for meningitis, and lumbar puncture is therefore a necessary part of the sepsis workup. The normal cerebrospinal fluid markers of premature infants have not been well established. This study was conducted to define the normal values of cerebrospinal fluid in these infants. Materials and Methods: In this cross-sectional research, we compared the CSF analysis of premature and term neonates admitted to Mahdieh and Mofid children's hospitals from 2014 to 2017. Results: Of 248 neonates, 44.4% were females and 55.6% were males. Fifty-five percent were term and 45% were preterm. The mean birth weight and gestational age of term and preterm babies were 3409 ± 65 and 1373 ±376 gram (P value<0.001) and 38.46 and 31.66 weeks respectively (P value<0.001). The mean age of preterm and term patients at the time of lumbar puncture was 25.96 and 9.66 days respectively (P value<0.001). Overall, analysis of the CSF, protein, glucose, WBC, PMN, and RBC revealed the normal values of 92.7%, 79.4%, 89.9%, 91.5%, and 35.5% respectively. By comparing CSF parameters of term and premature babies, it was exhibited that protein was the only CSF parameter that was significantly different between two given groups (10.23mg/dl vs. 71.47 mg/dl, P-value<0.001). The percentages of abnormal CSF parameters in the two groups was not significantly different. Conclusion: Our study revealed that the CSF markers of term and preterm neonates are similar; the exception was the protein level so that it was significantly high even in the preterm neonates without meningitis or intraventricular hemorrhage

Corrigendum to: “The effect of Phoenix dactylifera pollen on the expression of NRF2, SOD2, CAT, and GPX4 genes, and sperm parameters of fertile and infertile men: A controlled clinical trial” [Int J Reprod BioMed 2021; 19: 545-558]"

This article is a Corrigendum to: “The effect of Phoenix dactylifera pollen on the expression of NRF2, SOD2, CAT, and GPX4 genes, and sperm parameters of fertile and infertile men: A controlled clinical trial” [Int J Reprod BioMed 2021; 19: 545-558]". Please download the PDF or view the article HTML

The effect of Phoenix dactylifera pollen on the expression of NRF2, SOD2, CAT, and GPX4 genes, and sperm parameters of fertile and infertile men: A controlled clinical trial

Background: Oxidative stress is caused by the imbalance occurring between the creation and clearance of the reactive oxygen species (ROS), which is responsible for 30–40% of male infertility. The positive impact of phoenix dactylifera pollen (Date palm pollen, DPP) on the improvement of sperm parameters has been well documented in animal models. Objective: For evaluating the effect(s) of DPP on sperm parameters, ROS levels, expression of antioxidant genes, and activity of antioxidant enzymes of infertile men. Materials and Methods: In this controlled clinical trial, a total of 60 male case with infertility and 20 normospermic fertile men were recruited. Before and after the treatment with DPP, the case were administered 400 mg/kg of gelatinous capsules daily for 30 consecutive days and semen samples were taken. Quantitative real-time polymerase chain reaction was applied for the evaluation of the mRNA expression levels of Nuclear factor erythroid 2-related factor 2(NRF2), superoxide dismutase (SOD2), glutathione peroxidase 4(GPX4), and catalase (CAT) genes. Results: The mRNA expression levels of NRF2, SOD2, GPX4, and CAT (p < 0.05 for all) and significantly increased after treatment with DPP. The increased expressions of all antioxidant genes and enzymes significantly correlated with improvement in semen parameters including count (p = 0.01), motility (p = 0.05), and morphology (p = 0.01) of sperm. A significant correlation between the alteration of SOD2 gene expression and SOD activity, GPX4 and GPX, and CAT were also observed (p = 0.05). Conclusion: DPP can increase the expressions of NRF2, GPX4, SOD2, and CAT genes and also improve the semen quality in infertile men. Key words: DPP, Male infertility, SOD2, NRF2, GPX4, CAT, ROS, Spermatozoa

Drug Calculation Cards and Medication Errors in the Neonatal Intensive Care Units

Introduction: Medication administration errors are the most common medication errors. One of the most important causes of medication administration errors is a mistake in calculating the dose of medication by nurses. This study was conducted to evaluate the effects of using the Drug Calculation Cards on the amount and type of medication administration errors in the Neonatal Intensive Care Units (NICUs). Methods: This quasi-experimental study was conducted with one-group before-after design to examine the effects of using the Drug Calculation Cards on the amount and type of medication administration errors. Eligible NICU nurses in selected centers affiliated to Qazvin University of Medical Sciences were registered (n = 33) in the study within three months. Then, before intervention data were collected using “medication administration errors reporting” questionnaire. Three months later the intervention (drug calculation card) was done and the same medication administration errors reporting questionnaire was dispersed. The data were entered to the SPSS version 14 and was analyzed using descriptive statistics. Results: The mean medication administration error during the three months before and three months after the intervention were 12.41 ± 14.48 and 9.62 ± 12.72, respectively, which had a statistically significant difference (P = 0.004). Conclusions: Using the Drug Calculation Cards by nurses i

Prognosis of Mechanical Ventilation in Very Low Birth Weight Neonates: A Single-Center Study in Tehran.

Background and Aims: Approximately 4–7 percent of all live births are led to a very low birth weight (VLBW) situation where the morbidity and mortality rate are very high. A large number of VLBW newborns in intensive care unit (ICU) require mechanical ventilation due to various conditions. To reduce mortality in this group, identification of risk factors is important. This study aimed to determine the prognosis of mechanical ventilation in VLBW neonates at Mahdiye hospital in Tehran. Materials and Methods: This study is a prospective cohort study. VLBW neonates who consecutively were put on mechanical ventilation during the study period were enrolled.  Then, the enrolled neonates were divided into two groups: neonates who died after implementing the ventilator were in group-I and neonates who survived after receiving mechanical ventilation were in group-II. Demographic, clinical and paraclinical variables were gathered to find out the predictors of mortality of ventilated neonates. The data were analyzed by SPSS software version 21. Results: During the study period, a total of 177 neonates were ventilated due to different causes. 56% were male with a male to female ratio 1.27:1. Mean birth weight and gestational age were 1024.8 ± 247.5 grams and 27.9±2.2 weeks respectively. Out of 177 mechanically ventilated VLBW neonates enrolled for this study, 53% died. Significant factors determining mortality rate were mean weight, mean gestational age, pulmonary hemorrhage, advance resuscitation and duration of hospital stay (p<0.05). APGAR score, gender, Pneumothorax, IVH>II, Sepsis and Maternal Disease were not significantly associated with mortality in VLBW neonates requiring mechanical ventilation (P>0.05). Conclusion: This study showed that among the analyzed factors weight <1000gm, gestation <28weeks, pulmonary hemorrhage and complications during ventilation were the most significant predictors of mortality in ventilated VLBW neonates in the intensive care unit

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

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

Evaluation of the Beneficial Effects of rooming-in care, in icteric hospitalized neonates

Background: Rooming-in, motivated by World Health Organization (WHO) strategies and baby-friendly hospital policies, is a practice followed in many maternity hospitals of Iran. Mother-infant dyad may easily be damaged by the separation caused by medical and surgical problems, which result in hospital stay. Regarding this, the aim of this study was to investigate the effects of the rooming-in practice in icteric newborns admitted to Mofid Children's Hospital of Tehran, Iran. Methods: This study was conducted on 220 neonates admitted to Mofid Children's Hospital with the complaint of jaundice. Out of the 220 newborns, 124 cases were assigned into the intervention group (the rooming-in care) and 96 neonates were categorized into the control group (the routine-care). The two groups were compared in terms of the length of hospital stay, maternal satisfaction, nursing care time, and hospital stay complications. The data were collected by some trained mid-wives using a validated questionnaire. Data analysis was performed using paired sample t-test through SPSS version 16. Results: According to the results of the study, about 55% of the neonates were male. The neonatal mean ages of the intervention and control groups were 6.6 ±3.7 and 7 ± 3.8 days, respectively. Maternal satisfaction with neonatal care and maternal comfort during hospital stay were significantly higher in the intervention group (P=0.027). Furthermore, the two groups had no significant difference regarding the complications of hospital stay (P=0.655). Conclusion: As the findings of the present study demonstrated, in spite of the similarities of the health issues, nursery essentials, and hospital stay complications between the two groups, the rooming-in was more favorable according to the mothers’ viewpoints

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