The Etiology, Clinical Type, and Short Outcome of Seizures in Newborns Hospitalized in Besat Hospital/Hamadan/ Iran

How to Cite This Article: Sabzehei MK, Basiri B, Bazmamoun H. The Etiology, Clinical Type, and Short Outcome of Seizures in Newborns Hospitalized in Besat Hospital/ Hamadan/Iran. Iran J Child Neurol. 2014 Spring 8(2):24-28.ObjectiveSeizures in neonates are very different from those of older children and adults.The aim of this study was to determine the etiology, clinical presentation, and outcome of seizures in hospitalized neonates of Besat Hospital, Hamadan, Iran.Material & MethodsIn this retrospective study, we evaluated all neonates with seizures (aged 0-28 days) admitted to the Besat hospital, Hamadan, over a period of three years from September 2008 to September 2011. The data were obtained from hospital records and analyzed using SPSS 12.ResultsSeizures were reported in 102/1112 (9.1%) neonatal admissions. Among neonates with seizures, 57% were male and 23.5% were preterm. The mean birth weight was 2936±677 grams and the mean gestational age was 37.60±1.94 weeks. 16.7% of them were LBW and 2.9% VLBW. In terms of seizure type, subtle seizures were observed in 38.2%, tonic in 29.4%, clonic in 26.4%, andmyoclonic in 5.9% of cases. The main diagnosis in neonates with seizures included hypoxic-ischemic encephalopathy (HIE) (34.3%), infections (24.4%), intracranial hemorrhage (6.9%), hypoglycemia (5.9%), hypocalcemia (2.9%), inborn error of metabolism (1%), and unknown cause (24.5%). The mortality rate was 14.7%.ConclusionNeonatal seizures indicate a significant underlying disease. HIE was the most common cause of neonatal seizures in our study. Therefore, efforts should be made to improve care during childbirth.References1. Mwaniki M, Mathenge A, Gwer S, Mturi N, Bauni E, Newton CR, et al. Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization BMC Medicine 2010;8:16.2. Digra SK, Gupta A. Prevalence of seizures in hospitalized neonates. JK Science 2007;9(1):27-9.3. Faiz N, Malik M, Azam M, Afzal U. Etiology and type of neonatal seizures, Ann Pak Inst Med Sci 2009;5(2):77-86.4. Aftab R. Neonatal seizures: Etiology, Clinical types and outcome. Professional Med J 2007;14(2):199-203.5. Fakhraee SH. Neonatal seizures: A Review. Iran J child Neurol 2007:1(4):7-11.6. Sheth RD, Hobbs GR, Mullett M. Neonatal seizure: Incidence, onset and etiology by gestational age. J Perinatol 1999;19(1):40-3.7. Saliba RM, Annegera Jf, waller DK, Tyson JE. Incidence of Neonatal seizures in harris county, American Journal of epidemiology 2000,150(7):763-9.8. Moayedi AR, Zakeri S, Moayedi F. Neonatal seizures: Etiology and type. Iran J child Neurol 2007:23-6.9. Ronen GM, Penney S, Andrew W. The epidemiology of clinical neonatal seizure in new found land, a populationbased study. J Pediatr 1999;134(1):71-5.10. Arpino C, Domizio S, Carrieri MP, Brescianini DS, Sabatino MH, Curatolo P. Prenatal and perinatal determinants of neonatal seizures occurring in first week of life. Abs J child Neurol 2001:16(9):651-6.11. Tekgul H, Gauvrea K, Soul J, Murphy L, Robertson R, stewart J, et al. The current etiology profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics 2006;117(4):1270-80.12. Udani V. Long-term prognosis of neonatal seizure – where are we? Indian pediatr 2008;45(9):739-41.13. Ross AL, Lombroso CT.Neonatal seizures state. A study of clinical, pathological, and electroencephalographic features in 137 full-term babies with a long-term followup. Pediatrics 1970;45(3):404-25.14. Taksande A, Vilhecar K, Jain M, Lakra M. Clinico-Biochemical Profile of Neonatal Seizures. Indian J Pediatr 1995;52:424-7.15. Legido A, Clancy RR, Berman PH. Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics 1991;88(3):583-96.16. Malik BA, Butt MA, Shamoon M, Tehseen Z, Fatima A, Hashmat N. Seizures etiology in the newborn period. J Coll Physicians Surg Pak 2005;15(12):786-90.17. Nunes ML, Martins MP, BareaBM, Wainberg R C, Costa da Costa J. Neurological outcome of newborns with neonatal seizures. Arq Neuropsiquiatr 2008;66(2A):168-74.18. Taghdiri MM, Emadi M, Tavasoli AR. Plain CT Scan in neonatal convulsion. Iranian Red Crescent Medical Journal 2005;7(3):43-45.19. Taghdiri MM, Eghbalian F, et al. Auditory Evaluation of high risk newborn by automated auditory brain stem response. Iranian J Pediatric 2008 Dec; 18(4):330-334

A Study of Methadone-Poisoned Children Referred to Hamadan’s Besat Hospital/Iran

How to Cite This Article: Bazmamoun H, Fayyazi A, Khajeh A, Sabzehei MK, Khezrian F. A Study of Methadone-Poisoned Children Referred to Hamadan’s Be’sat Hospital Iran. Iran J Child Neurol. 2014 Spring 8(2):34-37.ObjectiveIncreasing use of methadone in withdrawal programs has increased methadone poisoning in children. This research aimed to study the causes of incidence of poisoning in children and its side-effects.Materials & MethodsIn this research, The hospital records of all methadone-poisoned children referred to Hamadan’s Be’sat Hospital from June 2007 to March 2013, were studied. Children with a definite history of methadone use or proven existenceof methadone in their urine, were studied.ResultsDuring 5 years, 62 children with the mean age of 53.24±29.50 months were hospitalized due to methadone use. There was a significant relationship betweendelayed referral to hospital and increased bradypnea. According to their history, 25.8% and 58.1% of the children had been poisoned by methadone tablet and syrup, respectively. The most common initial complaint expressed by parents, was decreased consciousness (85.5%). During the initial examination, decreased consciousness, meiosis, and respiratory depression were observed in 91.9%,82.3%, and 69.4% of the cases, respectively. Nine patients required mechanical ventilation. There was a significant relationship between the need for mechanical ventilation and seizure with initial symptom of emesis. There were two cases of death (3.2%), both of which were secondary to prolonged hypoxia and brain death. There was a significant relationship between poor patient prognosis (death) and presence of cyanosis in early symptoms, seizure, hypotension, duration of decreased consciousness, and duration of mechanical ventilation.ConclusionThis research indicated that the occurrence of seizure, hypotension, and cyanosis in the early stages of poisoning is associated with an increased risk of sideeffects and death and are serious warning signs. Early diagnosis and intervention can improve outcomes of methadone-poisoned children.References1. Nazari H. Clinical approach to methadone intoxication. J Addict 2007;2:18-20.2. Fayyazi A, Bagheri M, Khajeh A, Ahmadi S. Acute hydrocephaly following methadone intoxication in a child. Iran J Child Neurol. 2012;6(1):35-8.3. Binchy JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ.1994; 308(6940):1335-6.4. Li L, Levine B, Smialek JE. Fatal methadone poisoning in children: Maryland 1992–1996. Subst Use Misuse 2000;35(9):1141-8.5. Riascos R, Kumfa P, Rojas R, Cuellar H, Descartes F. Fatal methadone intoxication in a child. Emerg Radiol 2008;15(1):67-70.6. Milroy CM, Forrest AR. Methadone deaths: a toxicological analysis. J Clin Pathol 2000;53(4):277-81.7. Farnaghi F, Jafari N, Mehregan FF. Methadone Poisoning among Children Referred to Loghman-Hakim Hospital in 2009. Pajoohandeh Journal 2012;16(6):299-303.8. Zamani N, Sanaei-zadeh H, Mostafazadeh B. hallmarks of opium poisoning in infants and toddlers. Trop Doct 2010;40 (4):220-2.9. Malloy S, Soh C, Williams TL Reversible delayed post hypoxic leukoencephalopathy. Am J Neuroradiol 2006; 27(8):1763–5.10. Geibprasert S, Gallucci M and KringsT. Addictive Illegal Drugs: Structural Neuroimaging. Am J Neuroradiol 2010;31(5):803-8.

The Frequency of Intraventricular Hemorrhage and its Risk Factors in Premature Neonates in a Hospital’s NICU

Abstract Objective Intraventricular hemorrhage (IVH) is an important cause of mortality and disability in premature neonates. Regarding this, the present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU)at Fatemieh Hospital in Hamedan, Iran, 2016.  Materials & Methods  This cross-sectional study was conducted on178 neonates with a gestational age of ≤ 32 weeks admitted to Fatemieh Hospital affiliated to Hamadan University of Medical Sciences, Hamedan, Iran, in 2016. The study population was selected using census method. The newborns were subjected to cranial ultrasound on the seventh day of life. and they were assigned into two case and control groups (namely neonates with IVH and those without IVH, respectively). Intra- ventricular hemorrhage was classified into four grades regarding Papile classification. The patients’ demographic specifications, including 1- and 5-minute Apgar scores, type of delivery, birth weight, use of mechanical ventilation, prenatal corticosteroid, gestational age, and some complications (e.g., Pneumothorax), were collected using a checklist. The data were analyzed using SPSS software version 16 Results According to the results, prevalence of IVH in premature infants admitted to NICU was approximately 20 %,  , 61.2% of the neonates were male. The mean gestational age of the participants was 30.39 weeks. The comparison of delivery type between the case and control groups showed no significant difference between them in this regard(P=0.197). Furthermore, there was a significant difference between the two groups in terms of need for mechanical ventilation (P=0.03), pneumothorax risk of this condition in the preterm neonates is enhanced by some factors, such as low birth weight, 5-minute Apgar score, and gestational age as well as the need for mechanical ventilation. (P=0.001), and 5-minute Apgar scores (P=0.04). Additionally,the incidence of IVH showed a significant relationship with the mean gestational age (P=0.001) and birth weight (P=0.04). Conclusion According to the findings, the premature newborns admitted to the NICU revealed a relatively high prevalence of IVH. The condition is aggravated in preterm neonates by some factors such as low birth weight, 5-minute Apgar score, gestational age, and the need for mechanical ventilation

Developmental screening of children with congenital hypothyroidism using Ages & Stages Questionnaires test.

 Abstract:Objectives: Congenital hypothyroidism (CH) is one of the most common causes of mental retardation in children. This study investigated the developmental status of children with CH screened by Ages & Stages Questionnaires (ASQ) measurement scores.Materials & Methods: In this retrospective study, neurodevelopmental status of 78 children diagnosed with CH who being followed up at the outpatient Pediatric Endocrinology Clinic of Besat Hospital, Hamadan, Iran, was evaluated by ASQ method. Data on age, sex, birth body weight, height and head circumference, residency location, parental education level, primary venous TSH and T4 level, diagnosis age, treatment start age and initial levothyroxine dosage were extracted from medical records .Data analyzed using statistical software SPSS v16. P-value less than 0.05 was considered statistically significant.Results: Of the 78 patients (34=43.6% female), 32 patients (41%) had developmental disorder. 56 cases (71.8%) were living in urban areas. In terms of type of developmental impairment, global delay: 13 patients (40.6%), problem solving: 11 patients (34.3%), communication: 5 patients (15.6%), fine motor: 2 patients (6.2%) and personal-social: 1 patient (3.1%) were detected. The average of diagnosis and treatment age was 25.65 days in patients with developmental impairment and 17.99 days in those without delay. ASQ results had significant statistical correlation with initial dose of levothyroxine (p=0.017), hypothyroidism diagnosis age (p=0.002) and age of treatment initiation (p=0.018).Conclusions: Early diagnosis and treatment along with initial L-thyroxin dose were most important factor of ASQ scores of children with CH. Higher amounts of the LT4 is required at onset

Nasal Intermittent Positive Pressure Ventilation (NIPPV) Vs. Nasal Continuous Positive Airway Pressure (NCPAP) after Less Invasive Surfactant Administration (LISA) in Preterm Infants with Respiratory Distress Syndrome

Background: There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).Methods: The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth.Results: The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth  compared to the control group (8.3% vs. 27.7%, P=0.014); however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56.2%, P=0.332), the mean respiratory support duration (6.89±3.20 vs. 6.70±3.71 days, P=0.295), the mean hospital stay (19.52±12.364 vs. 17.40±9.57 days, P=0.591), development of bronchopulmonary dysplasia (4.2% vs. 8.5%, P=0.435), and mortality (6.25% vs. 12.8%, P=0.317).Conclusion: Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LIS

Comparison of Restricted Fluid Volume with Standard Fluid Volume in Management of Transient Tachypnea of the Newborns: A Randomized Controlled Trial

Background Transient tachypnea of the newborn (TTN) is one of the most common neonatal respiratory disease and its symptoms usually begins in the first few hours after birth. The volume of fluid intake according to the neonate's conditions varies. We aimed to compare the restricted fluids volume with standard fluids volume in treatment of neonates with TTN. Materials and Methods: This clinical trial was performed on 80 neonates with a diagnosis of TTN admitted in the Neonatal intensive care unit (NICU) of Fatemiyeh Hospital and Beasat Hospital of Hamadan Medical University in Iran. Patients were randomly divided to standard fluids volume (control = 40), and restricted fluids volume treatment groups (case = 40). The hospitalization duration, oxygen therapy duration as well as the number of days need for oxygen with hood; Nasal continuous positive airway pressure (NCPAP), and mechanical ventilation therapy was recorded. After data collection, the data were statistically analyzed via SPSS software (version 21.0). Results: The subjects were 30 (37.5%) females and 50 (62.5%) males (62.5%) with an average gestational age of 38.12(±1.07) weeks.The main aim from this interventional study was effect of restricted fluidtherapy on management of TTN in NICU section. The hospitalization duration, oxygen therapy duration and need for oxygen therapy with hood in the intervention group were significantly lower than the control group (P0.05). Conclusion TTN treatment with restricted fluids volume, compared with standard volume of fluids, significantly reduces the need for respiratory supports as well as the duration of hospitalization in the NICU section

Incidence and short outcome in multiple pregnancies: a single center cross-sectional study in Iran 2016–2017

BACKGROUND The incidence of multiple pregnancies in industrialized countries due to the use of assisted reproductive techniques has increased over the past two decades. Multiple births are more dangerous than single pregnancies for mother and baby. This study evaluated the frequency of multiple pregnancies and its neonatal complications. METHODS In this cross-sectional study, we assessed all multiple neonates hospitalized in Fatemieh Hospital of Hamadan, Iran from September 2016 to September 2017 in terms of gender, gestational age, birth weight, the use of assisted reproductive techniques, delivery method, cause of hospitalization, therapeutic intervention, and hospitalization outcome. RESULTS Of 10,581 deliveries during the study period, 351 (3.3%) was multiple pregnancies and 232 neonates hospitalized. The incidence of twin, triplet, and quadruplet birth were 1.7%, 0.39%, and 0.11% respectively. In this study, 178 twin and 54 triplet and quadruplet birth were compared. The mean gestational age and mean birth weight of triplet and quadruplet were lower than that of twin births (p<0.001). A significant difference was found on the frequency of assisted reproductive techniques (p<0.001). Female sex (p=0.007), lower mean gestational age (p=0.009), lower mean birth weight (p=0.017) and need to mechanical ventilation (p<0.001) were significantly associated with early neonatal death in multiple pregnancies. CONCLUSIONS The incidence of multiple births was high in the Hamadan province, which was often followed by infertility treatment. Moreover, multiple births cause prematurity, low birth weight, respiratory distress syndrome, and increased neonatal mortality rate

Etiologies of Prolonged Unconjugated Hyperbilirubinemia in Neonates Admitted to Neonatal Wards

Background: Jaundice is a common condition among neonates. Prolonged unconjugated hyperbilirubinemia occurs when jaundice persists beyond two weeks in term neonates and three weeks in preterm neonates. This study aimed to determine the etiologies of prolonged unconjugated hyperbilirubinemia in infants admitted to the neonatal ward of Besat Hospital in Hamadan, Iran. Methods: This study was conducted on all infants diagnosed with prolonged unconjugated hyperbilirubinemia during 2007-2012 in the neonatal ward of Besat Hospital in Hamadan, Iran. Demographic characteristics of infants, physical examination and laboratory findings were collected and analyzed to determine the etiologies of neonatal hyperbilirubinemia. Results: In total, 100 infants diagnosed with neonatal hyperbilirubinemia were enrolled in this study, including 49 male and 51 female neonates with mean age of 20±1 days and mean bilirubin level of 17.5±4.0 mg/dL. Main causes of hyperbilirubinemia were urinary tract infection, ABO incompatibility, hypothyroidism and glucose-6-phosphate dehydrogenase deficiency in 14%, 5%, 6% and 5% of neonates, respectively. Moreover, unknown etiologies, such as breastfeeding, were detected in 70% of the studied infants. Conclusion: According to the results of this study, determining the main causes of prolonged unconjugated hyperbilirubinemia in neonates is of paramount importance. In the majority of cases, neonatal hyperbilirubinemia is associated with physiological factors, such as breastfeeding

Evaluation of the Relationship between Troponin T Level and Prognosis of Preterm Neonates Admitted to Neonatal Intensive Care Unit of Fatemieh Hospital in Hamadan

Background and Objective: Due to the prevalence of myocardial dysfunction and Patent Ductus Arteriosus (PDA) in a large number of preterm neonates, the prognosis of these infants is highly related to their early diagnosis and treatment. In this regard, the present study aimed to determine the relationship between troponin T level and the prognosis of premature neonates admitted to the Neonatal Intensive Care Unit (NICU) of Fatemieh Hospital in Hamadan. Materials and Methods: In this cross-sectional study, a certain number of infants who underwent serum levels of troponin T from 72 hours to one week after birth were assessed for demographic information, length of hospital stay, complications during hospitalization, acidosis, inotropic agents, recovery, and mortality, as well as their relationship with troponin level. Results: Out of 61 neonates, 22 patients had large PDA with a troponin level of 436±50.2 pg/ml, 14 patients had a small PDA with a troponin level of 260.5±89.8 pg/ml, and 25 patients were without PDA with a troponin level of 277.1±229.7 pg /ml (P = 0.203). There was no statistically significant difference between the three groups. The mean levels of troponin were 423±521 and 274±154 pg/ml in deceased and surviving neonates, respectively (P=0.194). Inotropic was significantly higher in deceased patients (P=0.003), and troponin T level was statistically significant (P=0.008). The relationship between troponin level and severe acidosis (P=0.051) was not significant, with a small difference that could be clinically valuable. Conclusion: Serum troponin T level was higher in preterm neonates with large PDA and deceased ones who received inotropic agents due to hemodynamic disorders and severe acidosis