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