Brain CT Scan, Sonography and EEG Findings in Neonates with Seizure.

Objectives: This study aimed to determine the frequency of different types, causes, and abnormal findings of brain computed tomography scan (CT scan) and ultrasonography (US) and multichannel- electroencephalography (EEG) in neonates with seizure. The ability of brain CT scan was also compared with US in terms of detecting the underlying causes of neonatal seizures. Materials & Methods: In this cross-sectional retrospective study, the medical records of 90 neonates younger than 28 days with the definite diagnosis of seizure were reviewed. The data were analyzed using SPSS 22 through descriptive and Exact fisher tests. Results: Totally, 90 newborns (M: F = 1.5:1) with mean age of 63.11 ± 32.8 days were enrolled. 35.5% of newborns were born before the 37th week of pregnancy. In this study, 45.6% of EEG findings, 22% of brain CT scan findings, and 12.5% of US findings were abnormal. The automatisms (38.9%) and benign idiopathic neonatal seizure (70.7%) were the most common seizure type and cause respectively. The hypoxic Ischemic encephalopathy was the most common abnormal finding (30%) in brain CT scan. Conclusions: Given the accuracy of EEG in detection of brain pathologies, where available, all neonatal seizures should be initially confirmed using EEG. Radiologic investigations (CT scan, US) off the head/ cranium should be done to detect the cause of neonatal seizure. The capacity of brain CT scan to detect underlying causes of neonatal seizures is more than US.

Comparison of the Efficacy of Three Natural Surfactants (Curosurf, Survanta, and Alveofact) in the Treatment of Respiratory Distress Syndrome Among Neonates: A Randomized Controlled Trial.

BACKGROUND: Although several different types of natural surfactants are available, including Alveofact, Curosurf, and Survanta, the preferred type and the magnitude of their effects are unknown. OBJECTIVES: This study was designed to compare the effects of these three surfactants on the gas exchange and clinical outcomes of neonates with respiratory distress syndrome (RDS). METHODS: This triple-blind randomized clinical trial studied all preterm neonates ≤ 37 weeks with RDS who were admitted to the neonatal intensive care unit (NICU) of Taleghani hospital (Tabriz, Iran) between 2012 and 2013. The patients were divided into three groups, each of which received one of these surfactants. The incidences of ventilator dependency, patent ductus arteriosus (PDA), broncho-pulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), hospital-stay length, and continuous positive airway pressure (CPAP) failure, as well as blood gas levels, were recorded as endpoint measurements and compared. RESULTS: In total, 165 neonates of gestational age ≤ 37 weeks with RDS were examined. Neonates were allocated to three different groups randomly, including a Survanta group (n = 49), a Curosurf group (n = 62), and an Alveofact group (n = 54). The mean gestational age of the neonates was 31.6 ± 3.7 weeks, and their mean weight was 1,840 ± 790 grams. The male/female ratio was 2:1 (67% male, 33% female); 104 (63%) neonates were ≤ 32 weeks gestational age, and 61 (37%) were >32 weeks. There were no significant differences for gender or demographic characteristics among the neonates in relation to the type of applied surfactant. According to the clinical parameters (BPD, IVH, ROP, hospital-stay length, and mechanical ventilation requirement), no significant differences were observed between the groups before and after surfactant administration, but the differences between the Survanta and Alveofact groups for the incidence rates of pneumothorax (P = 0.03) and pulmonary hemorrhage (P = 0.03) were statistically significant. CONCLUSIONS: No significant differences were observed in most of the clinical variables between the three types of natural surfactant, but in neonates ≤ 32 weeks, the incidence of pneumothorax was significantly higher in the Alveofact group; in neonates > 32 weeks, the incidences of PDA, mean hospital-stay length, and mean mechanical ventilation time were also significantly higher in the same group. It thus appears that Curosurf and Survanta replacement therapies among premature neonates with RDS perform better than Alveofact replacement therapy.

Application of Lidocaine Spray for Tracheal Intubation in Neonates - A Clinical Trial Study.

BACKGROUND: Tracheal intubation is extremely distressing, painful, and may influence heart rate and blood pressure. Sedatives, analgesics, and muscle relaxants are not commonly used for intubation in neonates. OBJECTIVES: This study aimed to evaluate the effects of lidocaine spray as a non-intravenous drug before neonatal intubation on blood pressure, heart rate, oxygen saturation and time of intubation. PATIENTS AND METHODS: In a randomized, controlled study each neonate was randomly assigned to one of the two study groups by staffs who were not involved in the infant's care. The allocation concealment was kept in an opaque sealed envelope, and the investigators, the patient care team, and the assessors were blinded to the treatment allocation. The selected setting was NICU unit of a teaching hospital in Ilam city, Iran and participants were 60 neonates with indication of tracheal intubation with gestational age > 30 weeks. Patients in the treatment group received lidocaine spray and the placebo group received spray of normal saline prior to intubation. Main outcome measurements were the mean rates of blood pressure, heart rate, oxygen saturation, intubation time and lidocaine side effects were measured before and after intubation. RESULTS: Totally 60 newborns including 31 boys and 29 girls were entered into the study (drug group n = 30; placebo group n = 30). Boy/girl ratio in treatment and placebo groups were 1.3 and 0.88, respectively. Mean age ± SD of participants was 34.1 ± 24.8 hours (treatment: 35.3 ± 25.7; placebo: 32.9 ± 24.3; P < 0.0001). Mean weight ± SD of neonates was 2012.5 ± 969 g. Application of lidocaine spray caused a significant reduction of mean intubation time among treatment group compared with placebo group (treatment: 15.03 ± 2.2 seconds; placebo: 18.3 ± 2.3 seconds; P < 0.0001). Mean blood pressure, heart rate and oxygen saturation rate, among neonates in treatment group was reduced after intubation compared with their relevant figures before intubation; however, their differences were not statistically significant except for mean oxygen saturation rate that was reduced significantly in placebo group. No side effects were observed during study. CONCLUSIONS: Though the current study revealed some promising results in the application of lidocaine spray during neonatal intubation without any considerable side effects; however, the current investigation could only be considered as a pilot study for further attempts in different locations with higher sample sizes and in different situations.

The Evaluation of Red Reflex Sensitivity and Specificity Test among Neonates in Different Conditions.

OBJECTIVE: Red reflex test is an effective screening tool in the early diagnosis of neonatal eye abnormalities. The aim of this study was to detect the sensitivity and specificity of red reflex assessment in neonates, performed by pediatricians (or other care providers) in comparison with ophthalmologists. Also association between red reflex findings and neonatal variables is evaluated. METHODS: By a prospective study all neonates born from July 2011 until March 2012 in Mustafa Hospital, a general teaching hospital in Ilam city, Iran, were evaluated. Neonates were firstly investigated by pediatrician in substandard conditions at the first day of birth and several days later by ophthalmologist in standard conditions. FINDINGS: Totally 255 neonates including 141 boys and 114 girls were investigated, 144 of whom were born by cesarean section. There was a significant relationship between method of childbirth (72.9% disorders in CS vs 56.8% in vaginal delivery (P<0.007)), duration of delivery (disorders in prolonged: 100% and 11.8% vs no prolonged: 56.8% and 6.3% in standard and non standard conditions respectively (P<0.0001)), difficult delivery (98.6% disorders vs 6.5% in standard and non standard conditions respectively (P<0.01)) and increase or decrease of red reflex sensitivity test. A significant difference (identification of ophthalmic problems) was seen among neonates' inspections in primary hours and substandard conditions compared to further inspections in standard conditions particularly from 3(rd) day of birth. CONCLUSION: Due to a considerable difference between the results of ophthalmic examination of neonates in different conditions, red reflex examination by pediatricians is suggested for all neonates to early identification of ophthalmic problems at the first step. It is also suggested a red reflex screening for all neonates before being discharged from hospital as well as 6 weeks later and in case of any problem to be referred to ophthalmologist.

Effects of Metoclopramide on Feeding Intolerance among Preterm Neonates; A Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy and safety of metoclopramide in the treatment of feeding intolerance in preterm neonates less than 36 weeks of gestational age. METHODS: A randomized, controlled, masked cross-over study. A block of 4 randomizations was used. The "drug group" received intravenous metoclopramide before feeding and placebo group received placebo at the same time. The time to full enteral feeding and suspected adverse effects of metoclopramide, length of hospital stay or incidence of NEC or septicemia were the main outcome measures. FINDINGS: Mean (standard deviation) of weight and Apgar score among metoclopramide and placebo groups were 1638.3±321 gr, 8.9±1.4 and 1593.3±318.8 gr, 8.8±1.3 respectively. Times to full feeding were significantly shorter in the metoclopramide group than in the control group (12.9±5.6 vs 17.0±6.3; P<0.0001) and also the numbers of withheld feedings were significantly lower (P<0.0001). According to the regression analysis, lower weight and placebo group were significantly related to increasing of lavage frequency, number of vomits, start time of feeding, number of feeding cessations and decreased feeding completion time (P<0.0001).No adverse effects of this treatment modality were observed in the two groups. CONCLUSION: Intravenous metoclopramide may be considered as an attempt in facilitating and treatment of feeding intolerance in preterm neonates.

Determining the correlation and accuracy of three methods of measuring neonatal bilirubin concentration.

OBJECTIVE: There are different methods for measuring bilirubin concentration; however, it is quite important for practitioners to know which method should be used in certain clinical situations. The present prospective study aimed to compare three different methods for measuring neonatal bilirubin concentrations. METHODS: All full term neonates who were either brought into emergency departments or admitted to the neonatal wards in Kerman city in 2011 were recruited (n = 428). The correlation coefficients were estimated for the routine ways of bilirubin concentrations including "Capillary", "Cutaneous" and "Laboratory" methods. FINDINGS: Of 428 recruited neonates, 178 were female. Mean age ±SD was 178±71 hours. The correlation coefficient for "David Icterometer" vs "JM103" was 0.91, while the corresponding coefficient for "David Icterometer" vs "Capillary" was 0.96. It was also equivalent to 0.85 for correlation between "JM103" and "Capillary" methods. The David Icterometer measured an average of 2.36 mg/dl levels of bilirubin concentration compared to the JM103 method. The Capillary method showed a lower bilirubin level than the venous concentration (0.91 mg/dl on average). Compared with the "Capillary", the "JM103" measured a slightly higher level of bilirubin with an average 0.57 mg/dl. CONCLUSION: Due to low difference (less than 1 mg/dl) between "JM103" and the "Capillary methods" for measurement of neonatal bilirubin concentration, these two methods could alternatively be used instead of usual laboratory method.