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Research Article
Phenobarbitone Versus Levetiracetam: A Qualified Approach to Initial Neonatal Seizure Management
Mohammed Mahfuzur Rahman*,
Abid Hossain Mollah,
Md Saiful Islam,
Shaha Mohammad Abdullah Al Baki
Issue:
Volume 11, Issue 2, June 2025
Pages:
34-42
Received:
13 February 2025
Accepted:
25 February 2025
Published:
26 March 2025
Abstract: Background: Seizures in newborns are frequent throughout the first month of life and might affect their neurodevelopment. Despite its limited effectiveness and association with cognitive impairment in human subjects, phenobarbitone (PB) is presently the preferred anti-epileptic medication (AED). The use of intravenous levetiracetam to treat seizures in neonates is growing. We have designed a randomized control study using levetiracetam in the initial treatment of acute newborn seizures since there is currently inadequate information on the safety and effectiveness of intravenous levetiracetam in neonates. The objective of the research was to determine if levetiracetam is more applicable than phenobarbitone at reducing convulsions in acute newborn seizures. The procedure of the research was conducted as a randomized control trial. After meeting the inclusion and exclusion criteria, 100 neonates, ages 0 to 28 days of any sex who were admitted to the special care baby unit (SCABU) of Dhaka Medical College Hospital and had a clinical presentation of neonatal seizures were randomly assigned to levetiracetam (Intervention Phenobarbitone; Control Group = 50). Seizures, the amount of time it took to be seizure-free, and the length of hospital stay were the outcome factors. Regular monitoring was conducted for 48 hours and continued until discharge or death. The outcome of the research was conducted as a randomized control trial. After meeting the inclusion and exclusion criteria, 100 neonates, ages 0 to 28 days of any sex who were admitted to the special care baby unit (SCABU) of Dhaka Medical College Hospital and had a clinical presentation of neonatal seizures were randomly assigned to levetiracetam (Intervention Phenobarbitone; Control Group = 50). Seizures, the amount of time it took to be seizure-free, and the length of hospital stay were the outcome factors. Regular monitoring was conducted for 48 hours and continued until discharge or death. In conclusion, the study found that when used as a first-line antiepileptic medication to treat acute newborn seizures, levetiracetam dramatically reduces convulsions when compared to phenobarbitone. It was discovered that none of the therapy techniques had any negative effects.
Abstract: Background: Seizures in newborns are frequent throughout the first month of life and might affect their neurodevelopment. Despite its limited effectiveness and association with cognitive impairment in human subjects, phenobarbitone (PB) is presently the preferred anti-epileptic medication (AED). The use of intravenous levetiracetam to treat seizure...
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Case Report
Celiac Disease and GH Deficiency in Children: A Case Report
Issue:
Volume 11, Issue 2, June 2025
Pages:
43-48
Received:
6 March 2025
Accepted:
20 March 2025
Published:
10 April 2025
Abstract: Growth is a complex and multifactorial process influenced by a combination of genetic, environmental, and hormonal factors. The regulation of growth involves a delicate balance of these factors, with hormones, such as growth hormone (GH), playing a pivotal role in the development of linear growth. Growth disorders, such as stunted growth, are common reasons for consultation in pediatric practices. However, diagnosing the cause of stunted growth can be a challenging task, as there are numerous potential contributing factors. These factors are often intertwined, with patients frequently presenting with two or more abnormalities simultaneously, such as growth hormone deficiency (GHD) and celiac disease. This overlapping of conditions can complicate diagnosis, as the symptoms of one condition may mask those of another, leading to a delay in identifying the true underlying cause. In our observation, we report two cases of patients who presented with growth disorders, each demonstrating how one condition can obscure another. The first patient was initially diagnosed with celiac disease, and while a gluten-free diet was implemented, there was little improvement in growth. Further investigations revealed an additional diagnosis of growth hormone deficiency, highlighting the importance of considering multiple diagnoses in cases of stunted growth. The second patient was first diagnosed with growth hormone deficiency, but after further evaluation, a diagnosis of celiac disease was made, which helped explain the persistence of the growth issues. In conclusion, stunted growth can result from various factors, and the presence of one disease can mask another. Thus, it is crucial to conduct thorough investigations and reconsider initial diagnoses to ensure that all potential causes are explored and appropriately addressed.
Abstract: Growth is a complex and multifactorial process influenced by a combination of genetic, environmental, and hormonal factors. The regulation of growth involves a delicate balance of these factors, with hormones, such as growth hormone (GH), playing a pivotal role in the development of linear growth. Growth disorders, such as stunted growth, are commo...
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Research Article
The Impact of COVID-19 Infection on the Incident of Preterm Birth
I Made Rian Amerta Dananjaya*
,
I Made Kardana
Issue:
Volume 11, Issue 2, June 2025
Pages:
49-54
Received:
13 March 2025
Accepted:
24 March 2025
Published:
10 April 2025
Abstract: Corona virus disease (COVID-19) has been a global pandemic since 2019, impacting various aspects of life, including maternal and neonatal health. Pregnant women diagnosed with COVID-19 are at a higher risk of obstetric complications, such as preterm birth. This study aims to analyze the relationship between COVID-19 infection in pregnant women and the incidence of preterm birth. This study employed a cross-sectional design using medical record data from the Neonatology division at Ngoerah Hospital Denpasar since February 2021 until Desember 2022. Samples were collected using consecutive sampling, including 167 subjects: 67 babies born to mothers with infection of COVID-19 and 100 babies born to mothers without COVID-19. Bivariate analysis was performed using the Chi-Square test, while multivariate analysis employed logistic regression to control for confounding variables. For the result, preterm birth was observed in 29.9% of babies born to COVID-19-positive mothers, compared to 13% of those born to COVID-19-negative mothers, with a significant association (p = 0.008; PR = 2.27; 95% CI 1.301-6.233). Multivariate analysis showed that mothers with COVID-19 had a 2.78 times higher risk of delivering preterm (p = 0.014; 95% CI 1.232-6.301) COVID-19 infection in pregnant women has a significant association with the incidence of preterm birth.
Abstract: Corona virus disease (COVID-19) has been a global pandemic since 2019, impacting various aspects of life, including maternal and neonatal health. Pregnant women diagnosed with COVID-19 are at a higher risk of obstetric complications, such as preterm birth. This study aims to analyze the relationship between COVID-19 infection in pregnant women and ...
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Review Article
Genetically Confirmed Hereditary Spherocytosis About 3 Cases
Angela Kibangou*,
Mounia El Alaoui Hanafi,
Salima Hajjaji,
Noufissa Benajiba,
Khadija Maani,
Abdelhak Abkari
Issue:
Volume 11, Issue 2, June 2025
Pages:
55-57
Received:
2 March 2025
Accepted:
20 March 2025
Published:
14 April 2025
Abstract: Hereditary spherocytosis, also known as Minkowski chauffard disease, is a constitutional red blood cell disease most common in North Africa with a prevalence of 1/2000. Autosomal dominant transmission. The disease is revealed by a chronic hemolysis chart made of a pallor, an icterus and a huge splenomegaly. The diagnosis is usually confirmed by a globular resistance test or better flow cytometry. It is easier when there is a family history associated with regenerative hemolytic anemia with the presence of spherocytosis. This assessment must be made before any transfusion of globular pellet. The red blood cell has a capacity of deformation and elasticity that ensures its permanence in the blood circulation, red blood cells are limited in their physical performance by genetic irregularities affecting different proteins of the membrane skeleton usually the anykrine, band 3, protein 4, 2 as well as the alpha or beta chains of the spectrin This assessment must be done before any transfusion of globular pellet. If necessary, a genetic study may be proposed to confirm the diagnosis. In this work we report 3 observations of genetically confirmed hereditary spherocytosis in children. The objective of our work is to raise the diagnostic difficulties of hereditary spherocytosis in patients who receive an emergency transfusion before the diagnosis confirmation and who have significant transfusion needs.
Abstract: Hereditary spherocytosis, also known as Minkowski chauffard disease, is a constitutional red blood cell disease most common in North Africa with a prevalence of 1/2000. Autosomal dominant transmission. The disease is revealed by a chronic hemolysis chart made of a pallor, an icterus and a huge splenomegaly. The diagnosis is usually confirmed by a g...
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Case Report
A Rare Case of Shwachman-Diamond Syndrome: Diagnostic Challenges and Management
Xinyi Xu,
Yihui Huang*
Issue:
Volume 11, Issue 2, June 2025
Pages:
58-62
Received:
2 April 2025
Accepted:
8 April 2025
Published:
29 April 2025
Abstract: Background: Rare inherited bone marrow failure syndromes pose significant diagnostic challenges in pediatric practice due to their variable and overlapping clinical presentations. Shwachman-Diamond syndrome (SDS) is one such rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, skeletal abnormalities, and variable immune deficiency. Due to its low prevalence and heterogeneous clinical presentation, SDS is frequently underrecognized or misdiagnosed, especially in pediatric patients. Objective: To review the diagnostic and therapeutic process of a pediatric patient with SDS, with the aim of enhancing clinical awareness and understanding of this rare multisystem disease. Methods: A detailed analysis was conducted of the patient’s clinical manifestations, physical examination findings, laboratory results, imaging data, and genetic testing, alongside a review of the therapeutic regimen and follow-up. Results: The patient exhibited hallmark features of SDS, including short stature, recurrent respiratory infections, and persistent neutropenia. Genetic analysis revealed an SBDS (NM_016038.4): c.258+2T>C (intron 2/4) mutation, confirming the diagnosis. Supportive and symptomatic treatments were administered, including infection prevention, nutritional support, and regular monitoring of hematologic status. Conclusion: This case underscores the importance of considering SDS in children with unexplained cytopenias and recurrent infections. Genetic testing plays a pivotal role in achieving a definitive diagnosis. Early recognition and appropriate management can improve outcomes and provide valuable reference for clinicians encountering similar cases.
Abstract: Background: Rare inherited bone marrow failure syndromes pose significant diagnostic challenges in pediatric practice due to their variable and overlapping clinical presentations. Shwachman-Diamond syndrome (SDS) is one such rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, skeletal abnor...
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Research Article
Characteristics of Severe Dengue Infection with Compensated and Decompensated Shock in Children in a Tertiary Hospital in Bali, Indonesia
Issue:
Volume 11, Issue 2, June 2025
Pages:
63-71
Received:
25 March 2025
Accepted:
2 April 2025
Published:
29 April 2025
Abstract: Severe dengue infection in Indonesia has a high mortality rate. This study aims to identify the characteristics of severe dengue infection with compensated and decompensated shock in children at a tertiary hospital in Bali, Indonesia. This study employs a descriptive retrospective design with a cross-sectional approach to identify the characteristics of severe dengue infection in children with compensated and decompensated shock at a tertiary hospital. Secondary data were utilized from children with dengue infection who were treated at Prof. Dr. I G. N. G. Ngoerah hospital from January to December 2023. The study population consists of children with dengue infection. The inclusion criteria include children aged 0–18 years diagnosed with severe dengue infection, while the exclusion criteria are children with incomplete medical record data. Prevalence of severe dengue infection in children was 36.9%, with 55.4% presenting with compensated shock. Of the 64 patients, the majority were children and adolescents (95.4%), with 70.8% being male. Most patients had good nutritional status (58.5%), no comorbidities (93.8%), and secondary dengue infection (89.2%). The median values of leukocytes, hemoglobin, hematocrit, platelets, and the neutrophil-to-lymphocyte ratio (NLR) in the compensated and decompensated shock groups were 5.25 and 6.1; 14.4 and 14.2; 42.6 and 43.1; 36 and 29; and 0.58 and 0.96, respectively. The mortality rate was 3.1%. Majority of children with severe dengue infection were children and adolescents, male, with good nutritional status, no comorbidities, and secondary infection. All cases of severe dengue manifested with significant plasma leakage, with a survival rate of 96.9%.
Abstract: Severe dengue infection in Indonesia has a high mortality rate. This study aims to identify the characteristics of severe dengue infection with compensated and decompensated shock in children at a tertiary hospital in Bali, Indonesia. This study employs a descriptive retrospective design with a cross-sectional approach to identify the characteristi...
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Research Article
Understanding Pathways from Childhood Irritability to Psychopathology: A Scoping Study Review
Aderonke Oyetunji,
Ann Genovese,
Trevena Moore
Issue:
Volume 11, Issue 2, June 2025
Pages:
72-80
Received:
31 March 2025
Accepted:
11 April 2025
Published:
29 April 2025
Abstract: Irritability can be a prominent characteristic of various psychopathologies, including childhood psychiatric and neurodevelopmental disorders. Genetic, environmental, and prenatal factors influence the development and progression of childhood irritability. This review aims to highlight the biological and behavioral pathways associated with childhood irritability, examine the relationship between irritability and childhood psychopathology, identify the existing gap in the literature, review these connections, and provide guidance for future research. Articles published on PubMed and Google Scholar from 2000 to 2023 were reviewed using a combination of search terms such as "childhood irritability,” “maternal stress,” and “prenatal stress.” The literature search yielded roughly 2,800 articles using the predefined search terms, of which 65 were deemed relevant to this scoping review. The articles reviewed identified a link between prenatal stress, childhood irritability, and the development of adult psychopathology. Pathological irritability and its emerging connection to maternal stress pose a risk factor for developing neurodevelopmental disorders and psychopathology in the pediatric population. Much of the current literature addresses the biopathophysiologic pathway linking maternal stress to childhood irritability in offspring. However, no interventional research studies have reported on how to interrupt this pathway or mitigate its progression with predictable outcomes. Therefore, identifying a critical period during childhood or adolescence when the progression from childhood irritability to adult psychopathology can be recognized may reduce the risk of developing neurodevelopmental disorders or psychopathology in childhood and throughout life.
Abstract: Irritability can be a prominent characteristic of various psychopathologies, including childhood psychiatric and neurodevelopmental disorders. Genetic, environmental, and prenatal factors influence the development and progression of childhood irritability. This review aims to highlight the biological and behavioral pathways associated with childhoo...
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Review Article
Magnetic Resonance Imaging in the Detection of Neuroanatomical Changes in Down Syndrome: A Narrative Review from the Developing Fetus to Childhood
Raneem Nabil Halaweh*
Issue:
Volume 11, Issue 2, June 2025
Pages:
81-92
Received:
31 March 2025
Accepted:
9 April 2025
Published:
19 May 2025
Abstract: Background: Down syndrome (DS) or trisomy 21 is a genetic disorder caused by unusual cell division and an extra copy of chromosome 21. DS is characterized by phenotypic characteristics identified clinically and is the most common genetic cause of intellectual disability in children. DS can also result in other medical complications that involve the heart, the digestive system and memory disabilities leading to Alzheimer’s disease (AD). Although diagnosis is made clinically, screening tests such as chorionic villus sampling (CVS), amniocentesis and ultrasound detecting translucency of the nuchal folds of the neck are used to detect it at its early stages. There is no known treatment for DS, however, early detection and intervention can improve quality of life (QoL) for patients and their parents. Aims: This review aims to identify the importance of neuroimaging, particularly magnetic resonance imaging (MRI), in early diagnosis of DS. The review will explore how neuroanatomical changes can guide future research and focus interventions to target needs of individuals. Method: This review included 12 studies on DS from the year 2000 to date. Participants included ranged from fetus to 15-year-old teenagers. Diagnosis of DS was first made by CVS, amniocentesis or ultrasound depending on mother’s preference followed by karyotyping confirming trisomy 21. The main imaging modality included in the review is high-resolution MRI which all participants underwent for comparison. Results: Results of the MRI showed an overall reduction in volume in different areas of the brain in DS patients compared to controls. Most prominent volume reduction were found in the frontal lobes, hippocampus and brainstem. With increasing age there was preservation of volumes in parietal and temporal lobes. After the age of 11 years, changes in the grey and white matters started to appear. Conclusion: Early detection of brain changes, especially in fetus, could improve developmental outcomes for people suffering from DS by providing early and tailored interventions focusing on potential cognitive impairments associated to damaged brain areas. These neuroanatomical changes in DS patients are correlated to cognitive disabilities that are controlled by specific areas of the brain, relating this review to its clinical relevance. Some limitations of the studies included in the review was the small sample size. Selection bias was introduced by recruiting participants solely from hospitals where healthcare access might be limited to those can afford it. Some strengths include the consistency in diagnosing DS first with chorionic villus sampling, amniocentesis and ultrasound and confirmation it with karyotyping.
Abstract: Background: Down syndrome (DS) or trisomy 21 is a genetic disorder caused by unusual cell division and an extra copy of chromosome 21. DS is characterized by phenotypic characteristics identified clinically and is the most common genetic cause of intellectual disability in children. DS can also result in other medical complications that involve the...
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Research Article
The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development
Issue:
Volume 11, Issue 2, June 2025
Pages:
93-100
Received:
17 April 2025
Accepted:
28 April 2025
Published:
29 May 2025
DOI:
10.11648/j.ajp.20251102.19
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Abstract: Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.
Abstract: Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by...
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