Iranian Journal of Neonatology
Volume:6 Issue: 4, Autumn 2015

Nasal intermittent positive pressure ventilation (NIPPV) is a non-invasive ventilatory mode, which delivers mechanical ventilation via nasal tubes or prongs. The present study was conducted to compare the efficacy of NIPPV and nasal continuous positive airway pressure ventilation (NCPAP) in reducing the need for intubation in preterm infants with respiratory distress syndrome (RDS). This randomized, clinical trial was conducted at the neonatal intensive care unit of Imam Reza Hospital, affiliated to Mashhad University of Medical Sciences during eight months since April 2014. Preterm infants with RDS were recruited before showing any indications for endotracheal intubation after birth. The NIPPV and NCPAPV groups were matched in terms of clinical characteristics. Each infant was randomized to receive either NIPPV or NCPAPV immediately after extubation. Nasal ventilation was deemed successful if intubation was not required within at least 72 hours. Brain sonography was carried out on the third day of life in all infants. Data were recorded for all neonates until hospital discharge. In total, 28% (15/53) and 26.4% (14/53) of infants in the NIPPV and NCPAPV groups were intubated within the first 72 h after birth, respectively (P=0.168). Neither of the procedures induced major adverse effects, although the incidence rate and severity of intraventricular hemorrhage were higher in the NIPPV group, compared to the NCPAPV group (P=0.026). Although NIPPV is confirmed as the first-line treatment for the management of neonatal RDS, this mode of ventilation showed no superiority over NCPAPV in eliminating the need for mechanical ventilation in the present study.

Infants of diabetic mothers (IDM) is a critical issue in pediatrics, which is regarded as a major risk factor for birth trauma, respiratory distress syndrome (RDS), birth asphyxia, transient tachypnea of the newborn (TTN) and jaundice. IDM is also a risk factor for microvascular (e.g., ocular and renal complications) and macrovascular complications (e.g., cerebrovascular accident, atherosclerosis and cardiovascular complications). Lipids are a heterogeneous group of hydrophobic organic molecules which can be extracted from tissues using non-polar solvents. Lipids, due to their hydrophobic property, are mainly found in membranes enclosing various cell organelles. Diabetes mellitus management with insulin (nowadays also with oral hypoglycemic medications) has improved the outcomes of gestational diabetes mellitus (GDM) (most infants born to diabetic mother are large for gestational age). The neonatal mortality rate in IDM is over five times higher than that of infants of non-diabetic mothers. In this study, therefore, we aimed to assess the effect of maternal diabetes on cord serum lipid profile. This prospective (case-control) study was carried out on 60 infants born in Al-Zahra teaching hospital during February 2014–October 2014. The study group consisted of 30 randomly chosen IDM, and the control group comprised 30 infants who were born to healthy mothers. The results of this study demonstrated that there are significant differences between IDM and infants of healthy mothers regarding lipid profile and birth weight. This study confirms that cord serum lipid profile (serum cholesterol, serum triglycerides and low-density lipoprotein) is higher at birth in IDM. Moreover, this study shows a significant association between lipid profile and body weight.

Feeding intolerance is a common problem among premature infants. There is limited information on the safety and effects of oral probiotic supplements, especially products containing Lactobacillus reuteri, and the incidence of necrotizing enterocolitis (NEC) in low birth weight preterm infants. This study aimed to evaluate the effects of Lactobacillus reuteri on the gastrointestinal complications and feeding tolerance in premature infants. This randomized triple-blind clinical trial was conducted on 60 premature infants divided into two groups of intervention and placebo. Subjects in the intervention group received one drop/kg of supplementary oral probiotic with 0.5 ml of distilled water, and infants in the placebo group only received 0.5 ml of distilled water. Probiotic administration continued to reach full enteral feeding. In this study, mean time to reach full enteral feeding was 12.83 and 16.75 days in the intervention and placebo groups, respectively, which was indicative of a significant difference (P=0.01). However, mean of neonatal weight at discharge had no significant difference between the two groups. In addition, 6.7% and 36.7% of infants in the intervention and placebo groups were diagnosed with NEC, respectively, which showed a significant difference (P=0.005). Also, prevalence of jaundice and sepsis was not significantly different between the study groups. According to the results of this study, Lactobacillus reuteri could reduce the time to reach full enteral feeding while diminishing the incidence of NEC in very low birth weight premature infants.

In Neonatal intensive care units (NICU) different sound intensities and frequencies are produced from different sources, which may exert undesirable physiological effects on the infants. The aim of this study was to determine the noise level and its sources in the NICU and neonatal ward of Al-Zahra Hospital of Rasht, Iran. In this descriptive cross-sectional study, the intensity of the sounds generated by the internal and external sources in the NICU and neonatal ward was measured using a sound level meter device. The sound produced by each of the sources was individually calculated. Data were analyzed performing descriptive and analytical statistics, using SPSS version 19. The mean noise levels in six rooms and a hallway during morning, afternoon and night shifts with the electromechanical devices turned on were 61.67±4.5, 61.32±4.32 and 60.71±4.56 dB, respectively. Moreover, with the devices tuned off the mean noise levels during morning, afternoon and evening shifts were 64.97±2.6, 60.6±1.29 and 57.91±4.73 dB, respectively. The differences between the mean noise levels in the neonatal wards (standard noise level=45 dB) during each shift with the electromechanical devices turned on and off were statistically significant (P=0.002 and P<0.05, respectively). Phone ring tones in a one meter distance and neonatal crying registered the highest values (85 and 81 dB, respectively). According to the obtained results, the highest noise levels were generated by the electromechanical devices inside the NICU and neonatal ward, and there were no significant differences in the noise level with the devices turned on and off. Moreover, personnel’s noise-generating behaviors were the main sources of noise. Therefore, it seems that providing educational preparation for the staff can diminish the ambient noise level.

Breastfeeding failures and oral feeding problems in preterm infants result in long-term health complications. In this study, therefore, we aimed to evaluate the effect of oral stimulation along with non-nutritive sucking (NNS) on independent oral feeding initiation and weight gain in preterm infants. This prospective randomized clinical trial was carried out at Aliasghar Hospital in Tehran, Iran, 2014. A total of 50 26-32 weeks gestational age hospitalized infants, who were fed through tubes, were recruited in the study. The newborns were randomized into A, B and C groups. In the A and B groups, the neonates were stimulated through oral stimulation as well as non-nutritive sucking for 5 or 10 days, while in the group C, no especial intervention was performed. Infant's mean daily weight gain, the number of days until initiation of oral feeding, oral feeding progression, the number of days until reaching full oral feeding and date of discharge were recorded. The obtained data were analyzed and compared in the three groups using SPSS version 16.0. Of all the participants, 25 cases (55.55%) were male. Mean gestational age at birth and mean birth weight were 28.64±1.93 weeks and 1337.11±185.07 grams, respectively. In the group A, newborn's weight at reaching four and eight oral feedings per day and their weights at discharge were significantly higher than the other two groups (P=0.016, 0.001 and 0.001, respectively). Mean daily weight gain in the group A was higher (84.2850 g) than the other groups (69.5814 vs. 64.2677 g). However, ANOVA results showed that this difference was not significant (P=0.108). Moreover, independent samples t-test indicated that this difference between groups A and C was significant (P=0.049). In clinically stable preterm neonates, oral stimulation and should be implemented to increase their weight; however, further studies are required to address this issue.

Infants are regarded as a vulnerable group in need of nursing care, particularly during NICU admission. Parents of these infants often experience emotional, psychological and physical upheavals. Therefore, nurses can be of great help to the parents and facilitate a healthy transition from this period. Improper communication with parents, who seek information on their infant’s condition, intensifies their stress, fear and misunderstanding. In fact, inadequate communication with healthcare providers and lack of family support are major issues for the parents of NICU-admitted infants. In this qualitative study, via content analysis, we objectively selected and collected data from parents, physicians and nurses, residing in Isfahan, Iran in 2012. Data saturation was reached after conducting 25 in-depth, semi-structured interviews. Based on the findings, five major categories were extracted: 1) care provision in NICUs; 2) diagnostic difficulties; 3) NICU admission process; 4) challenges of hospitalization; and 5) maintenance of infant viability. Nurses’ proper response to parents’ questions about the infant's condition reduced stress among parents. Based on the findings, training is essential to healthy family dynamics and infant’s well-being, particularly for younger parents who support their infants at home. Also, regular updates on infant’s condition could help reduce parents’ stress and discomfort.

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. 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. 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. 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.

Epidermolysis bullosa (EB) comprises a group of genetically determined skin fragility disorders, which are characterized by blistering of the skin and mucosa, in response to little or no apparent trauma. These disorders represent heterogeneous phenotypes and are associated with various complications ranging from localized skin fragility to neonatal death. Nevertheless, the term "Epidermolysis" is a misnomer as epidermal disruption is not the principal alteration in two of the primary types of EB. In clinical, laboratory and epidemiological studies, this complex and heterogeneous group of disorders is classified, on the basis of the mode of inheritance, into three major types: EB simplex (EBS), junctional EB (JEB) and dystrophic EB (DEB). EB is a rare disease with an incidence rate of approximately 50 in 1 million live births, and 9 in 1 million people in the world population. Of these cases, about 92% are EBS, 5% are DEB, 1% is JEB and 2% are unclassified (1). In this study, we presented the case of a male newborn with EB and concomitant pyloric stenosis. To the best of our knowledge, only one case of this rare combination of EB with duodenal atresia has been retrieved in PubMed.

Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, which are known as the meninges. This infection may be caused by Streptococcus pneumonia bacteria. In this study, we presented the case of a female newborn with meningitis secondary to Streptococcus pneumonia. Her birth weight and height were normal. After 24 hours of birth, the neonate was diagnosed with tachypnea, without presenting any signs of fever or respiratory distress. The newborn was referred to Sheikh Children's Hospital, where chest X-ray showed clear lungs with no evidence of abnormality. Furthermore, the cardiothoracic ratio was normal. A complete blood count demonstrated white blood cell (WBC) count of 5400/uL. In Blood/Culcture ratio (B/C) test, Streptococcus pneumonia was reported, and the results of the cerebrospinal fluid (CSF) analysis confirmed this result. Following 14 days of receiving antibiotic therapy, the results of CSF analysis were within the normal range. Her visual and hearing examinations were normal, and demonstrated improved situation. The infant was discharged with exclusive breastfeeding.

Cornelia de Lange syndrome (CdLS) is an uncommon multiple congenital anomaly with unknown cause and recurrent risk and may be the result of an inheritance metabolic error. In classical form of the syndrome there is a recognizable facial appearance at birth although in children with mild disease this may be less obvious at birth but become more noticeable over the first three years of life. In this article we present an infant with multiple congenital anomaly who finally diagnosed as Cornelia de Lange syndrome.