Iranian Journal of Neonatology
Volume:10 Issue: 1, Winter 2019

  The results of previous studies suggested that there is an increased risk of patent ductus arteriosus (PDA) in the neonates with lower serum cortisol levels. This study aimed to assess the association between serum cortisol values and PDA and investigate if there is an association between PDA and the antenatal administration of betamethasone. The present study was carried out on the neonates with gestational age between 28 to 35 weeks. The prenatal administration of betamethasone to the mothers was extracted from the records. A pediatric cardiologist performed an echocardiographic assessment on the second day of life (DOL) and fifth DOL and the infants were evaluated for the presence of PDA. The blood samples were obtained on the second and fifth DOL and serum cortisol levels were measured. We evaluated the association between serum cortisol levels and PDA. Also, the correlation between PDA and the antenatal administration of betamethasone was assessed. The mean scores of serum cortisol levels on the second DOL in the neonates with and without PDA were 4.99±2.69 (μg/dl) and 7.23±2.87 (μg/dl), respectively that were significantly lower in the first group, compared to those of the second group. However, the mean levels of serum cortisol in the neonates with and without the prenatal administration of betamethasone were not significant (P=0.522). We have concluded that lower serum cortisol level was associated with the increase in the risk of PDA and the prenatal administration of glucocorticoids may not reduce the occurrence of PDA.

  The prevalence of allergic diseases is increasing worldwide. The effective role of omega-3 fatty acids in the maturation of immune system and protection against atopic diseases has been well discussed. However, previous studies revealed conflicting results. This study was conducted to investigate the effect of fish oil consumption by nursing atopic mothers on the level of interferon gamma (IFN-γ) in their breast milk and incidence of allergic disease in their infants. This randomized clinical trial was conducted on 94 atopic mothers, who were assigned to two equal groups receiving either 1000 mg fish oil capsules or placebo for 60 days after delivery. The breast milk was collected 120 days after delivery, and IFN-γ level was measured. The history of the symptoms of atopic disease in infants was collected from their mothers through ISAAC questionnaire; in addition, the infants’ growth was evaluated. Sixty mother-infant pairs completed the trial. The mean values of IFN-γ in breast milk was higher in the fish oil group (1.11±1.15 Pg/ml) than in the placebo group (0.81±0.86 Pg/ml), but the difference was not significant (P=0.288). In addition, the incidence of allergic symptoms of infants was not significantly different between the two groups (P=0.84). In this trial, the consumption of fish oil by lactating mothers did not have a significant effect on IFN-γ level in their breast milk and the incidence of allergic symptoms in their infants. Future studies with longer follow-ups are necessary in this regard.

  The aim of this study was to evaluate the efficacy of the topical use of chamomile oil as a complementary method in the improvement of infantile colic symptoms. This randomized controlled trial was carried out on 74 infants with colic at Sabzevar University of Medical Sciences in Sabzevar, Iran. The infants were randomly allocated into two groups. In the intervention group, chamomile oil was applied topically on the abdominal region three times a day for 14 days. The placebo group received paraffin oil in a similar manner. A data collection form was daily filled out for all infants by their parents. Number and duration of crying episodes and duration of sleep were assessed at the baseline and on the 7th and 14th days of the intervention. Results showed that there was a significant difference in the crying time of the two groups on days 7 and 14 as compared to that at the baseline (P=0.03 and P=0.002, respectively). There was a significant increase in sleep duration only on the 14th day of treatment as compared with that at the baseline (P=0.01). Although the number of crying episodes in both groups decreased, there was no significant difference between the two groups (P=0.08). Based on the regression test, although the values obtained on days 1 and 7 were not statistically significant, compared to those at the baseline, the number of crying episodes decreased on the 14th day (95% CI: -115.39 to -15.04; P=0.012). Topical consumption of chamomile oil may be used as a complementary, safe, and cost-effective way to improve and reduce the symptoms of infantile colic.

  The most common cause of preventable blindness in children is retinopathy of prematurity (ROP). The most important risk factors for this disease are preterm delivery and low birth weight (LBW). This research was performed to evaluate the prevalence ofand risk factors for ROP in preterm neonates. Our research was a cross-sectional descriptive and retrospective study conducted on preterm neonates in the Neonatal Intensive Care Unit (NICU) of Mahdieh Hospital in Tehran, Iran, in 2015. All neonates with a gestational age of < 32 weeks and birth weight of < 1,500 g were enrolled. Demographic data and risk factors for ROP were evaluated. Statistical analysis was conducted by SPSS (version 20) with a 95% confidence interval and. P-value less than 0.05 was considered statistically significant. Our study was conducted on 154 patients. Mean gestational age and birth weight of the newborns were 28.69±1.82 weeks (range: 23-32 weeks) and 1114.94±240.982 g (range: 550-1500 g). The ROP was detected in 76 (49.4%) patients, 55.26%, 34.2%, and 10.53% of whom had stages I, II, and III of ROP. Stages IV and V were not seen in our patients. The incidence of ROP was significantly affected by low gestational age and birth weight, delivery room resuscitation, prolonged oxygen therapy and mechanical ventilation, and repeated packed cell transfusion. Despite the improvement in the care of preterm infants in the NICUs, the prevalence rate of ROP was high. Therefore, it is critical to adopt better care for disease prevention, timely screening, and appropriate treatment programs for the neonates who are at the risk of this disease.

  Varicella-zoster infection is a serious and potentially fatal disease, especially among newborns.Several studies have described postnatal varicella zoster exposure among neonates and reported on the efficacy of varicella-zoster immunoglobulins (VZIG) used as post-exposure prophylaxis. Unfortunately, VZIG is not available in Jordan. A limited number of studies have investigated the efficacy of intravenous immunoglobulins (IVIG) as an alternative preventive post-exposure to the varicella virus. This retrospective descriptive study was conducted to review the outcomes of two separate incidents of varicella-zoster exposure and the prophylactic use of IVIG in the neonatal intensive care unit in Jordan. The sources of exposure in both incidents infected medical health workers. During the exposure, cohort measures were applied to neonates whose mothers did not receive immune prophylaxis against IVIG. Newborns were followed appropriately. Totally, 22 cases were identified representing two exposure incidents without a varicella-zoster infection. The results indicated that IVIG was an effective prophylactic therapy for neonates post varicella virus exposure.

Human resources are considered the most valuable capital of every healthcare system, and the quality of care is closely related to the quantity and skill of this group. Therefore, the proper estimation of the required nursing staff in different wards can help improve the quality of nursing care. The purpose of this study was to determine the hours of provided care by nursing staff in neonatal care units. In this descriptive study, the research samples consisted of all nursing activities done by the nursing staff including head nurses, nurses, and nurse assistants working in the neonatal intensive care units of the chosen educational hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data collection tool was a nursing checklist with four categories, including direct care, indirect care, managerial activities, and personal activities. Calculating their activity duration was done using a stopwatch. Data analysis was performed by SPSS software (version 21). The obtained findings showed that the time allocated to direct care by head nurses and nurses in morning and evening shifts was always less than the time allocated to indirect care and the nurses spent most of their time doing indirect activities. According to the obtained results of the present, it is essential that nursing managers provide the possibility of reducing some nursing activities’ time by applying more accurate supervision and time management and thus increase the quality of care by providing purposeful healthcare.

  This study aimed to evaluate the safety and efficacy of inhaled salbutamol for the treatment of Transient Tachypnea of the Newborn (TTN). Totally, 80 neonates with TTN were randomly assigned into two groups of treatment and placebo. The treatment and placebo groups received one dose of nebulized salbutamol (dose of 0.15 ml/kg in 2 ml of normal saline) and only 2 ml 0.9% normal saline without salbutamol, respectively. Before starting the study and30, 60 min, and 4 h after nebulization, the respiratory and heart rates, oxygen saturation, a fraction of inspired oxygen, respiratory distress score, the arterial blood gas(after 4 hours), and the time of hospital stay evaluated. The data were analyzed in SPSS software (version 23) through Fisher's exact test, Mann-Whitney U test, and ANOVA. There were no significant differences between the case and control groups with regard to gender, gestational age, birth weight, mother's history of asthma, type of delivery, first-and fifth-minute Apgar, pneumothorax, and respiratory rates. The duration of tachypnea, hospital stay, oxygen therapy, and the time of initiating enteral feeding were shorter in the case group compared to the control group. The administration of the salbutamol can significantly improve respiratory distress following 4 h and reduce the duration of hospital stay, tachypnea, and the time of enteral feeding

  When a neonate is born prematurely and admitted to the Neonatal Intensive Care Unit (NICU), the mother usually experiences high levels of anxiety that can disrupt the maternal bond, as well as the natural course of neonatal development. Since spirituality is one of the significant factors affecting anxiety, the present study was designed to evaluate the effect of spiritual care based on the “Ghalbe Salim” model on anxiety in mothers with premature neonates. In this clinical trial, a total of 60 mothers with premature neonates who were admitted to the NICUs of Hafez and Hazrat-e-Zainab hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, were recruited through convenience sampling during January to November 2017. The study was conducted in two stages. In the first stage, one of the hospitals was randomly designated as the control group, and the other one was selected as the intervention group. In the second stage, the interventions commenced again after switching the sampling setting. Mothers in the intervention group received four 30-minute sessions of spiritual care based on the “Ghalbe Salim” model every other day, and their anxiety level was assessed before and after the intervention using State-Trait Anxiety Inventory (STAI-Y) by Spielberger. The data were analyzed using Chi-squared test, independent t-test, paired sample t-test, and Mann-Whitney U test. There were no significant differences between the intervention and control groups before the intervention in terms of mean state and trait anxiety scores (P>0.05). However, after the intervention, a significant difference was observed between the two groups in terms of both state and trait anxiety scores (P=0.001). According to our findings, spiritual care based on the “GhalbeSalim” model was effective in reducing the anxiety level in mothers with premature neonates.

  Blood culture is a method in neonatal intensive care unit (NICU) and a gold standard for the diagnosis of infection that is essential for proper newborn management. The aim of this study was to compare the performance of nurses in the NICUs of Tabriz University of Medical Sciences using a standard sampling method. This descriptive cross-sectional study was performed on 90 nurses working in Al-Zahra and Taleghani ‎Educational and Medical Centers, and Tabriz Children Hospital using the convenience sampling method. The study tool included a two-part questionnaire in which the first part contained demographic characteristics of the infants and nurses and the service area. The second part included a checklist of the nurses' performance before and during ‎the blood culture procedure. Data analysis was performed using SPSS statistical software (version 21), as well as descriptive and analytical statistics. Most nurses did not attend training courses for blood culture. The total performance scores before and during blood ‎culture sampling were ‎13.20‎‏±‏‎2.57 and ‎12.48‎‏±‏‎2‎.14‎, respectively.‎ Nurses are responsible for the correct sampling of blood culture and this procedure requires sufficient skill. Therefore, organizations must adapt their system to the standards in order to determine the benefits and disadvantages of the standards.

Mild congenital heart defects require no treatment, while severe forms of these diseases need immediate interventions. There are several limits in preterm neonates on drug interventions, interventional procedures, and even heart surgery due to the prematurity of pulmonary, renal, and central nervous systems. Considering the mentioned points, the collaboration of other medical professions, particularly neonatologists, is needed in the treatment of these newborns. The application of surgical and interventional instruments are associated with limitations owing to the low birth weight in these neonates. Therefore, it is essential to review and modify the treatment program for this group of patients. By the advancement of surgical treatments mainly in fetal course and the approval of their efficiency, designing a new interdisciplinary field is necessary. In developing countries, such as Iran, the prenatal diagnosis of congenital heart diseases is difficult because of the lack of expertise in this area. On the other hand, abortion seems to be problematic due to the religious reasons. The legal gestational age for abortion is less than 20 weeks, and the probability of dealing with these kinds of diseases is more than developed countries.
During several years, we encountered at least 15 cases with the above-mentioned criteria, five of whom required an immediate intervention. Three patients were dextro-Transpotion of the great arteries, one patient had pulmonary atresia with ventricular septal defect, and the two other ones were suffering from coarctation of the aorta and tricuspid atresia type 1A, who all underwent the palliative surgery

  The necessity of professional nursing support to increase the role of families in neonatal care and their empowerment has been a subject of growing attention. The aim of this study was to determine the effect of telenursing on attachment and stress in the mothers of premature infants. In this clinical trial, 50 mothers with premature infants who were admitted to neonatal intensive care unit (NICU) at Shahid Beheshti Hospital in Isfahan with a gestational age of more than 33 weeks were selected by convenience sampling method. They were randomly assigned to two groups of intervention (n=25) and control (n=25). The intervention group received an educational program designed through telephone and counseling center for the mothers of premature infants that started one week after the admission and continued one week after discharge. However, the control group only received the usual care provided in the NICU. One week after the admission of the infant, Maternal Postnatal Attachment (MPA) and Parent Stressor Scale: Neonatal Intensive Care Unit (PSS-NICU) questionnaires were completed. The PSS-NICU questionnaire and MPA questionnaire were completed at the time of discharge and one week after the discharge by the participants, respectively. The average increase in total attachment scores one week after discharge was significantly higher in the intervention group, compared to that of the control group (P<0.05). Moreover, the average decrease in the total stress score of the intervention group at the time of discharge in comparison to pre-intervention was significantly higher than that of the control group (P<0.05). Considering the positive effects of telenursing on increasing attachment and mitigating the stress of mothers with premature infants, it is suggested to employ this supporting method to enhance the attachment and reduce the stress of mothers

Background: Since the treatment of meconium ileus is very different from other types of intestinal obstruction, it is very important to distinguish these two entities. The aim of this study was to assess sonographic findings to differentiate meconium ileus from other types of obstruction.
Methods: This study was performed in Dr. Sheikh and Akbar hospitals, Mashhad Medical University of Science, Iran, during 2017- 2018. The imaging signs of 25 newborns (aged 2-8 days) with delayed passage of meconium were documented. These neonates were suspicious of low type intestinal obstruction. In cases with the simple form of meconium ileus and the small left colon syndrome, ultrasonic guided Gastrografin enema was performed for the treatment. In the patients with the failure of medical treatment and in other surgical cases, the appropriate surgical procedure was performed.
Results: The subjects in this study were diagnosed with small bowel atresia (n=9), a simple form of meconium ileus (n=6), a complicated form of meconium ileus (n=3), small left colon syndrome (n=3), bowel atresia and duplication (n=1), and Hirschsprung’s disease (n=3). The ultrasound findings were as follows: a totally or partially micro-colon in almost all patients, collapsed small bowel in right lower quadrant in all of the patients with bowel atresia, hypoechoic meconium in rectosigmoid in small left colon syndrome and Hirschsprung’s disease, hypoechoic tubular or beaded intraluminal inspissated meconium within terminal ileum, and the floating air bubbles (sonographic soap bubble sign) within fluids on proximal dilated loops in meconium ileus cases.
Conclusion: Although plain abdominal radiography confirmed bowel obstructions in all patients with delayed passage of meconium, it had a low level of specificity in the diagnosis and cause of obstruction. Abdominal ultrasound had a high level of accuracy in the correct diagnosis of meconium obstructions and its differentiation from other intestinal obstructions. Accordingly, it eliminates the need to do a diagnostic contrast enema in order to differentiate these entities

  This study aimed to identify the most important obstacles to proper interaction of parents with their neonates who were hospitalized in neonatal intensive care units (NICUs). This descriptive cross-sectional study was conducted on 90 NICU nurses and 400 female and male parents using census and convenience sampling methods. To collect data, in a period of three months, a researcher-made questionnaire was prepared, including the factors threatening the parents' interaction with their neonates in NICUs. Data analysis was performed using the descriptive statistics including the number, percentage and mean scores of responses in SPSS software (version 16). By calculating the mean scores of responses, from the nurses' points of view, "feeling of emotional discomfort due to being away from the neonate" (3.63) and "nurses’ not understanding parents since they have no children" (1.42) were the most and the least important factors, respectively. From the mothers' points of view, "parental stress due to the neonate’s hospitalization" (3.47), and "the maternity wards being away from NICUs" (1.37) were the most and the least important factors, respectively. Also, the most and the least important obstacles in the perspectives of the fathers were "parental stress due to the neonate’s hospitalization" (3.09) and "the unwanted neonate", respectively. The results showed that the stress and tension of parents were the most influencing factor on the interaction of neonate-parent in NICUs. Some neonatal and organizational factors were considered less important as the barriers to neonate-parent interactions in these wards.

Vein of Galen aneurysm (VGA) is the most common form of symptomatic cerebrovascular malformation in neonates. It develops in a fetus in the first trimester of pregnancy due to unknown reasons, but it is likely to have a genetic etiology. The prognosis of VGA is usually poor, particularly in newborns with heart failure due to high-flow intracerebral shunt. Surgery and endovascular embolization are partially successful treatments for controlling congestive heart failure and pulmonary hypertension. Case report: In this article, we present the case of a 3600-gram, full-term, female neonate hospitalized with respiratory distress and severe heart failure. The neonate was the second child of a 28-year-old mother. After echocardiography and brain sonography, she was diagnosed with the vein of Galen malformation. The case had severe and persistent congestive heart failure and refractory pulmonary hypertension. It is important to perform the auscultation of fontanel in newborns and consider VGA as a differential diagnosis in the neonates with congestive heart failure.

  Cardiac conduction disorders are rare syndromes in neonates and children. According to the literature atrial septal defect, especially ostium secundum type, is associated with atrioventricular (AV) block. Wenckebach conduction heart block is very rare in a neonate; however, there is a dearth of research on the prevalence of this type of heart block regarding the neonates and pediatrics literature. This disorder has only been addressed earlier in thalassaemia major and dengue fever in Pediatrics. There have been different anatomical and metabolic and genetic etiologies for this condition. Wenckebach block is a gradual delay in sending the electrical signal from the sinoatrial node to the ventricles with each beat until there is a single dropped beat, which could be uneventful or problematic later in life. This study aimed to present a deep investigation of a rare case of congenital Wenckebach conduction heart block.
Case report: The case in this study was a 52-hour-old female neonate who was diagnosed to suffer from Mobitz type 1 or Wenckebach heart block possibly due to a small ostium secundum atrial septal defect. Therefore, it was suggested to provide supportive care and regular follow-up visit. Precise antenatal care and investigation are required to reduce the morbidity and mortality rate of such condition.