فهرست مطالب
Iranian Journal of Neonatology
Volume:8 Issue: 3, Summer 2017
- تاریخ انتشار: 1396/07/18
- تعداد عناوین: 16
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Pages 1-5BackgroundRespiratory distress syndrome is one of the main complications associated with low birth weight, and a main cause of mortality in premature neonates. The present study aimed to compare the efficacy of ventilator continuous positive airway pressure (CPAP) and bubble CPAP in the treatment of respiratory distress syndrome (RDS) in premature neonates.MethodsThis randomized controlled clinical trial was conducted on 119 neonates diagnosed with RDS, with the gestational age of 28-34 weeks and birth weight of 1000-2200 grams, who were admitted in the neonatal intensive care unit (NICU). Infants were allocated to two groups of ventilator CPAP (VCPAP) and bubble CPAP (BCPAP) therapy.ResultsMean weight, gestational age, and one-minute Apgar score were not significantly different between the two groups. However, duration of treatment with mechanical ventilation in the BCPAP group was significantly lower compared to the VCPAP group. In addition, frequency of complications had no significant difference between the two groups.ConclusionIn the treatment of RDS, duration of mechanical ventilation was lower in the BCPAP group compared to the VCPAP group in premature neonatesKeywords: Bubble CPAP, Neonate, Oxygen therapy, Respiratory distress syndrome
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Pages 6-10BackgroundExamining the relationship between cord blood and maternal serum zinc levels and birth weight.MethodsA total of 127 infant-mother pairs were assigned to study (n = 58; with birth weightResultsThe study protocol was reviewed and approved by the ethics committee of the Urmia University of Medical Sciences (Ir.umsu.rec.1393.108 1393/04/24). Participants were provided with detailed information about the study and were assured that confidentiality would be maintained at all times. Written consent was obtained prior to data collection.
The mean age of the pregnant women was 26.1±5.8 years (age range: 18-40 years). The mean birth weight of the neonates in the two groups was 3275.9±552 kg. Pregnant women with serum zinc levels of higher than 70 μg/dl gave birth to neonates with birth weight higher than 3.5, whereas mothers with serum zinc levels of less than 60 μg/dl gave birth to infants with birth weight less than 3 kg (P=0.034). Mean serum zinc level in the cord blood of LBW group was 79.16±19.86 μg/dl, which was significantly lower than that in the NBW group (95.14±17.56 μg/dl; PConclusionMaternal and cord blood zinc concentrations were shown to be associated with birth weight of the newbornsKeywords: Low birth weight, Newborn, Pregnant, Serum zinc -
Pages 11-18BackgroundPreterm neonates are at a high risk of respiratory depression at birth. Incidence of respiratory distress is reported in 60-80% of the neonates born with the gestational age of less than 28 weeks and 15-30% of the neonates with the gestational age of less than 32-34 weeks. The present study aimed to compare the incidence and risk of failed extubation in using caffeine and aminophylline in the preterm neonates with the gestational age of ≤30 weeks in the periextubation period.MethodsThis single-centered, parallel, open-label, randomized controlled trial was conducted in a tertiary care referral hospital in India during June 2014-2016. Neonates with the gestational age of ≤30 weeks who were intubated for a minimum of 24 hours were enrolled in the study. Neonates with major anomalies, heart disease, and sepsis were excluded from the study. After the random allocation of the infants to treatment with the standard dose of caffeine citrate and aminophylline methylxanthine, intubation continued for seven consecutive days with or without non-invasive ventilatory support. As the primary objective, the incidence and risk of failed extubation were assessed. Secondary objective of the research was to compare the relative incidence of acute adverse effects, persistent apnea, and the associated morbidities.ResultsNeonates treated by caffeine were at a higher risk of extubation failure (1.09 times) adjusted with birth weight (31.5% versus 21.4%; RR=1.09; 95% CI: 0.81-1.46; P=0.55), which was not statistically significant. In addition, risk of apnea within seven days and after seven days of methylxanthine therapy was 1.57 (95% CI: 0.95-2.61) and 1.10 (95% CI: 0.95-2.61) times higher in the neonates with caffeine treatment. Also, rate of tachycardia was high in the neonates treated by aminophylline, which was statistically significant (RR=0.27; 95% CI: 0.13-0.56; PConclusionAccording to the results, the incidence and risk of extubation failure were clinically high in the caffeine-treated neonates. However, aminophylline administration could continue as a prophylactic agent in developing countries under medical supervision.Keywords: Aminophylline, Caffeine, Extubation failure, Mechanical ventilation
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Pages 19-24BackgroundSepsis is defined as a systematic inflammatory reaction against infection. Despite the recent advances in medical and pediatric sciences, sepsis remains a significant life-threatening health issue. The main problem associated with this disorder is the nonspecific and non-discriminative symptoms of noninfectious diseases. The present study aimed to introduce diagnostic parameters of high sensitivity and specificity for neonatal sepsis.MethodsThis case-control study was conducted in Mashhad, Iran during 2013-2015. Subjects included 40 septic neonates with confirmed diagnosis by a subspecialist of pediatrics and 40 neonates without clinical and laboratory findings of sepsis as the control group. Blood samples were collected from all the infants. In addition, differential white blood cell count of peripheral blood smear was performed, and immature/total neutrophil ratio (I/T) was calculated for all the PBS slides. Plasma calprotectin levels were also determined using the sandwich ELISA method.ResultsMean plasma concentration of calprotectin was 33190±23760 and 18980±13410 ng/ml in the septic and control groups, respectively. Moreover, mean I/T was 0.61±0.22 and 0.51±0.26 in the septic and control groups, respectively. The obtained results indicated that calprotectin levels and I/T were significantly higher in the septic group compared to the control group (PConclusionAccording to the results, nucleated red blood cell count and calprotectin levels were the most specific parameters for the definite diagnosis of neonatal sepsis, while neutrophils had the highest sensitivity in this regardKeywords: Calprotectin, ELISA, Immature neutrophils, Neonatal sepsis, NRBC
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Pages 25-30BackgroundThe cost-effective strategies are of paramount importance in the improvement of neonatal health services. Regarding this, the present study aimed to evaluate the health sector reform of the Islamic Republic of Iran and its impact on hospital costs related to the admission of neonates in Amirkola Children's Hospital.MethodsThis observational analytic study was conducted in 2015 to evaluate the hospital records of all neonates admitted to Amirkola Children's Hospital during late 2013 (before the implementation of health sector reform in Iran) and late 2014 (after the implementation of this reform).ResultsAccording to the results, the number of the neonates admitted to this center has increased by 11% after reform. Furthermore, the mean total hospital cost and share of insurance organizations have elevated by 2.2 and 2.5 fold, respectively. Mean of the cost paid by the patients has reached to 2.7 million Rials, which has had a 33% decrease, compared to that of the pre-reform stage. Additionally, 5.8% of the total expenditures related to neonatal inpatient cares were paid out-of-pocket.ConclusionAs the findings of the present study indicated, the health sector reform in Iran has increased the rate of neonatal admission and decreased the amount of direct payment by the people.Keywords: Children's hospital, Health sector reform, Neonatal care, Out-of-pocket payment
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Pages 31-37BackgroundPrenatal attachment and positive adaptation with the concept of motherhood play a pivotal role in maternal and fetal health. The present study aimed to evaluate the effect of the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model on maternal fetal attachment in the pregnant women referring to prenatal clinics.MethodsThis quasi-experimental study was conducted on 100 nulliparous women in their third pregnancy trimester (36-41 weeks), who referred to the selected prenatal clinics in Shiraz, Iran during 2011-2012. Intervention was performed based on the BASNEF model in six training sessions for 90 minutes. Data collection tools were the Cranleys maternal-fetal attachment scale and BASNEF model. Data analysis was performed in SPSS version 18 using Pearsons correlation-coefficient, independent t-test, and Chi-square at the significance level of 0.05.ResultsAfter the intervention, a significant difference was observed in the mean score of maternal-fetal attachment in the intervention group compared to the control group (PConclusionAccording to the results, training based on the BASNEF model could increase the maternal-fetal attachment in nulliparous pregnant women and improve the psychological health indicators of the neonates.Keywords: Attachment, BASNEF Model, Fetus, Mothers, pregnancy
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Pages 38-43BackgroundHypernatremia might lead to neurological and developmental disabilities. This study aimed to determine the frequency, risk factors, and one-year neurological prognosis of hypernatremia in newborns. The findings of the present study may assist the prevention of hypernatremia mortality and complications.MethodsThis cross-sectional study was conducted on all neonates admitted to the neonatal ward and the Neonatal Intensive Care Unit (NICU) of Bahrami Children's Hospital, Tehran, Iran from September 2013 to September 2014. All the newborns, who were diagnosed with hypernatremia (serum sodium>150 mEq/L) were included in this study. The data were collected using a form, which included clinical symptoms and risk factors for neonatal hypernatremia in addition to the laboratory data. Additionally, the patients were subjected to the developmental examination for one year. Another form was used during the follow-up period to collect all the relevant data.ResultsA total of 1,923 newborns were examined in the present study. The results demonstrated that 74 (3.8%) neonates had sodium levels of >150 mEq/L. Furthermore, jaundice was found to be the most prevalent presentation of hypernatremia, which was reported in 57% of the admitted neonates. Additionally, weight loss was the most common observation on the follow-up examinations. Neonates admitted at older ages (>7 days) had higher sodium levels (160.71±8.98 mEq/L). There were 18 neonates with seizures before or during the hospitalization and 19 (25.7%) cases showed abnormal development during the one-year follow-up. Moreover, a statistically significant relationship was observed between the abnormal development and the presence of seizure (OR: 2.543, CI: 1.358-4.763).ConclusionThe findings of the current study demonstrated the critical role of weighing the newborns 72-96 h after birth and monitoring for jaundice in the prevention of the neonatal hypernatremia. Furthermore, seizures in these patients were associated with an increased risk of future developmental problems; however, more studies are required in this regardKeywords: Hypernatremia, Neurologic manifestations, Newborn, Outcome assessment, risk factors
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Pages 44-47BackgroundJaundice is one of the most common findings in the neonatal period. In almost all the cases, neonatal jaundice occurs due to the elevated level of unconjugated bilirubin. Evidence is scarce regarding the association between magnesium and bilirubin levels in neonatal hyperbilirubinemia. The present study aimed to investigate serum magnesium levels before and after phototherapy.MethodsThis observational study was conducted on 65 neonates with jaundice, who were admitted to 17 Shahrivar Hospital of Rasht, Iran during September 2011-2012. Neonates with total serum bilirubin level of >20 mg/dL underwent phototherapy with 12 lamps. Magnesium levels were measured before and 24 hours after phototherapy. Data analysis was performed in SPSS version 19 using descriptive statistics (mean and standard deviation) and paired t-test at 95% confidence interval, and P-value of less than 0.05 was considered statistically significant.ResultsIn total, 65 neonates, including 37 boys (56.9%) and 28 girls (43.1%), were enrolled in the study. Mean magnesium level was significantly higher before phototherapy (2.07±0.33) compared to after phototherapy (1.81±0.27) (PConclusionAccording to the results, mean magnesium level was significantly higher before phototherapy compared to after phototherapy. However, physiological characteristics of magnesium were not assessed. It seems that the findings of the present study could lay the groundwork for further investigation in this regard.Keywords: Jaundice, Neonate, Magnesium, Phototherapy
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Pages 48-52BackgroundOpioids are used to relieve pain during labor and may affect the neurobehavioral conditions of infants. However, effects of using drugs, such as oxytocin, as a routine component of pre- and post-delivery care on the breastfeeding behaviors of newborns remain unclear. The present study aimed to investigate the association between the maternal use of oxytocin during labor and breastfeeding behaviors of neonates within two hours after birth.MethodsThis descriptive-analytical study was conducted on 160 women selected via convenience sampling. The participants were assigned to two groups of oxytocin administration (n=70) and physiologic delivery (n=90). Data were collected using demographic questionnaires and infant breastfeeding assessment tool (IBFAT). IBFAT was completed by the researcher through observing the behaviors of infants during breastfeeding after birth. Data analysis was performed in SPSS version 20, using descriptive and analytical statistics, including independent t-test, correlation-coefficients, and analysis of variance.ResultsMean age of the mothers in the oxytocin administration and physiologic delivery groups was 26.9±5.9 and 27.8±5.5 years, respectively. Breastfeeding was significantly stronger in the infants whose mothers had physiologic delivery compared to the group administered with oxytocin during labor.ConclusionAccording to the results, use of oxytocin during labor directly weakens the breastfeeding of neonates. Therefore, it seems necessary to inform and prepare women for physiologic delivery during pregnancyKeywords: Breastfeeding behaviors in infants, Labor, oxytocin, Physiologic delivery
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Pages 53-57BackgroundNeonatal screening is a preventive medical measure to screen infants shortly after birth for treatable metabolic disorders and endocrinopathies. The present study aimed to evaluate and compare the accuracy of laboratory samples in the screening programs for metabolic diseases in Mashhad city, Iran with international guidelines.MethodsThis observational study was conducted on all the patients referring to the health centers of Mashhad, Iran during two weeks. In total, 220 infants were enrolled in the study and divided into three groups of health center 1, 2, and 3. A checklist was prepared based on the international guidelines to evaluate the neonatal screening procedures.ResultsIn total, 220 neonates aged 3-14 days (90 girls and 130 boys) were enrolled in this study. Mean weight and height of the neonates was 3215.90±485.12 grams and 49.85±2.04 centimeters, respectively. In all the cases, mode of nutrition was breastfeeding, and sampling was performed within 36 hours after birth. Neonates had no history of corticosteroid administration, catecholamine administration, parenteral nutrition, and blood transfusion. Heels of the neonates had no contact with the filter paper, and the samples were dried away from direct sunlight and heat. Two of the health centers used disinfectants and dried the heels of infants afterwards prior to drawing the samples.ConclusionAccording to the results, the studied health centers followed the protocol properly. However, two of the health centers used disinfectants in such way that we were not sure whether the heels of the neonates were dried completelyKeywords: Health centers of Mashhad, Metabolic diseases, Neonatal screening
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Pages 58-61BackgroundNeonatal survival is one of the most important challenges today. Over 99% of neonatal mortalities occur in the developing countries, and epidemiologic studies emphasize on this issue in the developed countries, as well. In this study, we attempted to investigate the causes of neonatal mortality in Taleghani Hospital, Tabriz, Iran.MethodsIn this cross-sectional study, we studied causes of neonatal mortality in neonatal intensive care unit (NICU) of Taleghani Hospital, Tabriz, Iran, during 2013-2014. Data collection was performed by the head nurse and treating physician using a pre-designed questionnaire. Most of the data were extracted from the neonatal records. Information regarding maternal underlying diseases and health care during pregnancy was extracted from mother's records.ResultsA total of 891 neonates were admitted to NICU of Taleghani Hospital of Tabriz, Iran, during 2013-2014, 68 (7.5%) of whom died. Among these cases, 37 (%54.4) were male, 29 (29.4%) were extremely low birth weight, and 16 (23.5%) weighed more than 2.5 kg. The main causes of mortality were congenital anomalies (35.3%), prematurity (26.5%), and sepsis (10.3%), respectively.ConclusionCongenital anomaly is the most common cause of mortality, and the pattern of death is changing from preventable diseases to unavoidable mortalitiesKeywords: Causes, Neonatal mortality, NICU, Tabriz
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Pages 62-65BackgroundHospitalization of infants in the neonatal intensive care unit (NICU) may disrupt the proper interaction with infants and lead to anxiety and depression, while adversely affecting the role of families. Therefore, it is necessary for healthcare teams to be familiar with the principles of parental mental health in the NICU. The present study aimed to codify the principles of parental mental health in the NICU.MethodsThis study was conducted with a triangulation methodology in two steps. In the first step, the principles of mental health care for parents in the NICU were compiled and translated. In the second step, the principles were edited using the Delphi method based on the opinion of experts (physicians, faculty members, and health policymakers). Final principles of parental mental health in the NICU were codified.ResultsIn total, four general principles of holistic care, relationship with parents in the NICU, special care for establishing communication with families in the NICU, and principles of infants and family care were obtained.ConclusionSince healthcare teams may not be familiar with the principles of parental mental health in the NICU, the results of the present study could lay the groundwork for promoting the knowledge of healthcare team members in interaction with parentsKeywords: Healthcare Team, NICU, Mental Health of Parents
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Pages 66-71BackgroundInfantile colic is defined as episodes of extreme and excessive crying due to unknown causes. Various results have been reported regarding the management of colic with probiotics in terms of effectiveness, with no side effects or health risks in the infants. The present study aimed to evaluate the effect of probiotics on the infants with colic using the quadratic inference functions (QIF).MethodsThis single-blind, randomized, clinical trial was conducted on 98 infants admitted to the pediatric gastroenterology clinic of Bu Ali Sina Hospital in Sari, Iran. The neonates were diagnosed with infantile colic by a pediatric gastroenterologist. Patients were randomly divided into two groups (49 subjects per each). In the control group, the infants received placebo, and in the case group, the neonates were administrated with BioGaia probiotic oral drops for 21 days. The QIF method was fitted to analyze the influential factors in the improvement of infantile colic.ResultsAccording to the QIF results in data analysis, mean duration of crying had a significant difference between the infants in the case and control groups (PConclusionAccording to the results of longitudinal data analysis, use of probiotics in the evolving gut could reduce infantile colic and improve the quality of life in the studied neonatesKeywords: Infantile colic, Probiotics, Quadratic inference functions
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Pages 72-74BackgroundMaple syrup urine disease (MSUD) is an inherited branched-chain amino acid metabolic disorder caused by the deficiency in the branched-chain alpha-keto acid dehydrogenase (BCKD) complex. In MSUD, elevation of the branched-chain amino acids, such as alpha-keto acid and alpha-hydroxy acid, occurs due to the BCKDC gene deficiency, appearing in the blood, urine, and cerebrospinal fluid, which leads to neurological damage and mental retardation. MSUD phenotypically penetrates due to the mutations in the coding genes of four subunits of the BCKD complex, including the BCKDHA, BCKDHB, DBT, and DLD genes.
Case report: We aimed to report the cases of three families whose children were affected by MSUD and presented with symptomatic features during the first week of birth, which were identified by mass spectrometry. DNA study was performed as a diagnosis panel containing four encoded BCKDC subunit genes.ConclusionIn the current study, DNA analysis and phenotypic manifestations indicated a novel mutation of c.143delT, p.L48Rfs*15 in the BCKDHA gene in a homozygous state, which is a causative mutation for the classic MSUD phenotype. Early diagnosis and neonatal screening are recommended for the accurate and effective treatment of this diseaseKeywords: BCKD deficiency, DNA mutational analysis, Maple syrup urine disease -
Pages 75-77BackgroundSpontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare findings in children. Various etiologies have been reported for SPM, such as foreign body aspiration in infants, especially in those aged less than three years. In addition to the complications associated with foreign body aspiration, SPM may also become a life-threatening condition if left untreated. In the present report, we discussed a case of subcutaneous emphysema, pneumothorax, and pneumomediastinum in a 13-month-old infant previously treated for pneumonia.
Case report: The infant was initially presented with subcutaneous emphysema of the neck, without respiratory distress following pneumonia. In the chest radiography, mediastinal shift and possible pneumothorax were reported, and a chest tube was inserted as the respiratory condition deteriorated. Emergency bronchoscopy showed a foreign body logged in the left respiratory tract, which was removed. Three days later, the chest tube was detached, and the patient was discharged in healthy conditions within the next two days.ConclusionPediatricians constantly need to consider the risk of foreign body aspiration, particularly in the presence of respiratory complications, such as SPM, even in the infants with an unreliable history of foreign body aspirationKeywords: Foreign Bodies, Pneumothorax, Subcutaneous Emphysema -
Pages 78-81BackgroundOne-third of all major congenital anomalies are Congenital heart disease (CHD) and Reported CHD prevalence increased over time and in Asian countries is more than western countries. Ectopia cordis (EC) is a rare congenital anomaly with an estimated incidence of 1:100 000 live births in developed countries. EC is characterized by abnormal heart placement outside the thorax, mostly on the thoracoabdominal side. This form is often associated with pentalogy of Cantrell.
Case report: We report one cases of the ectopia cordis at the Emam Reza Hospital in Mashhad. In this report, a rare case with incomplete pentalogy of Cantrell are described. It was a boy with a large omphalocele with evisceration of the heart. He had normal capillary refill and responded to stimuli. This patient was a male fetus with ectopia cordis with intracardiac anomalies; a large omphalocele with evisceration of the heart; a hypoplastic sternum and rib cage.ConclusionPrognosis seems to be poorer in patients with the complete form of pentalogy of Cantrell, EC, and patients with associated anomalies. Intracardial defects do not seem to be a prognostic factorKeywords: Congenital heart disease, Ectopia cordis, Neonate