فهرست مطالب masoud dehdashtian

 One of the leading causes of neonatal mortality in low- and middle-income countries (LMICs) is neonatal sepsis caused by carbapenem-resistant gram-negative bacteria.

 This study aimed to determine the frequency, bacterial profile, and outcome of carbapenem-resistant Gram-negative neonatal sepsis in southwest Iran.

 This 15-month retrospective cross-sectional descriptive study was conducted at a level 3 referral training hospital. The study included all neonates hospitalized from birth who had positive blood cultures for Gram-negative bacteria. Patients were divided into carbapenem-resistant and carbapenem-sensitive groups.

 During the study, Gram-negative bacteria were isolated from the blood cultures of 113 neonates. Positive Gram-negative bacteria blood cultures and carbapenem-resistant cases were 2.38% and 1.52%, respectively. In these cases, 66 (58.4%) of the infants were males, 100 (88.4%) were preterm, and 74 (65.4%) required mechanical ventilation within the first three days of life. The study found 45 (39.8%) infants with early-onset sepsis. Acinetobacter was the most common isolated organism, while Enterobacter had the lowest isolation rate. Carbapenem resistance was discovered in 72 (63.7%) positive blood cultures. Acinetobacter had the highest prevalence of carbapenem resistance, while Pseudomonas had the lowest. Mortality rates in infants infected with carbapenem resistance bacteria (CRB) were 89.3% compared to 10.7% in those infected with carbapenem-sensitive bacteria (CSB).

 The frequency of carbapenem-resistant Gram-negative sepsis in our ward was 1.52 percent of all admissions, and Acinetobacter bacteria was the most common cause of this type of neonatal sepsis. Infants infected with CRB had a higher mortality rate than those infected with CSB, 89.3% versus 10.7%.

 Early-onset neonatal sepsis (ENOS) is one of the most common causes of mortality in neonates. The bacteria causing ENOS are generally transferred from the mother to the infant before or during labor.

 This study aimed to determine the prevalence rate of nasopharyngeal colonization with common bacterial agents causing ENOS and their relationship with blood culture outcomes in neonates.

 All neonates transferred to the neonatal intensive care unit were included in the study. Posterior pharynx secretions were swabbed and cultured in blood agar and MacConkey agar. Also, a blood specimen from each neonate was inoculated into a blood culture bottle. The grown bacteria were identified by biochemical standard tests. The antibiotic sensitivity test was performed by the disk diffusion method using Mueller-Hinton agar, and the results were evaluated according to the CLSI guidelines.

 The pharyngeal specimens collected from 114 newborns were positive in 83 (72.8%) cases. Staphylococcus epidermidis was the most common bacterium in all weight groups. However, the isolates of Klebsiella, Escherichia coli, S. aureus, and Streptococcus agalactiae were also high. Thirteen newborns died. Neonates’ pharyngeal specimens were positive among 11 (84.6%) cases who died and 101 (71.2%) neonates who survived. Twelve neonates had positive blood cultures. Simultaneous positive blood and pharyngeal cultures were reported in eight (7%) cases, in which the bacterial isolates from blood and pharyngeal samples were similar in three cases (37.5%). Among pharyngeal isolates, E. coli was resistant to ampicillin in 100% and gentamicin, cefotaxime, and ceftazidime in 50% of the cases. Also, S. epidermidis and Acinetobacter isolates from blood samples were resistant to ampicillin in 100% of the cases.

 Staphylococcus epidermidis accounted for 38.6% of bacteria cultured from pharyngeal swabs and 66.7% of bacteria cultured from blood samples, 37.5% of which were resistant to ampicillin and 100% were sensitive to vancomycin. One-hundred percent of E. coli cultures from neonatal pharynges were resistant to ampicillin and about 50% of them were resistant to gentamicin, cefotaxime, and ceftriaxone.
 

Supraventricular Tachycardia (SVT) is the most frequent arrhythmia requiring a medical treatment in neonates.
The aim of our study was to evaluate and manage neonatal supraventricular tachycardia.
This study was performed on 22 newborns that were diagnosed with SVT at two neonatal intensive care units (NICU) in south west of Iran from October 2012 to October 2015. Data on gender, age, weight, maternal age, gestational age, presence of congenital heart disease, blood pressure in admission, duration of hospitalization period, duration of SVT, medicine for the control of SVT, list of medicine administered at releasing time were collected. Echocardiography was performed for all patients. Data was analyzed by the SPSS version 18 software.
Twelve neonates were male (54.5%) and ten (45.5%) were female. The mean age was 11.68 ± 8.17 days. Three neonates (13.6%) had congenital heart disease. The mean duration of hospitalization was 6.54 ± 3.98 days. Nine patients (41%) only had responded adenosine. One patient had hypotensive that received D/C shock.
We concluded that in most SVT patients, conventional treatment can be helpful and an only minor percentage of patients need to receive flecainide as the last line of treatment.

The incidence of Transient Tachypnea of Newborn (TTN) is higher in infants born by cesarean section than with vaginal delivery. Treatment of transient tachypnea of newborn is supportive. The purpose of this study was to assess the effect of restricted fluid volume intake on the course of respiratory distress in patients with TTN. This is a quasi-experimental clinical trial of 83 neonates diagnosed with TTN admitted to a neonatal intensive care unit in south west Iran. In this study the effect of restriction of maintenance fluid volume in the course of respiratory distress in newborns with transient tachypnea was assessed. In the standard fluid volume intake group 18 (42.8%) cases needed nasal continuous positive airway pressure (NCPAP) and one (2.38%) case mechanical ventilation, and in restricted fluid volume intake group 13 (32.5%) cases needed NCPAP and two (5%) cases mechanical ventilation. 54.82% of cases were supported with oxyhood in the standard fluid volume and 62.5% in the restricted fluid volume intake group. Differences in duration of the needed NCPAP and oxygen hood between the two groups were significant. Fluid restriction had no adverse effect on the urine specific gravity or weight loss of the studied newborns. Limited fluid administered to newborns with transient tachypnea of newborn is safe and resulted in shorter duration of respiratory support.

Diazoxide is the main therapeutic agent for congenital hyperinsulinism. The drug is generally well tolerated; however, in this report severe adverse effects including heart failure (HF) and pulmonary hypertension (PH) in an infant are reported.Case report: A sixteen-day male infant with persistent hypoglycemia and with diagnosis of congenital hyperinsulinism underwent near total pancreatectomy. Despite surgery, hypoglycemia persisted, and thus oral dizoxide 5 mg/kg/dose three times per day was administered. At four months of age, the patient was again admitted to the hospital because of respiratory distress and poor feeding from a week earlier. On physical examination, he was tachypneic and mild intercostal retraction was present. Tachycardia existed without definitive murmur. Moderate hepatomegaly was detected. Chest X-ray revealed cardiomegaly. Echocardiography showed right atrial and ventricular dilatation, and pulmonary pressure of 70 mmHg. In the next day, respiratory failure developed and so the patient was intubated and mechanically ventilated. Diazoxide was discontinued and 10% dextrose water (DW) was initiated. Four days later, the patient was extubated. Blood glucose remained in normal limit. Gradually the concentration of DW was decreased. The patient was discharged and followed up without any medication. Echocardiogram in one month later showed normal heart dimension and reduction of pulmonary pressure to 20 mmHg, and resolution of right atrial and ventricular enlargement. Diazoxide reduces peripheral vascular resistance and blood pressure as the result of direct vasodilatory effect on smooth muscles in peripheral arterioles. It causes sodium and water retention and decrease of urinary output which can result in expansion of plasma and extracellular fluid volume, and consequently edema and congestive cardiac failure. Diazoxide therapy for infants with congenital hyperinsulinism is associated with the threat of PH and HF. Periodic echocardiography may be helpful for the infants under long term diazoxide therapy.

This study evaluates the frequency of diabetes complication in infants of diabetic mothers (IDMs), and investigates its relationship with patients’ follow-up care and maternal glucose control. Diabetic Mothers who delivered in Ahvaz Imam Khomeini Hospital in 2011 were given questionnaires to gather data on gender of infants, gestational age, type of diabetes (overt versus gestational), birth weight, birth trauma, Apgar score, respiratory distress, neonatal blood glucose, congenital anomalies, LBW and the way the mothers controlled their diabetes (follow-up visits to gynecologist, internist or endocrinologist and maternal glucose control). For each infant of a diabetic mother, one non-diabetic was chosen as a positive control. Out of 199 diabetic mothers, 151 (76%) suffered from gestational diabetes and 48 (24%) had overt DM. Low birth weight was present in 35 (18%) of neonates, macrosomia in 22 (11%), neonatal trauma in 10 (5%), respiratory distress in 28 (15%), congenital anomalies in 8 (4%) and hypoglycemia in 63 (32%). Rate of C/S, hypoglycemia, preterm labor and macrosomia were significantly higher in the diabetic group (P: 0.0001, 0.0001, 0.001 and 0.046 respectively). 130 mothers (66%) had regular follow-up visits and 66 (33%) had maternal glucose control, out of whom only 24 (12%) had correct and regular glucose control. Hypoglycemia and congenital anomalies had a significant lower rate in neonates of mothers with a regular visit (P: 0.001and 0.02 respectively). Maternal glucose control leads to significant reduction in the rate of congenital anomalies (P: 0.04). Regular visits of diabetic mothers and maternal glucose control can improve pregnancy outcome and decrease congenital anomalies and neonatal hypoglycemia.

To compare the trend of increase of growth indices among infants with low birth weight and infants with normal birth weight in the first 6 months of life. Subjects and One hundred and thirty five low birth weight infants and 135 infants with normal birth weight were compared during a one-year study period 2009) and their demographic data included birth body weight، length and head circumference at birth، 2، 4 and 6 months of life، type of diet، birth number، sex، type of their mother''s marriage and educational state were collected by a questionnaire trend of increase of growth indices among In first 6 months of life، in the LBW group the mean body weight was 5127±1076 g (p=0/001)، mean body length was 17. 8±3 cm (p=0. 013) and mean head circumference was 9. 1±1 cm (P<0. 001)، which was more than group with normal birth weight. In both groups، the average body weight، length and head circumference in males was higher than females. In the LBW group، the mean body weight in infants fed with breast milk was higher than infants fed with formula milk at age of 2 months. This study showed that although mean increase of growth indices in infants with low birth weight is similar to average growth state in infants with normal birth weight، but still growth of this group at end of 6 months of age is less than group with normal birth weight.

The elevated Mean Corpuscular Hemoglobin Concentration (MCHC) were reported in neonates with hereditary spherocytosis. The aim of this study was to assess the reliability of elevated MCHC as a screening test for the diagnosis of hereditary spherocytosis in newborns. Methods and Material: We revised records of 1301 neonates with diagnosis of severe hyperbilirubinemia from September 23, 2009 to September 22, 2011. The cases with MCHC ≥ 36g% were selected. Osmotic fragility test and cell blood counts were performed for cases that were enrolled in the study.Statistical analysis used: Statistical analyses were performed using Statistical Package for Social Sciences, version 15.0 (SPSS, Inc., Chicago, IL, USA). Chi-square test and T-correlation analysis were used for statistical analysis Out of a total 1301neonates with severe hyperbilirubinemia, 59 of them had MCHC ≥ 36 g%. Fifty two of 59 selected neonates were finally studied. All of them had MCHC ≤ 35.7g% and a normal osmotic fragility test. Elevated MCHC is not a reliable screening test for the diagnosis of hereditary spherocytosis in neonates with severe hyperbilirubinemia or anemia.

Atopic dermatitis is an inherited, chronic and relapsing skin disease. Although it is generally believed that breast-feeding has a protective effect on developing asthma and atopic dermatitis, nowadays, some researchers question this idea and suggest that breast feeding may be a risk factor for atopic dermatitis. The purpose of this study was to determine the effect of exclusive breast feeding in the first 6 month of life on development of atopic dermatitis in infants till one year of age. Subjects and In this retrospective cohort study, parents of infants who visited four health centers in ahvaz, the capital of Khozestan province, Iran, for MMR vaccination at 12 months of age were questioned about the kind of their infants feeding till 6 months age. Infants were divided to two groups, exclusive and non-exclusive breast- fed. The number of cases for each group was followed till 511 infants were reached. Frequency of atopic dermatitis in each group was investigated. Atopic dermatitis was noted in 22.3% of them. The prevalence of atopic dermatitis in non-exclusive breast fed infants was higher (P<0.001). The frequency of atopic dermatitis in exclusively and non-exclusively breast-fed infants was 15.35 and 29.25 % respectively. Odds ratio for exclusively breast fed infants was 19.36%, 95%CI (11.35%-19.58%) and for non-exclusively breast fed infants was 29.64%, 95%CI (25.26-34.07). Exclusive breast feeding not only decrease the frequency of atopic dermatitis in infants, but also decrease the risk of development of atopic dermatitis in infants with positive family history for atopia.

It is well recognized that hearing is critical to speech and language development, communication, and learning. Otoacoustic emission (OAE) is an efficient and sensitive method to identify subjects at risk for auditory impairment. Infants who require admission to neonatal intensive care unit are reported to be at 10-20 times greater risk for hearing impairment. The porpuse of this study was to investigate the incidence of hearing impairment in neonates screened by OAE. In a cross-sectional study, 148 newborns having risk factors for hearing impairment reffering to Taleghani hospital of Arak and Aboozar hospital of Ahwaz were evaluated. All clients had normal otoscopic findings. Transient evoked (TEOAE) and distortion-product otoacoustic emissions (DPOAEs) were measured in both ears. If the results of otoacoustic emissions were not normal, these tests were repeated one month later. Patients who did not pass the second stage were reffered for comprehensive auditory evaluations. Data analysis was performed using Kolmogrov-Smirnov and t-tests. 41 and 28 cases could not pass the examining test at the first TEOAE and DPOAE examination, respectively. Also, 23 and 16 cases did not pass the examining test at the second TEOAE and DPOAE evaluations, respectively. These participants underwent auditory brainstem response evaluation and 11 of them had abnormal responses. In 5 cases of confirmed ones, hearing impairment was due to aminoglycoside side effects. OAE hearing screening of at-risk newborns is a clinically beneficial approach to early detection of hearing impairment. Regarding the high prevalence of hearing loss in our subjects (7.43%), prevention of its complications is highly recommended in this population.