neonates

Evidence suggests that neonates exhibit heightened pain perception and increased sensitivity to its long-term effects compared to older infants. This study aimed to compare the effects of expressed breast milk and formula on behavioral and physiological responses, as well as crying duration, during the intramuscular administration of the Hepatitis B vaccine in newborns. In this randomized clinical trial, 60 healthy term neonates were allocated into three groups and evaluated during the intramuscular injection. The control group received injections following the standard ward procedure. In the first intervention group, neonates were administered 2cc of breast milk, while in the second intervention group, they received 2cc of formula via a syringe two minutes prior to the injection. Behavioral and physiological responses, along with crying durations, were documented using video recording and pulse oximetry. Data analysis was conducted using ANOVA, Kruskal-Wallis, Mann-Whitney, and chi-square tests. A significant difference was observed in the duration of crying (p = 0.03) and behavioral responses to pain during the injection (p = 0.04) among the groups. Expressed breast milk was found to reduce behavioral measures and crying duration during intramuscular injection in term neonates. Consequently, this simple, effective, accessible, and cost-free method can be employed to mitigate the adverse effects of pain in neonates.

Baby in mother’s womb depends on placental circulation for glucose. During birth,
the clamping of the umbilical cord abruptly curtails the glucose supply from the placenta and
thus neonates are more prone to develop hypoglycaemia and is preventable if we aware of the
maternal and neonatal risk factors. This study aimed to identify the incidence of hypoglycaemia
and its risk factors.

A prospective observational design was carried out among 115 neonates in neonatal
intensive care unit (NICU) during December 2021 to January 2022. Convenience sampling
technique was used to enrol the neonates who met the inclusion criteria. Neonatal and maternal
clinical characteristics, incidence, risk factors of hypoglycaemia, were collected by direct
observation and from medical record. Data were analysed using chi-square test, t test and
logistic regression with SPSS software version 25.

The incidence of hypoglycaemia was 30.4% .20.8 % had single episode and 9.6%
had multiple episodes. Mean (SD) lowest blood glucose value was 11.31 (17.91). Mean (SD)
age at which first episode detected was 6.33 (16.05) hours. Predominant symptoms were
jitteriness, lethargy and convulsion. Hypothermia, sepsis, prematurity, small for gestation, intra
uterine growth retardation, birth asphyxia, history of poor feeding, birth weight, twin pregnancy,
gestational diabetes mellitus were associated with neonatal hypoglycaemia significantly.

Incidence of neonatal hypoglycaemia can be minimized by identifying the risk factors,
adhering close monitoring and by early treatment. This will prevent poor neurodevelopmental
outcome

Data on congenital heart diseases in neonates, especially critical congenital heart disease, varies worldwide. Developing countries have higher mortality than developed countries. To study the clinical profile of congenital heart diseases in neonates. Prospective observational study. Neonates admitted to a tertiary care hospital with congenital heart disease. Clinical details, investigations, and management of neonates admitted to a tertiary care hospital were studied prospectively. Among the study neonates, 60% had acyanotic heart disease, the most common being ASD, while 40% had cyanotic heart disease, the most common being TGA—outborn cases comprised 60% of the total neonates. The most common presenting features were fast breathing and cyanosis; the most common clinical sign was murmur(59%). Among the study neonates, 15 cases had low calcium levels. Definitive surgery was done in 21 neonates, of which 7 succumbed. The staged repair was done in 9 neonates, of which 2 succumbed. Of 12 TGA cases,10 underwent definitive repair, and 7 did well at follow-up. Among the 10 TOF babies, 6 underwent staged repair. Out of the 7 cases of CoA, 6 underwent definitive surgery, and 1 expired. Among Critical CHD, mortality was 23.3%. The most common cyanotic heart disease was ASD, and the most common cyanotic heart disease was TGA. Surgery was done in 30 cases, out of which 9 succumbed, and mortality among surgical cases was 30%. At follow up TGA  cases with definitive surgeries were doing well. Mortality was lower compared to other studies in India. Hypocalcemia was observed in 16.6% of the CHD cases, which needs to be studied in the future.

Approximately 20 million low-birth-weight infants are annually born worldwide. Prematurity and low birth weight are significantly linked to infant mortality rates. Neonates in neonatal intensive care units are often separated from their mothers, leading to a lack of parental involvement in care, which poses numerous risks and threats.Kangaroo mother care has been identified as an alternative method that can mitigate these risks. This semi-experimental clinical trial examined the effects of independent variables (kangaroo mother care and incubator care) on dependent variables (body temperature, weight gain, exclusive breastfeeding, and physiological measures) in 130 low birth weight infants admitted to the neonatal intensive care unit at Tehran Imam Hussein Hospital during 2019-2020. This study observed an increase in maternal presence at the hospital. There were no significant differences between the two groups of mothers in terms of quantitative variables such as maternal age, number of pregnancies, and length of maternal hospital stay post-delivery. The average duration of kangaroo mother care was 12 ± 8.7 days, No differences were found between the two groups in variables such as gestational age, Apgar score, and weight and height at birth, at stability, and at discharge. This study demonstrated that kangaroo mother care reduces mortality, promotes exclusive breastfeeding, enhances emotional bonding between parents and neonates, reduces sepsis and patent ductus arteriosus, and shortens the duration of antibiotic use. This study supports the development of guidelines for educational programs to incorporate this alternative care method in neonatal intensive care units.

 Neonatal acute respiratory distress syndrome (NARDS) is an important cause of hypoxemic respiratory failure. This study aimed to investigate the short-term effects of endotracheal surfactant and budesonide combination therapy on NARDS secondary to late-onset neonatal sepsis (LONS).

 This was a retrospective, cross-sectional, and observational study. Newborns with NARDS due to LONS who received endotracheal surfactant and budesonide combination therapy between August 2022 and September 2023 were included in this study. Oxygenation status before endotracheal surfactant and budesonide treatment were compared with the values obtained two hours after treatment.

 Among 20 neonates, 10 (50%) were diagnosed with severe NARDS, and 10 (50%) were diagnosed with moderate NARDS. The mean corrected gestational age was 33.3±2.9 w when endotracheal surfactant and budesonide were administered to the neonates. The need for the fraction of inspired oxygen (0.75 [0.57-1.00]% vs. 0.55 [0.44-0.80]%; mean difference [MD]: 17.50%, 95% confidence interval [CI]: 14.99 to 22.50) and oxygen saturation index (OSI; 8.03 [4.98-13.94] vs. 4.71 [4.11-8.93]; MD: 2.23, 95% CI: 1.22 to 3.24) decreased (P=0.001 and P<0.001, respectively) after endotracheal surfactant and budesonide treatment. However, preductal oxygen saturation (SpO2 ; 93 [91-94]% vs. 95 [94-96]%; MD: -3.50%, 95% CI: -5.00 to -2.00) increased significantly after endotracheal surfactant and budesonide treatment when compared to pre-treatment values (P<0.001).

 The reduction in oxygen demand and OSI, along with an increase in SpO2 after treatment compared to pre-treatment values, suggests that endotracheal surfactant and budesonide combination therapy could be an effective option to improve oxygenation in NARDS secondary to LONS.

This study attempted to compare radiographic findings with that of the ultrasound in locating the central line tip and evaluate the agreement between these two diagnostic modalities. This hospital-based Prospective Observational Comparative Diagnostic Accuracy Test study was conducted on 51 neonates, in the NICU of a tertiary health care centre. A consecutive sampling technique was used for the neonates included in this study. The central catheter (umbilical vein catheter / peripherally inserted central catheter) was inserted. After the central line insertion, a thoracoabdominal X-ray was done to identify the catheter tip position as the standard protocol.  USG assessment of the central line tip position was also done. Out of the 51 central lines studied, 49 were UVC and 2 were PICC line insertion. USG was able to identify all the malpositioned (n=38) and optimally placed central line tips (n=10) as in X-ray and also additionally identified the three doubtful tips on X-ray as malpositioned (n=1) and optimally placed (n=2). X-ray showed that 78.5% of UVCs were low lying and 66.6% were in intrahepatic IVC as identified by USG. Among the procedure-related complications, post X-ray more complications were noted, the most common being hypothermia. Our study results show that Point Of Care Ultrasound is a safer, more efficacious, and quick bedside diagnostic test compared to the conventional radiography in detecting central line tip position in neonates, helping pediatricians to quickly confirm the central line tip position before starting infusions.

Neonatal mechanical ventilation has contributed to a significant decline in neonatal mortality but is associated with various complications. It is necessary to identify the prognostic factors and their management to reduce the complications in mechanically ventilated neonates. Therefore, this study was designed to investigate the common indications, complications, and predictive factors associated to immediate outcomes in neonates from rural North India who received invasive mechanical ventilation.
This study includes all neonates admitted to the neonatal intensive care unit requiring invasive mechanical ventilation for at least 12 hours. All enrolled neonates were categorized into two groups: those who were successfully extubated were labeled as survivors, while those who did not survive during ventilation were classified as non-survivors. Clinical and ventilator parameters, as well as the occurrence of complications were analyzed to identify factors associated with outcomes in ventilated neonates.
A total of 150 neonates who met the inclusion criteria were enrolled. The most frequent reason for ventilation was perinatal asphyxia. Among ventilated neonates, the mortality rate was 38.7%. When comparing survivor and non-survivor groups, a significant difference was observed in birth weight, gestational age, indication for ventilation, duration of ventilation, and blood acidosis (with a p-value < 0.05). Additionally, non-survivors experienced a higher prevalence of complications, including sepsis, shock, air leak syndrome, and pulmonary hemorrhage. Multivariate analysis revealed that gestational age less than 34 weeks, initial blood pH of 7.1 or lower, ventilation duration exceeding 72 hours, and the presence of sepsis, shock, or disseminated intravascular coagulation were significant independent predictors of mortality in ventilated neonates.
The mortality among ventilated neonates is still high in developing countries. Hospital acquired sepsis with shock is still the major complication among ventilated neonates. Early identification of risk factors for mortality and timely intervention may decrease the mortality.

Cerebral venous sinus thrombosis (CSVT) is a relatively rare condition characterized by seizures, cerebral edema, lethargy, and encephalopathy. In neonates, lethargy often indicates central nervous system (CNS) dysfunction, necessitating a comprehensive evaluation for various potential diagnoses including cerebrovascular accidents, infections, and metabolic disorders. Non-ketotic hyperglycinemia (NKH) is an autosomal recessive disorder, also known as glycine encephalopathy, resulting from a deficiency in the enzyme responsible for glycine catabolism. This leads to elevated levels of glycine in the blood, urine, and cerebrospinal fluid (CSF), accompanied by severe seizures, hypotension, hiccups, apnea, and progressive lethargy, which may progress to encephalopathy or even death.

Case Report: 

This report presents the case of a 3-day-old neonate admitted to the hospital with opioid toxicity, displaying reduced metabolic activity. Despite initial suspicion of ketotic hyperglycemia, further investigation revealed the presence of cerebral sinus thrombosis in addition to NKH.

This case underscores the complexity of neonatal presentations and highlights the importance of considering multiple differential diagnoses, especially when faced with unusual or overlapping clinical features. Early recognition and appropriate management of CSVT and NKH are crucial in improving outcomes for affected neonates.

Due to the novelty of COVID-19, no definite treatment has yet been found for this infectious disease, especially in neonates and early infants. Although most of the neonates affected by this virus have a mild or silent course of the disease, in the severe form, there is no approved antiviral drug. This study was done to evaluate the safety and efficacy of Remdesivir as the known effective antiviral drug in both adults and children’s populations. In this case series study, we present our experience of the administration of Remdesivir in the treatment of 15 infants with severe neonatal COVID-19, with severe respiratory distress, admitted to our neonatal intensive care unit. We prescribed the drug with a 2 to 3-hour infusion of a loading dose of 5 mg/kg on day 1, followed by 2.5 mg/kg/day 4 days later, concomitant with continuous cardiac monitoring and blood pressure monitoring every 15 minutes. Fortunately, no side effects were reported either during or after the administration of the drug. Long-term patient follows up, for 10 months after birth, did not reveal any particular complications. It seems that the use of Remdesivir to treat severe forms of neonatal and early infancy COVID-19 is safe and effective.

Our study aimed to compare the twice-weekly and three-time weekly prophylactic fluconazole regimens among low birth weight premature neonates.
Premature neonates (40 cases) were divided into two groups and received two and three-times-weekly fluconazole regimens for three weeks. Surveillance of fungal colonization was performed before treatment and twice weekly.
Fungal colonization occurred in 11 infants in group A and 4 infants in group B (55% vs. 20%, p=0.022). In both groups, the rectum was the most common site of colonization. Candida glabrata, Candida orthopsilosis and, Candida albicans were the most commonly isolated species in both groups. There were no significant differences between the two groups regarding birth weight, gestational age, and other baseline risk factors for fungal colonization.
In this study, the three-times-weekly administration of prophylactic fluconazole appears to be more effective in preventing fungal colonization than the twice-weekly regimen among premature neonates.

Clinical assessment of newborns in the first minutes after birth is a challenge in neonatal medicine. The aim of this study was to compare the diagnostic value of the combined and conventional Apgar scoring systems in identifying poor short-term outcomes in newborns

This prospective cohort study evaluated 660 newborns at Ayatollah Rouhani Hospital of Babol-Iran (a tertiary referral hospital), from October 2021 to November 2022. After birth, the 5th-minute conventional and combined Apgar scores were recorded. the newborns were followed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the sensitivity and specificity of the Apgar scores to predict short-term outcomes (mechanical ventilation requirement, occurrence of intraventricular hemorrhage, neonatal mortality, and retinopathy of prematurity).

Out of 660 newborns 373 (56.5%) males and 287 (43.5%) females), Fifty-seven (8.6%) newborns had IVH, 46 (6.97%), were diagnosed with ROP, 40 (6.1%) newborns required mechanical ventilation, and 41 (6.21%) died. The AUC of combined Apgar for predicting ROP and IVH (82% and 76% respectively) and the AUC of conventional Apgar for predicting death and mechanical ventilation (90% and 85% respectively) was higher than the others.

The conventional Apgar score was better than the combined Apgar score for predicting mechanical ventilation requirement and death. When infants were grouped by gestational age, none of theApgar scores was a good predictor of ROP. Also, Apgar was only a good predictor of IVH at gestational ages greater than 34 weeks, of which combined Apgar is better than the others.

Jaundice is common in infants and occurs because of hyperbilirubinemia, which can lead to brain injury in neonates. Phototherapy, in addition to its serious side effects, does not seem to be enough in resolving jaundice. This clinical trial aims to compare the efficacy of orlistat and phototherapy combination therapy with that of phototherapy alone in the treatment of neonatal jaundice.

This clinical trial was performed on 120 term neonates with jaundice. Block randomization was used to allocate the infants to the intervention and control groups. The intervention group received orlistat (4 mg/kg body weight) for three consecutive oral doses at the first, second and third day of hospitalization, along with phototherapy. The control group received a placebo and phototherapy. Total and direct plasma bilirubin levels were measured at baseline (before intervention) as well as 24 and 72 h after treatment.

There were no statistically significant differences between the two groups in terms of infant sex, weight, or age. The mean total and direct bilirubin levels in the experimental group did not change compared to those in the control group at the end of the trial (10.44±1.35 vs. 10.6±2.8 and 0.4±0.1 vs. 0.5±0.1, respectively).

Orlistat appears to be ineffective in accelerating bilirubin reduction in neonates with jaundice, at least for the first three days of life.

Blood pressure measurement in newborns using conventional auscultatory and palpatory methods is technically difficult. As a result, different blood pressure measuring devices such as oscillometric and doppler devices have been developed. However, in resource challenged environments, these devices are not widely available unlike pulse oximeters which are relatively cheap and portable. Thus, the objective of this study was to investigate the reliability of using the pulse oximeter in measuring systolic blood pressure in normal, term neonates whilst comparing it to oscillometric and doppler/aneroid blood pressure measuring devices.
This was a prospective, cross-sectional study involving 192 healthy terms, appropriate for gestational age neonates who were recruited. Their systolic blood pressures were measured simultaneously using oscillometry, doppler/anaeroid sphygmomanometer and pulse oximetry at 12-hour intervals for the first 48 hours of life.
One hundred and eighty-five babies were analyzed. Mean systolic blood pressure readings using doppler with anaeroid sphygmomanometer was 60.35(SD 2.27), by Oscillometric device, it was 69.83 (SD 12.55) and by pulse oximetry 55.08 (SD 2.11). Systolic blood pressure readings using a pulse oximeter were significantly lower compared to the other methods and the degree of absolute agreement between the rating instruments was poor especially with oscillometric measurements where the level of agreement further declined with time.
Pulse oximetry is a better alternative to oscillometry in systolic blood pressure measurement in newborns especially in resource challenged environments but it cannot be used interchangeably or substituted for doppler anaeroid systolic blood pressure measurement

 Sepsis is one of the most dangerous neonatal infections. Bacterial causes of neonatal septicemia are different.

 This study aimed to investigate the prevalence and antibiotic resistance pattern of microbial agents causing preterm neonatal sepsis.

 This descriptive study was performed on 1000 infants admitted to neonatal intensive care units 1 and 2 and the neonatal ward of Al-Zahra Medical Center in Tabriz, Iran, from March 2019 to June 2020. Sampling was completed through the convenience sampling method. Data were collected using a researcher-made questionnaire after evaluating its validity and reliability. The questionnaire included personal information of neonates, causes of infection, antibiotic use, hospitalization time, and medication resistance pattern. Antibiotic susceptibility testing was performed by disk diffusion technique according to the Clinical and Laboratory Standards Institute guidelines. SPSS software version 22 was used for data analysis.

 Among all studied neonates, 78 cases (7.8%) had positive blood cultures. The most common cause of neonatal infection was preterm birth (80.8%), and the most common bacterial causes of sepsis were coagulase-negative Staphylococcus (46.15) and Klebsiella pneumonia (28.2%). The highest antibiotic susceptibility of Gram-positive (coagulase-negative Staphylococcus) and Gram-negative bacteria was to ceftriaxone (47.3%) and piperacillin/tazobactam (100%), respectively, and the highest antibiotic resistance was to ampicillin and gentamicin (nearly 100%).

 Resistance to antibiotics used to treat sepsis has increased, which will cause irreparable problems in the treatment of preterm neonates if not addressed. Due to different microbial agents and drug resistance patterns in distinct regions, annual surveys should be conducted to determine drug resistance patterns, emphasizing preventive measures.

Fetal and neonatal health is of particular importance in pregnant women. Secondhand smoke (SHS) can jeopardize the health of the mother, fetus, and neonate. The present study was conducted to determine the relationship between exposure to secondhand smoke during pregnancy and neonatal-related outcomes. This retrospective cohort study was conducted in 2022 on 270 mother-newborn pairs through convenience sampling in two equal groups (n=135), including exposure and non-exposure to SHS at  Rohani Hospital, Babol, Children's Hospital, Amirkola, and Imam Ali Hospital, Amol. In order to collect the data, a checklist including the demographic characteristics, medical variables, questions related to the exposure of mothers to cigarette smoke, the neonatal outcomes questionnaire, and the SNAPPE-II scale were used. Data analysis was performed using STATA statistical software (version 17), and the significance level of all tests was considered less than 0.05. The mean age of mothers was 28.30±5.83 years, and 61% of births were by cesarean section. The SNAPPE-II score was 8.23​±5.29 in the non-exposure group and 20.68±13.53 in the exposure group (P=0.005). The prevalence of neonates with a birth weight of less than 2500gr was higher in mothers exposed to SHS (P=0.033).  Considering confounding variables, the neonates in the non-exposure group were, on average, 1.46 cm taller than those in the exposure group (P=0.005). Exposure to smoking increases the risk of premature birth by 1.65 times (P=0.032).   Exposure of pregnant mothers to SHS is associated with adverse neonatal outcomes. Therefore, it is recommended to train families to avoid exposure to cigarette smoke, especially during pregnancy, and also for health centers to pay special attention to this matter in the care of pregnant mothers.

Seizure is a common sign in neonates hospitalized in the neonatal intensive care units (NICU) that may lead to morbidity and mortality. Most neonatal seizures are subclinical. Conventional EEG (cEEG) is the gold standard for detecting and monitoring seizures but is not widely available. Amplitude-integrated electroencephalography (aEEG) has been used for over a decade to evaluate infants with seizures. In this study, we tried to determine the efficacy of aEEG as
a widely available diagnostic tool in diagnosing seizures.

All cases with seizures or suspicious seizures were admitted to the NICU of the Children’s Medical Center for one year. cEEG and aEEG were performed for these infants. aEEG was recorded for at least six hours with a description of the tracing. Clinical information, outcomes, and questionnaires (patient information) were recorded in detail. The obtained data were analyzed with the SPSS version 24 software.

Eleven out of twenty-five aEEG recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (68%) and hypotonia (28%); the mortality rate was 12%. No significant correlation was observed between aEEG findings and gender, age, familial relation, outcome, ultrasound result, type of seizure, and underlying disease.