فهرست مطالب

Neonatology - Volume:7 Issue: 1, 2016
  • Volume:7 Issue: 1, 2016
  • تاریخ انتشار: 1395/02/01
  • تعداد عناوین: 15
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  • Fatma Yi, Lmaz, Selma Atay, Duygu Ari, Kan*, Sedef Tekeli GÜler Pages 1-8
    Background
    Patient and parent satisfaction is a significant indicator for the evaluation of quality of care in healthcare systems. This study aimed to evaluate the effect of sociodemographic characteristics on the satisfaction of the parents of newborns admitted in neonatal intensive care units (NICUs) in maternity and infant disease hospitals.
    Methods
    This descriptive study was conducted on 113 mothers with infants admitted in the NICU of a state hospital in Turkey during April 1-September 30, 2013.Data were collected using sociodemographic questionnaire and Pediatric Quality of Life Inventory (PedsQL) healthcare satisfaction scale. Data analysis was performed using descriptive statistics (mean and percentage), T-test, Mann-Whitney U test, and Kruskal-Wallis test.
    Results
    In this study, mean score of maternal satisfaction with NICU services was 65.66±20.01. No statistically significant differences were observed between maternal age, PedsQL satisfaction subscales, and total score of satisfaction. Moreover, statistically significant associations were observed between the following variables: maternal training and total satisfaction, employment status and subscales of PedsQL, technical skills and general satisfaction, and social security status and emotional support. However, no statistically significant differences were observed between the sociodemographic characteristics of newborns, total score of satisfaction, and mean scores of PedsQL satisfaction subscales in mothers.
    Conclusion
    According to the results of this study, level of maternal satisfaction with NICU services was higher than the international average. Therefore, it is recommended that NICU nurses offer sufficient emotional support for both mothers and neonates in this unit and allow mothers to stay with their infants during hospitalization. Furthermore, it is suggested that training programs be implemented on effective communication skills between nurses and patients.
    Keywords: Intensive care, Maternal satisfaction, Newborn, Sociodemographic factors
  • Sunny Oteikwu Ochigbo*, Ifeoma Venn, Kingsley Anachuna Pages 9-12
    Background
    Bilirubin encephalopathy is a clinical syndrome, associated with bilirubin toxicity in the central nervous system, resulting in chronic and permanent sequelae. It has been estimated that approximately 60% and 80% of term and preterm newborns develop jaundice in the first week of life, respectively. In the present study, we aimed to determine the prevalence, morbidity, and mortality of bilirubin encephalopathy in the neonatal unit of the University of Calabar Teaching Hospital, Calabar, Nigeria.
    Methods
    In this retrospective, descriptive review, medical records of all newborns, diagnosed with bilirubin encephalopathy over the past five years (from January 2010 to December 2014), were studied. Information retrieved from the medical records included age, sex, presence of fever, duration of disease, place of delivery, causes of the disease, and selected treatments. Variables such as hospital discharge, discharge against medical advice, and mortality were also evaluated.
    Results
    Out of 2,820 newborns, 21 (0.74%) cases were admitted on account of bilirubin encephalopathy. Among these affected cases, 17 (81%) were male and 4 (19%) were female (male-to-female ratio of 5:1). Based on the findings, 18 newborns (85.7%) had pyrexia, while 8 (38.1%) and 6 (28.6%) cases were hypertonic and hypotonic, respectively upon admission. Only 33.3% of deliveries took place in healthcare facilities. The established factors responsible for jaundice included infection, i.e., septicemia (n=15, 71.4%), ABO incompatibility (n=4, 19.1%), and glucose-6-phosphate-dehydrogenase (G6PD) deficiency (n=2, 9.5%). The mean maximum total bilirubin level in subjects was 321.3 μmol/L (range: 242.5–440.3 μmol/L). Also, mortality was reported in 4 (19%) out of 21 cases.
    Conclusion
    Based on the findings, neonatal septicemia is associated with bilirubin encephalopathy. Therefore, identification and prompt treatment are of utmost importance in preventing the associated morbidity and mortality.
    Keywords: Bilirubin, Exchange blood transfusion, Infection, Kernicterus
  • Mehri Jamilian*, Maryam Karamali, Bahman Sadeghi, Maasoumeh Ghazi Mirsaeed Pages 13-18
    Background
    Previous studies reported that neonatal and maternal complications as well as duration of labor could be diminished through labor management. Therefore, we aimed to evaluate the effect of intramuscular (IM) administration of atropine and hyoscine combination on labor progress and maternal and neonatal outcomes in primigravid women admitted to Taleghani Hospital of Arak, Iran.
    Methods
    In this double-blind, placebo-controlled clinical trial, 216 primigravid women were randomly allocated to four groups (54 cases in each group) as follows: atropine group received 0.01-0.5 mg (1cc) of IM atropine; hyoscine group received 20 mg of IM hyoscine in a single dose; atropine and hyoscine combination group received 0.01-0.5 mg of atropine and 20 mg of IM hyoscine in a single dose; and control group only received IM injection of 1cc distilled water in a single dose. Thereafter, Bishop score, duration of the active phase and the second stage of labor, type of delivery, and Apgar scores at one and five minutes were recorded. Chi-square/Fisher’s exact tests and One-way ANOVA were run, using SPSS version 20.
    Results
    The Bishop scores were significantly higher in the atropine and hyoscine groups, compared to the other groups (P0.05).
    Conclusion
    The atropine and hyoscine combination reduced the duration of active phase in the primigravid women without serious maternal or neonatal adverse effects.
    Keywords: Active phase, Atropine, Hyoscine, Maternal, neonatal outcomes, Primigravid
  • Gholamali Maamouri, Fatemeh Zegheibizadeh*, Fatemeh Khatam, Hasan Boskabadi Pages 19-24
    Background
    In the recent decades, the prevalence of nosocomial infections in neonates has grown and almost 21% of preterm neonates experience these kinds of infections. Some factors were proposed to have a protective effect against neonatal infections through promoting the development of the immune system of the newborn. This study aimed to evaluate the efficacy of oral glutamine supplementation in management of neonatal sepsis.
    Methods
    Neonates were randomly allocated to case and control groups. The infants in the case group received 0.3 g/kg/day glutamine, every eight hours from three days of age to 28 days. Hospital stay duration and occurrence of necrotizing enterocolitis (NEC) as well as sepsis were recorded for each patient. Data were analyzed using SPSS version 16.
    Results
    In general, 105 neonates were enrolled in the study, 52 of who were allocated to the glutamine group and 53 neonates assigned to the control group. The results showed that 52 (49.5%) cases were male and 53 (50.6%) were female with mean gestational age of 30±2 weeks. Life threatening infections occurred more commonly in the control group (P=0.036). Six neonates (11.5 %) in the glutamine group and eight (15.1 %) in the control group developed clinical sepsis (P=0.592). NEC occurred only in the control group (P=0.118). Mean durations of hospital stay in the glutamine and placebo groups were 20±12 days and 26±18 days (P=0.065), respectively. Mean durations of oxygen therapy were 6±5 days and 16±11 days for the glutamine and control groups, respectively (P=0.039).
    Conclusion
    Oral glutamine administration reduced life threatening infections and duration of receiving supplemental oxygen.
    Keywords: Glutamine, neonate, Prevention, Sepsis
  • Fariba Hemmati, Zahra Hashemi* Pages 25-31
    Background
    Considering the increasing rates of early hospital discharge and kernicterus in healthy full term newborns, timely identification of neonates at risk of severe hyperbilirubinemia is of great significance. The aim of this study was to investigate the predictive value of umbilical cord serum (UCS) bilirubin level for subsequent hyperbilirubinemia. Moreover, we compared the predictive value of UCS bilirubin with that of risk factor assessment and predischarge bilirubin level.
    Methods
    In this prospective, cohort study, 450 healthy neonates born at the gestational age of ³ 35 weeks were included. UCS bilirubin concentration, direct Coombs test results, and blood group were determined in the newborns. Total serum bilirubin level was re-assessed before hospital discharge. The subjects were followed-up for 1-4 days after discharge and the total serum bilirubin level was measured in neonates with clinical jaundice. Results of the assessment of risk factors for hyperbilirubinemia were recorded.
    Results
    In total, 319 newborns were followed-up within the study period. The mean UCS bilirubin level in non-icteric and icteric neonates was 2.35 and 2.49 mg/dl, respectively. No significant relationship was found between UCS bilirubin level and development of hyperbilirubinemia (P=0.30), whereas a significant correlation was detected between predischarge bilirubin level and development of jaundice (P=0.009). Gestational age, birth weight, history of jaundice in siblings, and mode of delivery were the clinical risk factors which showed a significant correlation with postnatal hyperbilirubinemia.
    Conclusion
    Based on the findings, UCS bilirubin level could not predict subsequent hyperbilirubinemia. Therefore, the best predictive marker for neonatal jaundice is the assessment of clinical risk factors and predischarge bilirubin level.
    Keywords: Hyperbilirubinemia, neonate, Prediction, Prevention, Umbilical cord blood
  • Minoo Fallahi*, Abolfazl Afjeh, Hedieh Saneifard, Navid Namazi, Mohammad Kazemian, Shahrzad Tabatabaee Pages 32-36
    Background
    Recent studies have demonstrated the high prevalence of vitamin D deficiency in the general population. Pregnancy and preterm delivery are known as risk factors for vitamin D deficiency. Consequently, vitamin D level in women with preterm deliveries might vary from those with term pregnancies. In this study, we aimed to compare vitamin D level in term and preterm infant–mother pairs.
    Methods
    This cross-sectional study was conducted in the neonatal intensive care unit of Mahdieh Hospital in Tehran, Iran in 2013. Serum level of 25-hydroxy vitamin D in preterm infant-mother pairs (≤ 32 weeks of gestation and birth weight ≤ 1500 g) was compared with term infant-mother pairs within the first 24 hours after delivery.
    Results
    In total, 62 infant-mother pairs were recruited in this study, including 33 preterm (53.2%) and 29 term (46.8%) newborns; overall, 32 (51.6%) infants were male. the mean maternal age was 27.3 years in the preterm group and 26.4 years in the term group. The mean serum vitamin D level in preterm infants was 13.91 ng/ml. In the preterm group, vitamin D level was within the range of 4-59 ng/ml in newborns and 8-62 ng/ml in mothers. In the term group, the mean vitamin D level was 13.39 in infants and 13.7 ng/ml in mothers. In total, 48.5% and 65.5% of preterm and term groups had vitamin D deficiency, respectively. Among all newborns, 56% had vitamin D deficiency, although the difference between term and preterm neonates was not statistically significant. Also, there was no significant correlation between the infants’ serum vitamin D level and birth weight. Based on the findings, serum vitamin D levels in mothers and newborns were significantly correlated (P
    Conclusion
    According to the present study, there was no significant correlation between gestational age and vitamin D level in infant-mother pairs; however, vitamin D levels in mothers and newborns were significantly correlated.
    Keywords: Vitamin D, neonate, Osteopenia of prematurity, Preterm
  • Ehsan Garosi, Fatemeh Mohammadi, Fatemeh Ranjkesh* Pages 37-40
    Background
    Maternal and neonatal factors could help determine the potential incidence of hyperbilirubinemia. In this study, we aimed to identify the relationship between the severity of jaundice in newborns and maternal and neonatal factors.
    Methods
    This descriptive, cross-sectional study was conducted in 2014. Icteric newborns, admitted to Qods and Kowsar teaching hospitals in Qazvin, Iran were recruited in the study. Data were collected, using a researcher-made checklist consisting of three parts: demographic, maternal, and neonatal information. For data analysis, statistical tests including t-test, Mann-Whitney, analysis of variance, and Pearson's correlation test were performed, using SPSS version 19.
    Results
    The results showed that the mean total bilirubin level was significantly higher in newborns delivered vaginally (17.3±3.5 mg/dl), compared to cases born by cesarean section (16.1±3.9 mg/dl) (P=0.02). Also, the mean total and direct bilirubin levels were higher in neonates delivered using oxytocin (0.4±.1 and 17.99±0.4, respectively), compared to those without oxytocin induction (0.383±0.1 and 16.2±0.28, respectively) (P=0.001). Moreover, the mean total and direct bilirubin levels were higher among female newborns (0.397±0.013 and 17.2±0.29, respectively), compared to the male neonates (0.379±.22 and 15.9±0.37, respectively) (P=0.005 and P=0.02, respectively).
    Conclusion
    Since factors such as mode of delivery, oxytocin induction, and neonate's gender could contribute to jaundice, continuous assessment of newborns after birth could facilitate early diagnosis, promote disease management, and reduce the subsequent complications.
    Keywords: Infants, Jaundice, Maternal factor
  • Mohammad Torkaman, Gholamreza Bagheri, Ahmad Ahmadi, Amin Saburi* Pages 41-46
    Background
    Hypoglycemia is one of the most common neonatal disorders, associated with severe complications. There has been a great deal of controversy regarding the definition and screening of hypoglycemia. Therefore, in this study, we aimed to determine a cut-off value for blood glucose level in glucometer readings.
    Methods
    This cross-sectional study was conducted on 238 newborns at risk of hypoglycemia, admitted to Baqiyatallah Hospital of Tehran, Iran in 2012; the subjects were selected via simple sampling. After obtaining informed consents from the newborns’ parents, 1 cc blood samples were sent to the laboratory for measuring the blood glucose level. Moreover, venous blood samples, as well as heel-stick blood samples, were obtained for glucometer measurements. Blood glucose measurements were used to determine the cut-off value by the receiver operating characteristic (ROC) curve and make comparisons with the diagnostic criteria for hypoglycemia in the literature.
    Results
    A total of 238 infants with the mean weight of 2869±821.9 g were enrolled in this study. The mean (±SD) blood glucose levels were 65.1±22.9, 82.9±24.7, and 84.4±24.8 mg/dl, based on the standard laboratory method, glucometer reading of venous blood samples, and glucometer reading of heel-stick capillary blood samples, respectively. The optimal cut-off point for hypoglycemia was determined as 65 mg/dl, using glucometer-based assessment of heel-stick blood samples.
    Conclusion
    The significant difference in blood glucose levels measured by the laboratory method and outpatient glucometer readings highlights the importance of a cut-off value for rapid assessment and control of blood glucose and timely detection of hypoglycemia. In fact, the cut-off value introduced in the present study could facilitate such measurements.
    Keywords: Glucometer, Neonatal hypoglycemia, Screening
  • Fereshteh Ghorat, Reza Ghafarzadeh, Reza Jafarzadeh Esfehani* Pages 47-51
    Background
    Perinatal mortality rate is an important indicator of community health status. This study aimed to evaluate perinatal mortality and its determinants in Mobini Hospital of Sabzevar, Iran.
    Methods
    This descriptive, cross-sectional study was performed within a two-year (2011-2012) period at Mobini Hospital of Sabzevar. Our study population included all the cases of stillbirth and live birth after the 22nd week of gestation to full term, died within the first week after delivery. The data including maternal and neonatal/fetal age, parity, mode of delivery, history of stillbirth, gestational age, reason of death, gender, and weight of the fetus or newborn were obtained from patient records as well as interviews with the mothers and treating physicians. To analyze the data, independent sample t-test, and Chi T square/Fisher’s exact test were run using SPSS, version 11.5.
    Results
    Perinatal mortality and stillbirth rates were 16.6 and 9.1 per 1000 births, respectively, while the rate of early neonatal mortality was 7.4 per 1000 live births. The most common reasons for neonatal death were pre-term labor and sepsis, while the most common reason for stillbirth was unknown etiology. There was a significant difference between stillbirth and early neonatal death in term of gestational age (P
    Conclusion
    According to our results, perinatal mortality rate in our region was not high compared to other regions of the country, although it was higher than that of European countries. We found that premature labor was the cardinal cause of neonatal mortality, which can be prevented by careful perinatal care and improving hospital equipment, especially those of neonatal intensive care units.
    Keywords: Neonatal mortality, Perinatal mortality, Prevalence, Stillbirth
  • Abdolghader Pakniyat, Mohammad Reza Fallah*, Zahra Fakour, Farzad Moloudi, Seyran Khezri, Sima Masoudi Pages 52-57
    Background
    External genital anomalies are the most common congenital disorders in male infants with unknown etiology in the majority of cases. According to recent reports, incidence rate of these anomalies is rising in different countries. This study aimed to evaluate the prevalence of external genital anomalies and possible underlying factors in male newborns.
    Methods
    This cross-sectional study was conducted on all the male neonates born in Motahari Hospital of Urmia during October 2009-June 2010. Neonatal screening results and demographic data were recorded separately in a questionnaire for each neonate. Data analysis was performed in SPSS V.20 using descriptive statistics (mean, frequency, percentage, and standard deviation) and Chi-square test to evaluate the correlations between quantitative variables.
    Results
    In this study, external genital anomalies were identified in 83 male neonates (8.3%). Moreover, 59 infants (5.9%) had cryptorchidism, 18 (1.8%) had hypospadias and 12 infants (1.2%) had microphallus. Moreover, a significant correlation was observed between the incidence of cryptorchidism and maternal comorbidities, low birth weight, prematurity, maternal gestational hypertension, and diabetes mellitus.
    Conclusion
    According to the results of this study, cryptorchidism is the most prevalent external genital anomaly in male newborns, followed by hypospadias. Occurrence of these anomalies is associated with several risk factors, such as prematurity, low birth weight, maternal diseases (e.g., diabetes and hypertension), and use of medications during pregnancy. In addition, cryptorchidism had a significant correlation with smoking habits, and further studies with larger sample sizes are required in this regard.
    Keywords: Cryptorchidism, Genital anomaly, Hypospadias, Newborn, Male
  • Farzaneh Mohammadi, Babak Karimi*, Atieh Mehdizadeh Hakkak, Abdolreza Norouzy, Bahareh Imani Pages 58-61
    Background
    Energy deficit is a common and serious problem in pediatric intensive care units. Parenteral nutrition, either alone or in combination with enteral nutrition, can improve nutrient delivery in critically ill patients by preventing or correcting the energy deficit and improving the outcomes. Intralipid 10% and 20% are lipid emulsions, widely used in parenteral nutrition. Despite several clinical advantages, intravenous Intralipid therapy has been associated with several complications.In this study, we aimed to investigate the effects of Intralipid 10% and 20% on peripheral intravenous catheter ablation in children receiving Intralipid in a pediatric intensive care unit.
    Methods
    In this observational study, 96 patients were recruited through simple non-random sampling over six months. In total, 48 patients received intravenous Intralipid 10%, while 48 patients were administered Intralipid 20% as part of their parenteral nutrition plan. Through separate peripheral intravenous catheters, 0.5-3 g/kg/day of Intralipid was administered at an infusion rate of 0.5 g/kg/h. Length of hospital stay and intravenous catheter ablation were compared between the two groups.
    Results
    Age of the patients ranged between two days and eight years. Esophageal atresia was the most common condition among patients receiving intravenous Intralipid infusion (8.3%). The mean duration of catheter survival was significantly shorter in patients receiving Intralipid 20% (28.77 vs. 68.23 h, P
    Conclusion
    Based on the findings, concentration of Intralipid infusion in pediatric patients, receiving parenteral nutrition, might be associated with intravenous catheter ablation.
    Keywords: Catheter, Intralipid, Parenteral nutrition, Pediatric intensive care unit
  • Reza Saeidi, Shaghayegh Rahmani*, Ashraf Mohammadzadeh, Ahmad Shah Farhat, Maryam Saeidi, Alireza Ataei Pages 62-66
    Background
    Prematurity is the most common cause of death and disability And Preterm infants, are prone to developmental complications. For this reason this study was designed for follow up of these babies until 2 years by modified DDST-2.
    Methods
    This study was a prospective longitudinal descriptive study from March 2009 to March 2011 in clinic of sheikh and Imam Reza Hospitals, mashhad, Iran. Sample size with Confidence coefficient of 95% and power 80%, was determined 100 hundred babies. Infants were seen by a pediatrician at a follow up clinic at 1, 3, 6, 9,12,15,18, 24, months.The developmental assessment was done using Denver-2 Developmental Screening Test.
    Results
    mean age for smiling was 4/6 ± 2/1 months which significantly differed with appropriate age (p = 0.000), mean age for telling two syllables words 11/7± 1/9 months, without significant difference of appropriate age.(p = 0.139). Average age for understanding NO was 10/4± 2/0 months that significantly differed with appropriate age(p = 0.000). The average age for telling 6 word was 17/8± 3/0, without significant difference with appropriate age (p = 0.510).
    Conclusion
    Children with history of prematurity and low birth weight have more disability and developmental delay so they need to developmental screening tests.
    Keywords: Low Birth Weight, Prematurity, developmental delay
  • Emel, Uuml, NsÜr*, Sibel Yel, Didem Atici, Mehmet Sait DoĞ, An, Ruhan DÜŞ, Ünsel, Ismail Dursun Pages 67-70
    Background
    Adrenal hematoma is a very rare acquired cause of neonatal hypertension. In this study, we report a case of neonatal hypertension associated with adrenal hematoma. A male neonate was immediately transferred to our neonatal intensive care unit after delivery due to meconium aspiration. He needed to be on mechanical ventilation support. During his hospital stay, hospital records showed normal blood pressure. However, 15 days after discharge, he was diagnosed with hypertension and was admitted to our Nephrology Division. Except for irritability, physical examination was normal. Blood pressure was normal, while right renal agenesis, grade two dilatation in the collective system of the left kidney, a round heterogeneous cyst (measuring 46×28 mm), and adrenal hematoma with no blood flow in the left suprarenal region were detected by ultrasound. Renal scintigraphy showed right renal agenesis, prolonged retention of the injected material in the left kidney, and a mass on the left kidney. Antihypertensive therapy was initiated for the neonate and the adrenal hematoma was checked weekly. The mass gradually shrank and his blood pressure readings returned to normal for his age.
    Conclusion
    Neonates with hypertension and history of birth complications should be evaluated for adrenal hematoma to determine the reasons for hypertension.
    Keywords: Adrenal hematoma, Hypertension, Newborn, Suprarenal mass
  • Reza Sharafi, Afagh Hassanzadeh Rad* Pages 71-74
    Background
    Lymphangiomas are relatively rare, benign, congenital malformations, which may affect the conjunctiva, lids and orbit of the eyes. Lymphangiomas are commonly located behind the orbital septum and usually manifest with proptosis, as well as the pain caused by spontaneous intralesional hemorrhage or upper respiratory infection. Previous studies have proposed the major causes of neonatal proptosis. In this article, we present the case of a female neonate born to a mother with triplet pregnancy. On day 28 of birth, clinicians were concerned about the proptosis in the right eye of the second sibling, and the neonate was evaluated via repeated ultrasound. The infant had good general appearance, and after ophthalmological consultation, both neonates were discharged on day 30 of birth. According to clinicians, the right eye proptosis was possibly caused by a benign lesion, such as lymphangioma. Moreover, it was noted that the proptosis would be absorbed gradually, and no interventions were required for the neonate. As predicted, the proptosis was completely absorbed at two months of age. Therefore, it is recommended that clinicians consider benign causes for neonatal proptosis, such as lymphangioma originating from neonatal sepsis.
    Keywords: Lymphangiomas, neonate, Proptosis
  • Alireza Jashni Motlagh*, Yadollah Zahedpasha, Mousa Ahmadpourkacho Pages 75-79
    Background
    X-linked lissencephaly with ambiguous genitalia (XLAG) is a recently described genetic disorder, in which patients present with lissencephaly, agenesis of the corpus callosum, refractory epilepsy of neonatal onset, acquired microcephaly, and male genotype with ambiguous genitalia. XLAG is responsible for a severe neurological disorder of neonatal onset in boys. A gyration defect consisting of anterior pachygyria and posterior agyria with a moderately thickened brain cortex, dysplastic basal ganglia, and complete agenesis of the corpus callosum are consistently found on magnetic resonance imaging (MRI). Females related to affected boys may have epilepsy and mental retardation or display agenesis of corpus collosum on MRI. These findings can indicate an X-linked semi-dominant inheritance.
    Case Presentation
    The patient was a one-day-old term neonate admitted to our neonatal intensive care unit due to refractory seizure. He was the second child of the family, born to non-consanguineous and healthy parents. His midface was slightly hypoplastic with long and smooth philtrum; the neonate had ambiguous genitalia, as well. Hormonal investigation demonstrated elevated serum 17OH-progesterone, dehydroepiandrosterone sulfate, and testosterone levels. Chromosomal analysis showed a normal male karyotype (46, XY). Brain computed tomography scan showed a typical pattern of lissencephaly with a posterior-to-anterior gradient of severity consisting of frontal pachygyria, posterior agyria, and absence of corpus collosum
    Keywords: Ambiguous genitalia, Corpus callosum, Lissencephaly, Seizure