Iranian Journal of Neonatology
Volume:7 Issue: 2, Spring 2016

Despite the efforts to enhance hygiene education and personal hygiene and use of antibiotics and vaccination, infectious diseases remain the second cause of mortality worldwide. Vaccination is one of the greatest medical achievements in the prevention of mortality and morbidity, which has decreased treatment costs. This study aimed to compare the complications caused by pentavalent and diphtheria-tetanus-pertussis (DTP) vaccination in infants aged 2-6 months.
This analytical cross-sectional study was conducted on all the infants aged 2-6 months referred to the healthcare centers of Anzali, Iran. Demographic data and complications of vaccination were collected from all the samples. Data analysis was performed using descriptive statistics, Fisher's exact test, Chi-square, and Mann-Whitney U test, and logistic regression analysis in SPSS.
In total, 353 infants, including 163 female (46.2%) and 190 male (53.8%), were enrolled in this study. According to the results, 229 infants (64.9%) presented with vaccination complications. Fewer side effects were noted in infants receiving pentavalent vaccination compared to those receiving DTP vaccination (P=0.38). In order of occurrence, the most common complications of DTP vaccination were fever, excessive crying, and fussiness, respectively. Moreover, a significant correlation was observed between the used milk by infants and the extent of complications caused by vaccination in the pentavalent group (P=0.037).
According to the results of this study, application of pentavalent vaccination not only minimizes the local reactions, but it also diminishes local discomfort through reducing the number of injections. Therefore, infants receiving this type of vaccination encounter minimum local reactions. It is recommended that further investigation be conducted on larger sample sizes in multiple healthcare centers.

Searching for an ideal marker for diagnosing neonatal infection is still an important concern in every country. There are many biomarkers reported for neonatal sepsis. Haptoglobin is an acute phase reactants which rise in response to infection and injuries. In this report we discussed the efficacy of serum haptoglobin level in different cut off levels in early onset neonatal sepsis.
Material and Total of 84 neonates divided in to a sepsis (43 neonates) and control group (41 neonates) and enrolled in this case-control study. Sepsis was defined base on both clinical and laboratory criteria. Serum haptoglobin level was evaluated in both groups. Sensitivity and specificity of haptoglobin in different cut off points was evaluated and study data was analyzed by SPSS 18 software.
Neonates in both groups didn’t have significant relation in term of gender, gestational age at birth and birth weight. Serum level of haptoglobin in sepsis group was significantly higher than control group (P=0.0001). Also there was significant relation between haptoglobin and positive blood cultures (p=0.0001). Cut of point of 25mg/dl had sensitivity of 67%, specificity of 95%, accuracy of 80% and positive predictive value of 93% and considered as preferable cut off point in early neonatal sepsis.
Serum plasma haptoglobin can be a specific diagnostic factor in diagnosing early neonatal sepsis in keeping with other diagnostic tests for sepsis.

Hyperbilirubinemia is one of the most common and persistent problems encountered in preterm newborns. This condition in preterm infant is more likely to be associated with neurological damage rather than terms. So far, no major studies have precisely assessed the effects of zinc sulfate on hyperbilirubinemia in low-birth-weight (LBW) neonates. Therefore, in this study, we aimed to evaluate these effects in LBW infants.
This randomized, double-blind, clinical trial (IRCT201401041162N22) was performed on 61 icteric LBW neonates, hospitalized in the neonatal intensive care unit (NICU) of Imam Reza Hospital in Mashhad, Iran from May 24, 2014 to May 24, 2015. The neonates were randomly divided into case and control groups, and the total serum bilirubin (TSB) level was measured at 0, 24, 48, 72, 96, and 120 h after treatment. The subjects received either 10 mg of zinc sulfate or placebo twice per day for five days (or by the end of treatment). The termination point of phototherapy was defined as a bilirubin level below 50% of the starting point. The collected data were analyzed, using SPSS version 20. Chi-square, t-test, and repeated measures ANOVA were carried out to compare the findings between the two groups.
The mean TSB level was 14.87±2.65 and 14.73±3.22 mg/dl in the control and case groups. The mean decline in TSB level was only significant at 24 h after the treatment (2.71 and 2.13 mg/dl in the case and control groups, respectively; P=0.04), while being statistically insignificant on other days of the assessment. Also, similar findings were reported regarding the duration of treatment in the case and control groups (58.84±14.97 and 65.60±16.59 h in the case and control groups, respectively).
The present study showed that administration of oral zinc sulfate in icteric LBW infants could significantly reduce TSB level only at 24 h following the treatment.

Obesity usually results from a combination of several modifiable and non-modifiable contributing factors, such as genetics, race, and socioeconomic status. Other factors, including birth by cesarean section, perinatal antibiotics usage, and promotion of exclusive breastfeeding for six months, could be potentially prevented or modulated. However, one of the factors can be easily implemented through reduction of protein content in infant formulas for non-breastfed infants. High protein (HP) in infant formula is one of the causes of rapid weight gain, predisposing the neonates to later obesity.
This study was performed to evaluate the effect of HP formula on weight gain and resulting risks of later obesity. The samples (i.e., non-breastfed infants) were randomly divided into two groups of HP formula (2.9 and 4.4 g protein/100 kcal before and after five months of age, respectively) and LP formula (1.77 and 2.2 g protein/100 kcal before and after five months of age, respectively) in this study. At the age of two, weight-for-length z-score of the infants in the HP formula group was calculated at 0.20 (95%CI: 0.06, 0.34), which was higher compared to the LP group. Meanwhile, the latter group had results similar to the findings of the control group (breastfed). Body length of the infants was not affected by the extent of protein intake. A six-year follow-up of the subjects indicated a significantly lower body mass index (BMI) (0.51) in the LP formula group (95% CI: 0.13, 0.90; P=0.009). In addition, a 2.43 fold risk of later obesity (95% CI: 1.12, 5.27; P=0.024) was reported in the LP group, which was lower compared to the HP formula group. Given the role of HP formula as one of the contributing factors in the development of metabolic syndrome and obesity risks in infants, it is recommended that lower protein content formulas be used in non-breastfed neonates to prevent later obesity and other complications.

Breastfeeding plays a pivotal role in the promotion of health and prevention of psychological problems in children. This study aimed to compare the effects of breastfeeding educational programs on the development of infants aged 1-3 months based on the model of Belief, Attitude, Subjective Norm, and Enabling Factors (BASNEF) and application of acupressure on the GB-21 point.
This quasi-experimental study was conducted on 150 pregnant women (gestational age: 36-41 weeks) receiving care in the educational clinics affiliated to Shiraz University of Medical Sciences, Iran. Subjects were divided into two intervention groups (educational and acupressure) and one control group. In intervention groups, in addition to routine prenatal care, pregnant women received training based on the BASNEF model and instructed acupressure. Mothers in the control group received only standard care during pregnancy. After the intervention, data were collected using Denver developmental screening test. Data analysis was performed in SPSS V.16 using one-way analysis of variance (ANOVA).
Among developmental gross motor skills, a significant difference was observed between the intervention and control groups regarding the ability to breast lift by relying on the arm (P=0.016). In terms of fine motor skills, a significant difference was observed in holding the rattle by infant (P=0.034). Moreover, time of acquiring individual and social developmental skills was higher in intervention groups compared to the control group. However, the difference was not statistically significant (P≥0.05). Therefore, no significant differences were observed between the two interventional groups in this regard (P≥0.05).
According to the results of this study, instructed acupressure on the GB-21 pointcould improve some gross motor and fine motor skills in infants. Therefore, it is recommended that the developmental indicators in infants aged 1-3 months be evaluated in longer periods.

Prevention of medication errors in neonatal intensive care units (NICUs) is of paramount importance due to age-specific and physiological conditions of neonates. This study aimed to evaluate the risk of medication prescription and administration via failure mode and effects analysis (FMEA), which was carried out at the Research and Medical Teaching Center of Imam Reza Hospital in Mashhad, Iran.
In this study, we adopted qualitative (action research) and quantitative (descriptive cross-sectional research) methods. The FMEA of the prescribed and administered medications in the NICU was performed using the nine-step FMEA by the National Center for Patient Safety. A diagram was plotted to determine the potential failure modes and effects of an error by the brainstorming team and to evaluate factors leading to errors. It was suggested to determine improvement strategies via interviews with team members and consider the requirements of the study units. Quantitative analysis of descriptive statistics (total points) was used to assess the content and qualitative data and reach expert consensus.
In this study, two processes, including prescription and use of drugs in the pediatric intensive care unit, were used. In this regard, seven activities, 29 sub-processes 29, and 68 failure modes were identified by FMEA technique, five of which were identified as high-risk modes using prioritization matrix. Moreover, a risk priority number (RPN) of 100 was considered critical for the possible errors in drug prescription by physicians and was proposed as a method to reduce or eliminate failure modes.
FMEA is an effective proactive risk-assessment tool, used to help multidisciplinary teams to understand the healthcare process and identify the possible errors. In addition, it helps prioritize remedial interventions for patients and enhance the safety of drug prescription in neonates.

Holistic care is the evaluation of the physical and mental states of individuals. Considering the importance of spirituality in healthcare and its pivotal role as the first step toward providing spiritual care, this study was conducted to determine the perception of Iranian nurses towards spirituality in neonatal intensive care units (NICUs).
This study was conducted on nine participants using qualitative content analysis. In addition, purposive sampling was used to select the participants. Study setting was the NICUs at hospitals affiliated to Ardabil University of Medical Sciences, Ardabil, Iran. Data collection was performed through semi-structured interviews with the samples.
Three main categories were discussed in this study, as follows: 1) “Meaning of spirituality” with three subcategories of “connectedness to God”, “sincerity”, and “prayers or recourse to Ahl-al-Bayt”; 2) “nature of spirituality” with three subcategories of “peace of mind”, “nursing performance beyond physical health care”, and “problem-solving”; 3) “respect for spiritual beliefs” with two subcategories of “respect for beliefs and values” and “persistent faith”.
The results of this study indicated that the perception of Iranian nurses toward spirituality is directly influenced by their religious tendencies, which denotes the importance of educational courses on spirituality for nurses. Therefore, it is recommended that nursing managers and directors implement training programs for the personnel in order to enhance spirituality.

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital malformation, accounting for less than 1% of cerebrovascular abnormalities. The majority of reported cases have been associated with congestive heart failure (CHF) in the neonatal period. Herein, we present a case of VGAM, diagnosed at 37 weeks of gestation during the intrauterine life
Case report: A full-term female newborn presented with severe CHF at two days of age. The patient's peripheral pulses were bounding in all four extremities. The first heart sound appeared to be normal, while the second had an accentuated pulmonic component. A systolic murmur (grade 3/6), best heard in the pulmonary area, was reported, and a cranial bruit was sought and found. The echocardiography showed evidence of right ventricular hypertrophy, while the chest X-ray indicated cardiomegaly with increased pulmonary vascularity. Moreover, echocardiography revealed dilation of the right heart chambers, a patent foramen ovale, severe tricuspid regurgitation, as well as a moderate-sized secundum atrial septal defect and a patent ductus arteriosus with right-to-left shunting. Transcranial ultrasound and contrast-enhanced CT scan of the brain detected a vein of Galen malformation. Magnetic resonance venography confirmed VGAM and identified the vessels feeding the aneurysm. Postnatal management included aggressive medical treatment of CHF. Transarterial embolization of the vessels feeding the aneurysm was suggested. However, the newborn succumbed to her disease on the following day.
VGAM, which is a rare cause of cyanosis and heart failure in newborns, can be clinically diagnosed via proper strategies. However, extensive distribution of aneurysm usually precludes surgical management and endovascular treatment.

There is inadequate knowledge about acute poisoning as a common problem in children. Acute poisoning in children, , is one of the health problems, requiring immediate treatment.
Case report: A two-month-old male infant with discoloration of the nails was admitted to the Emergency Pediatric Unit of Imam Reza Hospital, Mashhad, Iran in 2014. Following clinical evaluations, the blood lead level was determined to be high. The cause of neonatal condition was a traditional medicine, applied by the mother for the treatment of dermatitis in the infant. The lead concentration was high in this medicine, thus resulting in neonatal lead poisoning.
It is obvious that medicinal drugs should be used cautiously for children, especially infants. Also, drug characteristics and the process of production should be precisely specified. In fact, without taking precautions, any medicinal drug or substance could have various adverse effects on pediatric populations.