Iranian Journal of Neonatology
Volume:9 Issue: 1, Winter 2018

Preterm birth occurs in a large number of pregnancies, and its incidence has been reported to be on the rise. Acute kidney injury (AKI) is a common complication in the premature infants with respiratory distress syndrome (RDS). The present study aimed to determine the predictive factors, clinical courses, and outcomes of AKI in the neonates with the clinical and radiological manifestations of RDS.
Medical records of 84 premature neonates with RDS were evaluated in two groups of case (with AKI) (n=34) and control (without AKI) (n=50). Diagnosis of AKI was based on the increased level of serum creatinine (>1.5 mg/dL) after the third day of birth or increasing serum creatinine level. In addition, blood pressure and laboratory findings, including complete blood count, serum electrolytes, and urine volume, were compared between the two groups.
Mean age of the infants with AKI was 5.41±3.29 days, and the majority of the patients had nonoliguric renal failure. Among the samples, 23.5% died, and 76.5% were discharged without renal impairment. Birth weight, systolic blood pressure, blood urea nitrogen, calcium, and pH on admission had significant correlations with the presence of AKI. Moreover, birth weight was observed to be a relatively accurate predictive factor for AKI (AUC=0.08; 95% CI=0.68-0.91), with 73.5% sensitivity and 80% specificity.
According to the results, AKI was more common in the low-birth-weight infants with severe RDS compared to the other subjects

Premature infants with respiratory distress syndrome (RDS) are in dire need of respiratory support with a ventilator. However, the high tidal volume of mechanical ventilation may cause lung injury, and researchers have been concerned with the use of nasal continuous positive airway pressure (NCPAP). NCPAP has concomitant side effects, such as abdominal distention, which might disrupt the proper nutrition of neonates. The present study aimed to compare the effects of supine and prone positions on the abdominal distension of the newborns with NCPAP.
This clinical trial was conducted on 37 neonates during six months with a randomized block crossover design selected for the supine and prone positions on the back and abdomen, respectively. Samples were breastfed infants receiving noninvasive ventilation, who were kept in the mentioned positions for two hours. Data analysis was performed in Application SRS version 19 using descriptive and inferential statistics.
In the analysis of variance, comparison of the changes in the abdominal circumference at 15, 30, 60, 90, and 120 minutes in the supine position (P=0.004) and prone position (P=0.001) with repeated sizes indicated a significant difference in at least one of the mentioned timings.
According to the results, prone position while feeding could effectively reduce abdominal distension in the neonates receiving NCPAP.

Family-centered care (FCC) has recently been recognized as the most effective approach in pediatric and family care. Despite the emphasis of healthcare systems on commitment to the philosophy and application of FCC, the nature of this method remains unknown in the related studies. The present study aimed to describe and interpret the experiences of professional and familial caregivers about FCC in the neonatal intensive care unit (NICU) to reveal its structure and essence.
The study was conducted using Van Manen’s phenomenological approach on 18 participants, including 10 professional and eight familial caregivers, who were interviewed. In addition, the interactions between the caregivers during the FCC practice were observed closely. Data were collected from the interviews, and the field notes were transcribed. Data analysis was performed using Van Manen’s thematic analysis.
Four main themes and 12 subthemes emerged in the study. Experiences of the caregivers about FCC were manifested through the themes of ‘restoring stability’ (subthemes: ‘reconstituted family’, ‘comprehensive advocacy’, and ‘meta-family interaction’), ‘oriented coalition’ (subthemes: ‘family as a care partner’, ‘professional group action’, ‘unity of action in caregivers’, and ‘collaborative space governance’), ‘dynamics of care’ (subthemes: ‘family as an agent for the advancement of professional caregivers’, ‘perceived status of problem-solving’, and ‘confrontation of caregivers’), and ‘empowering the family caregivers’ (subthemes: ‘accompanying to learn’ and ‘functional evolution’).
According the results, FCC is a dynamic care intervention, which is established through purposeful interactions between heterogeneous group members (professional and familial caregivers) in order to achieve care goals and create balance in all caregivers. Moreover, the approach enables familial caregivers to play their role efficiently. Application of this comprehensive care requires the attention of healthcare policymakers and managers to provide the proper context for optimal care provision in the NICU.

Macrosomia is defined as the birth weight of greater than or equal to 4,000 grams, which is considered to be a public health issue threatening mothers and neonates. Studies indicate that the prevalence rate of macrosomia is on the rise in developing countries. The present study aimed to evaluate the influential factors in the occurrence of neonatal macrosomia.
This case-control study was conducted at Al-Zahra Hospital in Tabriz, located in the north-west of Iran, during March 2013-February 2014. Sample population included all the live-born neonates and their mothers. The case group consisted of the neonates with the birth weight of ≥4,000 grams (n=404), and the control group included 404 newborns weighing 2,500-3,999 grams. Data were collected using a maternal and neonatal information form (maternal age, neonatal gender, mode of delivery, maternal height, and maternal history of diabetes). Data were extracted from the medical files of the samples and recorded in the form. Data analysis was performed in SPSS version 20 using descriptive and inferential statistics (independent t-test and 2χ) at the significance level of α=0.05.
In total, 8,012 neonates were born during the study, 404 of whom has macrosomia (5.04%). Mean maternal age in the case and control groups was 29.6±6.1 and 27.9±8.3 years, respectively (P According to the results, there were significant associations between macrosomia at birth and maternal age, maternal history of diabetes, and birth rank. Therefore, proper planning and educational interventions are recommended for the control of the influential factors in the occurrence of macrosomia.

Contents of breast milk may change during the first weeks after childbirth, especially in preterm deliveries. The present study aimed to determine the macronutrient contents of breast milk in the mothers with preterm delivery.
This prospective-descriptive study was conducted in Mahdieh Hospital in Tehran, Iran in 2015. Participants included the mothers with preterm delivery, whose infants had a gestational age of In total, 51 mothers were enrolled in the study. Mean gestational age and birth weight of the neonates were 28.44±2.20 weeks and 1064±260 grams, respectively. Mean age and body mass index (BMI) of the mothers were 27.5±5.6 years and 26.44±17.54-40 kg/m2, respectively. In terms of socioeconomic status, 28 participants (60.8%) were categorized as class II (simple workers), and 20 mothers (45.4%) received basic prenatal care. During weeks 2-3 of delivery, the fat and calorie contents of breast milk increased significantly. However, protein content of breast milk was variable, and the carbohydrate level was observed to decrease. No significant associations were observed between the maternal age, socioeconomic status, BMI, and number of twins with the contents of breast milk, while the mode of delivery and level of prenatal care had significant effects on the protein level of breast milk.
According to the results, the levels of macronutrients in the breast milk of the mothers with preterm delivery were variable and within the normal range during the first four weeks of delivery.

Complementary infant formulas are the second most important sources of nutrition for neonates after breast milk. Considering the cariogenic potential of infant formulas, selection of these nutritive sources should be safe to reduce the risk of baby bottle syndrome in newborns. The present study aimed to estimate the plaque pH changes after rinsing with four customary used types of complementary infant formula.
An in-vivo, in-vitro study was conducted on five healthy neonates aged 12-18 months to assess the plaque pH changes caused by rinsing with four different types of complementary infant formula, including Rice and Milk Cerelac, Wheat and Milk Cerelac, Banana and Milk Humana, and Peach and Milk Humana. Data analysis was performed in SPSS version 17 using paired t-test to compare the pH changes associated with each formula. In all the statistical analyses, P-value of less than 0.01 was considered significant.
All the formulas significantly reduced the plaque pH to less than the pre-rinse pH. However, the plaque pH decreased to less than the critical pH level ( According to the results, rinsing with the Rice and Milk Cerelac formula reduced the plaque pH value more than the other formulas. Therefore, it seems that complementary infant formulas could decrease the plaque pH and play a key role in the development of caries in neonates depending on the ingredients.

Current findings suggest that iron deficiency anemia (IDA) may be a predisposing factor for febrile seizure (FS), while some studies show the lower prevalence of IDA in the children with FS.The present systematic review and meta-analysis aimed to elucidate the association between IDA and FS.
A comprehensive search was performed using MeSH keywords in databases such as PubMed, Scopus, Embase, ScienceDirect, Web of Science, and Google Scholar without time limit until 2017. Cochrane test and I2 index were used for the evaluation of heterogeneity among the retrieved studies. Data analysis was performed in Comprehensive Meta-Analysis (CMA) software version 2.
In total, 38 studies conducted on 3,738 cases and 3,720 controls were reviewed in this meta-analysis. Considering the significant heterogeneity (I2=87.981; P According to the results, IDA is a predisposing factor for FC. Therefore, children with FS must be examined for the risk of IDA

Birth of premature infants and their admission in the neonatal intensive care unit (NICU) are unexpected crises for the fathers. Therefore, raising the awareness of fathers regarding their experiences in such conditions could be helpful in the care of these neonates. The present study aimed to investigate the experiences of the fathers of the premature infants admitted in the NICU.
This descriptive, explorative, qualitative study was conducted via purposive sampling, and 13 parents of the premature infants admitted in the NICUs of two hospitals in Isfahan, Iran, were enrolled. Semi-structural interviews were performed with the fathers of premature infants, and thematic analysis was used for data analysis.
Three main themes emerged in the study, including ‘emotions and responsibilities’, ‘information needs’, and ‘beliefs’. In terms of the emotions and responsibilities, fear and accountability were considered to be the major concerns among the fathers. With regard to information needs and beliefs, the need to obtain appropriate information and having faith in God and the infallible Imams were expressed by the fathers, respectively.
Experiencing preterm birth and NICU admission are accompanied by stress and anxiety for the parents of the infants. Meanwhile, several factors could impair the ability of the fathers to cope with the crisis. Identifying and addressing the needs of the parents and providing the necessary training since the beginning of pregnancy could result in the effective management of NICU admission. In addition, proper facilities should be offered to support the fathers of preterm infants, such as parental leave.

Congenital limb defects (CLDs) are the leading cause of disability across the world.CLDsvary depending on the anatomical location, type, and cause of anomaly. The present study aimed to evaluate the prevalence and patterns of CLDs in the North of Iran.
This descriptive-analytical, hospital-based study was conducted in three hospitals in Gorgan, the capital of Golestan Province in the north of Iran. Samples included 32,895 newborns with CLDs, and stillborn neonates were excluded from the study. Data analysis was performed in SPSS version 16 using Chi-square at the significance level of ≤0.05.
Overall prevalence ofCLDs was three cases per 1,000 live births, and the rate was estimated at 3.17 and 2.82 cases per 1,000 live births in male and female infants, respectively. In addition, the prevalence of upper- and lower-limb anomalies was 1.03 and 1.91 cases per 1,000 live births, respectively. In terms ofethnicity, the prevalence of CLDs among the native Fars, Turkmen, and Sistani populations was 3.86, 2.02, and 3.85 cases per 1,000 live births, respectively. Clubfoot was the most common type of CLDs, and the most prevalent type of the associated malformationswas gastrointestinal anomalies.
According to the results, the prevalence of CLDs in the north of Iran was similar to European countries (2.11-3.18 cases per 1,000 live births), while it was lower compared to the other regions in Iran (5.8 cases per 1,000 live births).

Oral feeding problems are among the most common issues in preterm infants. Various methods and feeding support tools are used in this regard, such as cup feeding and feeding nozzle. The present study aimed to determine the preferred method between cup feeding and feeding nozzle to support oral feeding in premature neonates.
This clinical trial was conducted on 70 preterm infants with the gestational age of 30-33 weeks in Isfahan, Iran. Infants were divided into two groups of cup feeding and feeding nozzle application. The studied variables were the duration needed to reach the time of full oral feeding, weight changes since birth until full oral feeding, and length of hospital stay.
Mean duration to start full oral feeding was 4.03 and 5.1 days in the cup feeding and feeding nozzle groups, respectively (P0.05). Mean length of hospital stay was 23.1 and 21.9 days in the cup feeding and feeding nozzle groups, respectively (P>0.05).
According to the results, the time needed to reach full oral feeding was shorter in the cup feeding group compared to the feeding nozzle group. However, the mean length of hospital stay was two days shorter in the feeding nozzle group compared to the cup feeding group. Therefore, feeding nozzle could be utilized as a supportive method in the feeding of preterm infants.

Congenital nephrotic syndrome (CNS) can be caused by neonatal infections and renal diseases that usually occur in early infancy. The most common CNS is the Finnish type, which is an autosomal recessively inherited disease characterized by intrauterine onset of massive proteinuria. In this study, we presented a preterm neonate confirmed as the first case of CNS in Iran by genetic study, who was admitted to the Neonatal Intensive Care Unit of Imam Reza Hospital, Mashhad, Iran. The patient’s mother had gestational diabetes mellitus and a history of intrahepatic cholestasis of pregnancy. The newborn was hospitalized at birth because of hypoglycemia. Upon admission, repeat seizure, intraventricular hemorrhage, intracerebral hemorrhage, and edema (specific gravity of more than 58 and sever protein urea) were detected. Furthermore, hypoalbuminemia was observed. The result of the blood culture and cerebral spinal fluid culture were negative. In addition, TORCH and venereal disease research laboratory tests were negative. Finally, genetic study showed a mutation in C3250 DUPG.

Hypophosphatasia is a rare hereditary disorder of bone metabolism.In this article, we presented the case of a male infant with a soft skull and short, deformed limbs at birth, followed by seizures and respiratory distress during admission in the neonatal intensive care unit (NICU). Prenatal ultrasound showed limb hypoplasia, skull hypomineralization, and polyhydramnios. Seizures occurred on day nine of admission. The neonate was intubated after pneumonia on day 12of birth and died due to the same cause and respiratory failure on day 14. Clinical presentation and low alkaline phosphatase (ALP) confirmed the diagnosis of hypophosphatasia. The disorder covers a spectrum of severe neonatal type with severe hypomineralization to various adult types with osteomalacia and dental problems. Prenatal hypophosphatasia is diagnosed based on the clinical signs, including soft skull, short limbs, breathing difficulty, seizures, respiratory distress, laboratory results (low ALP and high pyridoxal 5-phosphate), and radiographic findings (hypomineralization and metaphyseal dysplasia.

Transient hyperammonemia of the newborn (THAN) is an overwhelming condition presenting with coma within 2-3 days of life and requiring immediate treatment. The etiology of this condition remains unknown. Duration of coma determines the degree of neurologic impairment and developmental delay in hyperammonemia.
Case report: A newborn (BW=2900 g) was presented with a clear prenatal and perinatal medical history, poor sucking, refusal to feed, and deep coma within 72 hours of birth; the infant required ventilator assistance. On admission, physical examinations showed normal conditions, except for mild generalized weakness. Moreover, there was no history of consanguinity or maternal or obstetrics illnesses. However, the laboratory tests revealed marked hyperammonemia (plasma ammonia > 397 μg/dL, normal: 27-102 µg/dl) and elevated lactate (36.1 mg/dl, normal Hyperammonemia should be considered in infants presenting with neurological deterioration as timely and appropriate intervention could result in good prognosis.