فهرست مطالب

Neonatology - Volume:9 Issue: 3, 2018
  • Volume:9 Issue: 3, 2018
  • تاریخ انتشار: 1397/05/20
  • تعداد عناوین: 14
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  • Fatemeh Saffari, Mohammad Hassan Nikpendar, Neda Esmailzadehha, Sonia Oveisi, Ali Homaei, Shabnam Jalilolghadr * Pages 1-5
    Background
    Congenital hypothyroidism increases the risk of sensorineural hearing loss (SNHL). Children with hearing impairment are prone to communication disorders. The present study aimed to determine the prevalence of SNHL in patients with congenital hypothyroidism in Qazvin, Iran.
    Methods
    This cross-sectional study was conducted on children with transient or permanent congenital hypothyroidism in Qazvin province, Iran in 2015. The patients were identified through national neonatal thyroid screening during 2006-2011. Hearing loss was assessed using the auditory brainstem response (ABR). A minimum of three years of follow-up was carried out to determine the permanency of congenital hypothyroidism. Data analysis was performed using t-test and Chi-square.
    Results
    In total, 155 children with congenital hypothyroidism were enrolled in the study, including 67 females (43.2%) and 151 cases of primary congenital hypothyroidism. Abnormal ABR was observed in 10 patients (6.45%) (6.6% in permanent cases and 6.1% in transient cases), seven of whom were female. In addition, eight patients with primary congenital hypothyroidism and two patients with central congenital hypothyroidism had abnormal ABR (P=0.165). Mean primary thyroid-stimulating hormone levels (52.45±39.91 versus 38.23±28.03 IU/l; P=0.355) and T4 (6.07±4.33 versus 6.98±3.40 µg/dl; P=0.307) had no significant differences in the children with SNHL and other patients. At the beginning of the treatment, mean age of the children with SNHL was 28.50±22.13 days, while it was 28.87±30.34 days in the other subjects (P=0.909).
    Conclusion
    According to the results, the prevalence of SNHL was lower in the patients with congenital hypothyroidism compared to the reported rates in other countries. However, the assessment of hearing loss should be prioritized in the infants with congenital hypothyroidism.
    Keywords: Communication disorders, Congenital hypothyroidism, Diagnosis, Mass screening, Sensorineural hearing loss
  • Yaswanth Gonuguntla, Tanmaya Metgud, N. S. Mahantshetti Pages 6-13
    Background
    Twin low-birth-weight (LBW) neonates are exposed to the increased risk of mortality and morbidity due to poor prognosis. The present study aimed to evaluate the effectiveness of kangaroo mother care (KMC) in the management of twin LBW neonates.
    Methods
    This prospective, observational study was conducted on 150 neonates with the birth weight of
    Results
    Neonates in the KMC groups were euthermic. Mean weight gain increased in KMC I (13.48±1.76 g/kg/day) and KMC II (13.15±1.66 g/kg/day) compared to the CMC group (11.99±1.20 g/kg/day) (P=0.0014). Length (43.55±1.90, 43.86±1.34, and 43.40 ± 1.94 cm, respectively) (P=0.567) and head circumference (31.13±0.77, 31.43±1.15, and 31.30±1.07 cm, respectively (P=0.498) were comparable in the CMC, KMC I, and KMC II groups. Early initiation of breastfeeding was observed in KMC I (2.68±1.55 days) and KMC II (2.97±2.88 days) compared to the CMC group (5.17±2.65 days) (P
    Conclusion
    According to the results, KMC is a cost-effective, humane intervention, which could effectively alleviate the burden of managing twin and singleton LBW neonates in low-income countries.
    Keywords: Kangaroo mother care, Low birth weight, Neonates, Singletons, Twins
  • Zahra Akbarian Rad, Seddigheh Esmaeilzadeh, Mohsen Haghshenas Mojaveri, Mojgan Bagherzadeh, Mostafa Javanian * Pages 14-19
    Background
    Early-onset sepsis is a common cause of neonatal mortality and mainly occurs due to the colonized microorganisms in the maternal recto-vaginal area. The present study aimed to evaluate the effects of maternal risk factors on recto-vaginal colonization and transmission rate of micro-flora from mothers to infants.
    Methods
    Upon admission, two samples were obtained from the distal third of vagina and rectum of mothers using sterile cotton swabs. Six hours after birth, sterile swab samples were collected from the external ear canal, nose, groin, and umbilicus of the infants. The samples were transferred to the laboratory on Stuart transport medium. Afterwards, the samples were transferred to standard culture media within 24 hours. Transmission rate of organisms was calculated based on the maternal and neonatal findings.
    Results
    In total, 13 bacterial and fungal species were detected in the samples. Escherichia coli was the most frequent gram-negative organism in the rectal and vaginal cultures (29.34%) with the transmission rate of 49.4% to the infants. Infants of the mothers with premature rupture of membranes (PROM) had significant Enterobacter cloacaecolonization. In addition, frequency of Candida albicans was higher in the mothers with gestational hypertension (21.4%) compared to non-hypertensive women (4.9%). Infants requiring advanced cardiopulmonary resuscitation (CPR) had significantly higher E. coli colonization (45.1%) compared to those not needing CPR (27.6%).
    Conclusion
    According to the results, gram-negative bacteria (E. coli and Enterobacteriaceae ) were the most frequent organisms in the maternal recto-vaginal area and body surface of the neonates in our clinical setting. Therefore, chemoprophylaxis is recommended for these organisms in prolonged PROM.
    Keywords: Communication disorders, Congenital hypothyroidism, Diagnosis, Mass screening, Sensorineural hearing loss
  • Shourangiz Beiranvand, Reza Hosseinabadi *, Majid Firouzi, Mohammad Almasian, Khatereh Anbari Pages 20-25
    Background
    Jaundice is a physiological phenomenon and common disorder in the neonatal period. Jaundice occurs in the first month of life in 60% of term and 80% of preterm neonates, leading to hospitalization. The present study aimed to determine the effect of oral zinc sulfate on serum bilirubin levels in the neonates undergoing phototherapy.
    Methods
    This randomized clinical trial was conducted on 90 normal term neonates aged more than 24 hours with the total serum bilirubin of 14-19 mg/dc, who were admitted to the neonatal ward of Shahid Madani Hospital in Khorramabad, Iran for uncomplicated jaundice. Based on the inclusion criteria, these infants were divided into two groups of experimental (n=45) and control (n=45) via block random allocation. Infants in the control group only received phototherapy, and the experimental group received oral sulfate zinc (5 mg b.i.d.) in addition to phototherapy. Total serum bilirubin levels were measured upon admission and 24 and 48 hours after admission.
    Results
    No significant differences were observed between the experimental and control groups in terms of age, gender, birth weight, hemoglobin level, reticulocyte percentage, and total serum bilirubin at the beginning of the study (P>0.05). Comparison of the bilirubin levels using repeated measures ANOVA at different times indicated significant differences in the neonatal serum values and blood cell counts between the study groups (time effect) (F=598.078; P
    Conclusion
    Although oral zinc salts inhibit the enterohepatic circulation of bilirubin, they might not be effective in the treatment of physiological jaundice in neonates. Due to the lack of human studies on the effect of oral zinc salts, further investigation is recommended.
    Keywords: Hyperbilirubinemia, jaundice, Term neonates, Zinc sulfate
  • Mamak Shariat, Nasrin Abedinia *, Ahmad Ali Noorbala, Jayran Zebardast, Sima Moradi, Nasrin Shahmohammadian, Akram Karimi, Mojgan Abbasi Pages 26-34
    Background
    "Exclusive breastfeeding (EBF) is globally promoted as the ideal method of infant feeding during the first six months of life due to its health benefits to both the mother and child" (1). The aim of this study was to examine the effect of the interventions leading to increased awareness, knowledge, and self-efficacy regarding exclusive breastfeeding and duration of breastfeeding.
    Methods
    This clinical trial was conducted on 129 pregnant women before the gestational age of 21 weeks and 6 days referring to Vali-e-Asr Hospital in Tehran, Iran. The study population was selected using the convenience sampling method. The participants were randomly assigned into two groups of intervention (n=64) and control (n=65). The mothers in the intervention group received one training session on breastfeeding self-efficacy, as well as training and audio packages regarding postpartum care and relationship with neonates. In addition, the women who suffered from anxiety, stress, or depression were provided with psychotherapies. The data collection instruments included the Self-Efficacy Scale, Edinburgh Postnatal Depression Scale, and Spielberger's State-Trait Anxiety Inventory.
    Results
    Exclusive breastfeeding was higher in the intervention group than in the control group during the first six months postpartum (P=0.015). The follow-up study showed that there were higher rates of breastfeeding for the two-year-old children in the intervention group (P
    Conclusion
    As the findings indicated, psychological intervention aimed at increasing self-efficacy had a significant impact on maternal breastfeeding self-efficacy and duration of breastfeeding.
    Keywords: Exclusive breastfeeding, Psychiatric disorder, Psychological therapies, Self-efficacy
  • Zahra Godarzi, Khadijeh Zarei, Mamak Shariat, Khosro Sadeghniat, Niko Nikafs, Hamideh Sepaseh* Pages 35-41
    Background
    The present study aimed to assess handling procedures and their effects on the sleep-wake time in the preterm infants admitted to the neonatal intensive care unit (NICU).
    Methods
    This observationalcross-sectional study was conducted in the NICU ofVali-e-Asr Teaching Hospital affiliated to Tehran University of Medical Sciences (TUMS), Iran in 2016. Sample population consisted of 15 preterm infants, and duration of the handling procedures was considered to be 15 days or 360 hours. Handling procedures were recorded within an uninterrupted 24-hours period. Sleep patterns of the infants were checked at 8 AM-8 PM using Als’ behavioral states scale of Newborn Individualized Developmental Care and Assessment Program (NIDCAP sheet).
    Results
    Mean frequency of the handling procedures during 24 hours was 59.93±15.86. Within 12 hours, mean frequency of the care/monitoring, therapeutic, and supportive procedures was 41.20±12.14 during the day, while it was 18.73±5.43 at night. Mean handling procedures in minutes was 18.73±5.43 for care/monitoring procedures, 13.60±13.28for therapeutic procedures, and 76.21±93.08 for supportive procedures. In therapeutic and care/monitoring handling procedures, sleep duration decreased in the infants, while it increased in the supportive procedure. Mean total oxygen saturation was 94.80±2.81, and mean total heart rate was 147.30±16.76.
    Conclusion
    According to the results, supportive handling could increase sleep duration in preterm infants. Therefore, it is recommended that this technique be applied for the comfort of preterm infants in the presence of parents.
    Keywords: Handling, Neonatal intensive care unit (NICU), Preterm infant, Sleep
  • Zahra Pourashoori, Keyvan Mirnia, Fatemeh Ghorbani, Abdolrasoul Safaiyan, Mohammad Ali Nematzadeh, Mohammad Arshadi Bostanabad* Pages 42-48
    Background
    Venipuncture is one of the most painful and common interventions in Neonatal ward. A preterm infant can not cope long-lasting physiologic stresses; therefore, the pain caused by blood sampling may change the infant’s physiologic responses to the stress. This present study aim is to investigated and compare physiologic changes (pulse rate and oxygen saturation) in two sites of blood sampling in preterm infants.
    Methods
    This crossover clinical trial was performed on 105 preterm infants of 28-32 weeks’ gestational age in Tabriz Alzahra teaching hospital. Infants were selected through convenient sampling method and were allocated to two groups using doubleblock. In group 1(53 infants): the blood was first drawn from head veins and after a 24-hour interval, it was repeated at the back of the hand. In group 2 (52 infants): this procedure was implemented conversely.Infant's demographic variables and physiologic values(pulse rate and oxygen saturation) were measured in both sampling methods. The data were analyzed using SPSS.13, Paired t-test and Friedman test. P˂ 0.05 was considered as significant.
    Results
    There was a significant difference between two groups considering infants’ age and various assessing timeswhen pulse rate changeswere investigated (Pv≤0.001);however, no significant difference was found regarding toblood sampling sites(head & back of the hand)).In addition, no significant difference was found in oxygen saturation changes in terms of age and blood sampling sites(head& back of the hand); however, these changes were significantly different in terms of different blood sampling times (PvTIME≤ 0.001).
    Conclusion
    Pulse rate and oxygen saturation changingwas not significantly different in two methods of blood sampling from head veins and back of the hand veins in preterm infants; therefore, both sites can be used for drawing blood. During blood sampling in preterm infants of lower gestational age, the rate of pulse increased;however, the level of oxygen saturation decreased. As a result, since infants of lower gestational age are more vulnerable, drawing blood is required to be performed at the first attempt and no more attempts should be made
    Keywords: Blood, Hand, Head, Infant, Physiologic, Venipuncture
  • Mandana Kashaki, Ali Mazouri, Arash Bordbar, Maryam Saboute, Zahra Behnamfar *, Atefeh Talebi Pages 49-56
    Background
    Breast milk provides adequate protein to facilitate growth for term infants. Appropriate nutrition is necessary for the growth of preterm infants. Extremely-low-birth-weight (ELBW) infants require higher protein intakes to achieve adequate growth.
    The present study aimed to evaluate the effect of protein supplements on the physical growth of infants weighing less than 1,000 grams through the serial measurement of their anthropometric indices (weight, height, and head circumference) during admission at the neonatal intensive care unit (NICU).
    Methods
    This triple-blind, randomized clinical trial was conducted on 64 infants weighing less than 1,000 grams, who were admitted to the NICU of Akbar Abadi Hospital in Tehran, Iran during 2015-2016. Data on the daily nutritional intake of the subjects were recorded until discharge from the hospital. Data analysis was performed in SPSS version 24.
    Results
    In total, 63 infants were enrolled in the study. Mean daily weight gain of the infants was 55.92±36.90 and 30.80±13.91 grams in the case and control groups, respectively (P=0.001). Mean weekly linear growth in the case and control groups was 0.77±0.67 and 0.76±0.29 centimeter, respectively (P=0.939). Mean weekly head circumference growth in the case and control groups was 0.51±0.10 and 0.34±0.16 centimeter, respectively (P
    Conclusion
    According to the results, protein therapy in the premature, extremely-low-birth-weight (ELBW) infants could improve the rate of weight gain and head circumference growth. Given the importance of weight gain in premature ELBW infants, it is recommended that protein therapy be employed in these newborns. Various studies have denoted the few side-effects of protein therapy, which indicates the safety of this method to resolve the lack of weight gain in these infants.
    Keywords: ELBW infants, Growth, Protein
  • Maryam Marofi, Fatemeh Abedini, Maryam Shirazi *, Zohreh Badiei, Zahra Baghersad, Farzaneh Nikobakht Pages 57-63
    Background
    Invasive procedures could change the physiological responses of neonates. The present study aimed to evaluate the effect of the sound of the Holy Quran on the physiological responses and pain caused by heel stick blood sampling in neonates.
    Methods
    This three-stage, two-group, clinical trial was conducted on 72 hospitalized term neonates at the neonatal intensive care unit (NICU) of Al-Zahra Hospital in Isfahan, Iran during 2013-2014. Subjects were selected via simple random sampling and allocated to two groups of intervention and control. Data were collected using a questionnaire consisting of the demographic characteristics, physiological responses, and pain of the neonates. Data analysis was performed in SPSS version 18.
    Results
    Post-hoc LSD test indicated that the mean respiratory and heart rates were significantly higher in the intervention group (sound of the Holy Quran) during blood sampling compared to before and three minutes after the procedure (P
    Conclusion
    According to the results, playing the sound of the Holy Quran during painful procedures could positively influence the stabilization of the physiological responses in the hospitalized neonates, thereby reducing their exposure to the risk of decreased oxygen saturation and the associated complications.
    Keywords: Holy quran, Intensive care unit, neonate, Physiological responses
  • Ahmadshah Farhat, Anahita Majma, Farah Ashrafzadeh, Javad Akhondian, Ashraf Mohammadzadeh, Ali Ghasemi * Pages 64-69
    Background
    The main objective of this study was to systematically review the reported potency of cord blood stem cells in treating patients with neurological disorders such as cerebral palsy.
    Methods
    PubMed, Scopus, and Cochrane were searched thoroughly on September 2016 using the following search terms: “Umbilical cord blood stem cells” AND “development” AND “cerebral palsy” to find articles in which the umbilical cord blood stem cells were used to treat patients with cerebral palsy. Only English-language studies conducted on patients with cerebral palsy were included and used for data extraction.
    Results
    Of a total of 77 articles found in the database search, only 6 papers fully met the inclusion criteria. The results showed successful treatment with cord blood stem cells in 165 patients with cerebral palsy.
    Conclusion
    Studies on both human and animal models have shown the beneficial effects of stem cell therapy in the treatment of various neurological diseases. Data presented that cord blood stem cells can be considered as a main therapeutic strategy to treat patients with cerebral palsy. In addition, it is shown that cord blood stem cells significantly improve motor function, cognition, and memory in patients with cerebral palsy.
    Keywords: Cerebral palsy, Stem cell therapy, Umbilical cord blood cells
  • Majid Khadem-Rezaiyan, Reza Saeidi, Masumeh Ghazanfarpour, Mohamadghasem Etemadi Mashhadi, Mona Najaf Najafi * Pages 70-75
    Background
    Many techniques have been proposed to relieve labor pain, one of which is hypnotherapy, which can be defined as the usage of hypnosis during labor to alleviate pain or anxiety. The aim of this systematic review was to examine the possible relationship between hypnosis and neonatal outcomes based on the available reports.
    Methods
    Major databases, including PubMed, Web of Science, Scopus, and Cochrane CENTRAL, were systematically searched up to February 6, 2018. In the next stage, the titles and abstracts of the retrieved articles were reviewed to identify the relevant studies. The quality of the studies was evaluated using the Jadad scale. Study appraisal and data extraction were carried out by one of the authors, and then double-checked by another researcher. Finally, the search process resulted in the inclusion of 10 trials.
    Results
    Based on eight studies, hypnosis for pain management during labor had no effect on Apgar score in neonates. No significant difference was reported between hypnosis and non-hypnosis groups in terms of the number of admission to the Neonatal Intensive Care Unit (NICU). Furthermore, the short-term effect of hypnosis on the continuation of exclusive breastfeeding was indicated in three studies. However, the duration of neonatal admission to nursery or NICU was not reported in any of the studies. Only one study reported that there was no significant difference between hypnosis and control groups concerning the frequency of hospital readmission.
    Conclusion
    Based on the evidence reported in the literature, it could be concluded that hypnosis can be regarded as a safe approach for pain management during the labor. Moreover, this intervention did not show to exert any adverse effects on neonatal health status.
    Keywords: Apgar score, Hypnosis, Labor pain, Neonatal outcome
  • Mahboubeh Valiani, Freshteh Ashtari, Fatemeh Mokhtari * Pages 76-82
    Background
    Multiple sclerosis (MS) is a chronic disease of the central nervous system, which is more prevalent in women than men. Considering the onset of MS in the women of reproductive age, the present study aimed to investigate the reciprocal effects of MS, childbirth, and postpartum.
    Methods
    This retrospective, descriptive-analytical study was conducted on 110 women diagnosed with MS during pregnancy in Isfahan, Iran during 2016-2017. The subjects had become pregnant within the recent decade and were selected via random sampling. Data on the demographic characteristics, pregnancy and postpartum profile, medicinal changes, symptoms, severity, and attack rates of MS were collected. Data analysis was performed in SPSS version 16.
    Results
    Mean age at the completion of pregnancy was 38.13 weeks. In total, 63.9% of the deliveries were accomplished via caesarean and 35.1% of the women had natural vaginal delivery. Mean pain intensity at childbirth was 7.11. No symptoms of MS attacks were reported in 86.7% of the subjects during delivery and 90.7% of the women within the first six weeks of childbirth. All the neonates were healthy, and 66.3% of the mothers had no psychological and emotional postpartum complications. In addition, 40.3% of the women started their MS medication within the first six months after childbirth.
    Conclusion
    According to the results, MS was not associated with the increased risk of preterm or post-term delivery. Moreover, it did not increase the severity of labor pain in the mothers. On the other hand, the rate of elective cesarean section was higher in MS patients compared to the general population, especially in the cases with disabilities. According to the Friedman curve, MS caused no substantial changes in the progression of delivery, and most of the neonates were healthy males with an Apgar score of 10. However, the severity of limb numbness and blurred vision increased in the women with MS in the postpartum period.
    Keywords: Childbirth, Multiple sclerosis, Postpartum, Pregnancy
  • Seyhan Erisir Oygucu *, Gonul Tezel, Muhammet Kazim Erol, Ozgur Erkal Pages 83-87
    Background
    Oculo-palato-cerebral syndrome is an extremely rare condition characterized by various features, including low-birth weight, microcephaly, cerebral atrophy, mild-to-severe developmental delay, cleft palate, persistent hyperplastic primary vitreous, microphthalmia, small hands and feet, joint laxity, and large ears with thick helices. Diagnosis of this syndrome is based on the clinical manifestations, particularly the presence of persistent hyperplastic primary vitreous in association with other malformations. Congenital chylothorax is also a rare condition in the neonatal period, which is caused by the abnormal accumulation of the lymphatic fluid within the pleural space. This condition may be detected prenatally or during the neonatal period.
    Case report: We presented the case of a patient with oculo-palato-cerebral syndrome and congenital chylothorax based on a literature review.
    Conclusion
    Oculo-palato-cerebral syndrome and congenital chylothorax are both rare conditions. To the best of our knowledge, this was the first case report on congenital chylothorax in association with oculo-palato-cerebral syndrome in the available literature. Since there have only been five case reports on these patients, further evidence is required to confirm the possible association between these rare conditions.
    Keywords: Congenital chylothorax, Oculo-palato-cerebral syndrome, Persistent hyperplastic primary vitreous
  • Yazdan Ghandi *, Vahab Ghanbari Sheldareh, Saeed Alinejad, Danial Habibi Pages 88-91
    Although myocarditis is uncommon in neonates, a wide variety of infectious pathogens can result in myocarditis, including viruses, bacteria, rickettsia, fungi, and protozoa. Viruses are most often the infectious disease found to cause acute myocarditis. On the other hand, bacterial myocarditis (BM) is an unusual cause of infectious myocarditis. BM is commonly seen in the context of sepsis or as part of a bacterial syndrome.
    Streptococcus pseudopneumoniae has mostly been isolated from the respiratory tract specimens. This infection is not prevalent in neonates. In this case report, a 5-day-old male neonate was admitted with the signs of fever, jaundice, and poor feeding. Moreover, he was lethargic and hypotonic with reduced neonatal reflexes and obvious tachycardia.
    Clinical and physical examinations were performed in addition to chest X-rays, echocardiography, cerebrospinal fluid (CSF) analysis, and other laboratory tests. The final diagnosis was confirmed as myocarditis and meningitis. The patient was treated with antibiotics and intravenous immunoglobulin (IVIG).
    On the sixth day of hospitalization, fever of the neonate fever resolved. On the 24th day, the CSF analysis was normal and the CSF, as well as blood culture were negative. The patient was discharged on the 30th day in good general and physical condition. The subsequent echocardiography performed four months’ post-hospitalization was normal.
    Keywords: Early sepsis, Meningitis, Myocarditis, neonate, Streptococcus pseudopneumoniae