فهرست مطالب

  • Volume:9 Issue: 4, 2018
  • تاریخ انتشار: 1397/08/06
  • تعداد عناوین: 14
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  • Jayashree Purkayastha , Maitreyee Dutta, Leslie Edward Lewis, Ramesh Bhat Y, Joshua Rajan X, Gaurav Ayappa Pages 1-6
    Background
    Therapeutic hypothermia has become an established protocol for all neonates with moderate to severe Hypoxic Ischaemic Encephalopathy (HIE). There are very few studies comparing the neurodevelopmental outcomes in asphyxiated neonates who received therapeutic hypothermia or did not. This study aimed to assess the neurodevelopmental outcomes of asphyxiated neonates with features of HIE at 10-14 months of age using Bayley Scale of Infant and Toddler Development III (BSID III) and to compare this outcome between neonates who received therapeutic hypothermia and those who did not.
    Methods
    Term infants with HIE admitted in neonatal intensive care unit (NICU) at a tertiary referral hospital were followed up at 10-14 months of age from December 2013 to August 2015. Neurodevelopmental outcomes were assessed using BSID III.
    Results
    A total of 76 neonates with birth asphyxia were admitted to NICU between December 2012 and August 2014. These neonates were followed up from December 2013 to August 2015, and 34 of them were included in the study. At10-14 months of age, 8 neonates (23.5%) had cognitive delay, 14 cases (41.17%) had motor delay, and 9 newborns (26.4%) had language delay using BSID III score of < 85 as cut off.
    Twenty (58.82%) infants had normal development in all 3 domains. Higher percentage of infants (73.68%) who received therapeutic hypothermia had normal BSID Score as compared to 40% of the neonates with normal BSID score (>85) who did not receive therapeutic hypothermia. Statistical analysis using Chi-square test showed P-value of 0.048 as statistically significant.
    Conclusion
    Neurodevelopment assessment at 10-14 months of age using BSID III of asphyxiated neonates with HIE showed significantly better outcome in infants who received therapeutic hypothermia than those who did not.

    Keywords: Bayley scale of infant development III, Hypoxic ischemic encephalopathy, Hypothermia, Neonates
  • Beatrice Ezenwa , Yeside Akinbolagbe, Iretiola Fajolu , Patricia Akintan, Luther Agaga , Veronica Ezeaka Pages 7-14
    Background
    Neonatal jaundice is a common medical condition encountered in the neonatal period in Nigerian hospitals. Its management is not homogenous among healthcare providers. Therefore, this study aimed at evaluating current practices related to the treatment of neonatal jaundice among doctors and nurses caring for neonates in Nigeria.
    Methods
    Healthcare providers managing neonates in Nigeria were surveyed during annual general and scientific meetings of the Nigerian Society of Neonatal Medicine in 2017. In addition, the Paediatric Association of Nigeria’s mailing list was utilized to disseminate a self-administered, pretested and structured questionnaire to doctors and nurses involved in taking care of newborns in Nigeria.
    Results
    The results of the study showed that local guidelines / protocols were highly applied by the respondents. The majority of the health care providers would screen newborns for neonatal jaundice before discharge. The practice of early discharge within 24 hours was rampant with a high frequency of late follow up at 6 weeks.
    Conclusion
    The practices regarding management of neonatal jaundice among healthcare professionals in Nigeria vary with better practices observed in specialist cadres. Newborn discharge and follow-up practices also vary and are sub-optimal. Therefore, there is a need for more awareness creation on neonatal jaundice treatment among cadres of health care practitioners. This should be complimented with the development of a national guideline on the management of neonatal jaundice in Nigeria
    Keywords: Health care practitioners, Neonatal Jaundice, Nigeria
  • Ramadan A Mahmoud _Magdy A Mohamed_Shereen P Aziz Pages 15-21
    Background
    Antenatal steroid therapy recently has been considered for term and late preterm neonates delivered by Cesarean section (CS), with the aim of preventing adverse respiratory morbidity. The main aim of this study was to investigate the metabolic effects of antenatal dexamethasone on blood glucose (BG), homeostasis, and serum C-peptide level when administered to term fetuses.
    Methods
    Umbilical cord blood C-peptide and BG were measured in singleton newborns of 37 weeks gestational age or older with planned CS; furthermore, the history of dexamethasone receiving was taken from mothers. Other parameters, such as, Apgar score, neonatal birth weight, BG follow-ups, and admission to the neonatal nursery were collected.
    Results
    Totally, 117 mothers met the inclusion criteria, of whom 60 had received antenatal dexamethasone. This study demonstrated that babies treated with antenatal dexamethasone had a decrease in umbilical cord BG (P=0.001) and BG follow-up three hours after birth (P=0.001) compared to untreated group. However, there was no statistically significant difference in the BG measurements within both groups in the first 24 h post birth (P=0.14). Furthermore, no statistically significant difference was observed within the two groups regarding umbilical cord C-peptide measurements (P=0.08), birth weight (P=0.17), and the numbers of neonates that needed admission to the nursery (P=0.36).
    Conclusion
    Although antenatal dexamethasone causes immediate mild BG homeostasis alterations in term newborns delivered by elective CS, its use is not associated with a statistically significant effect on serum umbilical cord C-peptide measurements, neonatal birth weight, and the rate of neonatal nursery admission
    Keywords: Antenatal dexamethasone, Blood glucose, Cesarean section, Cord blood C-peptide, Full-term infant Statistics
  • Gholamreza Faal , Fatemeh Eghbal Pages 22-27
    Background
    In this study, we aimed to compare ventilator-derived and bubble continuous positive airway pressure (CPAP) in neonates with respiratory distress syndrome admitted to Neonatal Intensive Care Unit of Vali-e-Asr Hospital, Birjand, Iran, in 2014.
    Methods
    This cohort study was conducted among 68 patients assigned into two groups. The neonates in group A (32 infants) were treated with bubble CPAP and those in group B (36 infants) were treated with a ventilator-derived CPAP. The protocol of treatment was applying CPAP with the positive end-expiratory pressure (PEEP) of 5-6 cm H2O and fraction of inspired oxygen equivalent to 30-40%, depending on the gestational age. In case of need for higher oxygen levels to maintain oxygen saturation of arterial blood (SpO2) (90-95%), surfactant was administered and additional PEEP was applied (up to 8 cm H2O). Data analysis was performed using independent t-test and Chi-squared in the SPSS software, version 18.
    Results
    The duration of CPAP and oxygen therapy was 1.67±1.22 days and 3.57±2.67 days in group A and 2.09±1.53 days (P=0.21) and 4.67±3.74 days (P=0.16) in group B, respectively. There was a significant difference between the groups in terms of discharge weight and surfactant dosage (P=0.042 and P=0.007, respectively). Moreover, although the length of stay in hospital in the ventilation group was almost 4 days longer than the other group, there was no significant difference between the groups in this regard.
    Conclusion
    There was no significant difference between bubble CPAP and ventilator-derived CPAP. Moreover, further studies with larger sample size are recommended
    Keywords: CPAP, Bubble CPAP, Prematurity, RDS, Ventilator CPAP
  • hedieh saneifard , Mitra Radfar, Sedigheh Shahrivar, Marjan Shakiba, Nooshin Faraji Pages 28-32
    Background
    Gestational weight gain is an impressive factor in the fetal outcome. Intrauterine growth restriction (IUGR) is one of the most important problems during fetal period that may lead to many perinatal and long-term complications and growing neonatal morbidities and mortalities. The aim of the study was to ascertain the relationship between umbilical cord blood leptin concentration and fetal growth in neonates born with intrauterine growth restriction.
    Methods
    Maternal serum and umbilical cord blood leptin concentration were measured by immune radiometric assay at term gestation. The study was conducted on 22 women with uncomplicated singleton pregnancies as control group (group A) and 22 women with fetal growth restriction in singleton pregnancies as case group (group B). All subjects had normal pregravid body mass index (BMI).
    Results
    The results of the study showed that maternal serum leptin concentrations were significantly higher in group B comparing to group A (44ng/ml [28.9-58.2] vs. 24.6ng/ml [18.8-33.3]; P<0.001). However, umbilical cord blood leptin levels were significantly lower in group B comparing to group A (8.6 ng/ml [range 4.5-12.7] vs. 14.6 ng/ml [11.7-16.7]; P<0.001). Moreover, umbilical cord blood leptin levels were directly correlated with maternal BMI and neonatal birth weight in both groups.
    Conclusion
    In growth-restricted fetuses at term, umbilical cord blood leptin concentrations were significantly lower than normal fetuses, suggesting that fetal adipose tissue is a major source for leptin production. Maternal serum leptin concentrations were higher in the presence of a growth restricted fetuses. This increas may be due to early hypoxia or an intrinsic placental mechanism, by which small placenta produces more leptin as a compensatory mechanism. Human recombinant leptin may have some roles in the treatment of IUGR fetuses in future
    Keywords: Adipose tissue, Intrauterine growth restriction, Leptin, Umbilical cord
  • Ghobad Mashayekhy, Majid Hmidi, Soleiman Kheiri, Marzieh Khalili Dehkordi , Roya Choupani Pages 33-40
    Background
    The cornerstone of the treatment of respiratory distress syndrome (RDS) is respiratory support and surfactant replacement therapy. The administration of surfactant through a thin intratracheal catheter is one of the methods used to reduce one of the standard technique complications of a surfactant injection (Intubation-Surfactant-Extubation method [INSURE]). The aim of this study was to compare the effectiveness of this method on the treatment of RDS in neonates with one of the INSURE technique.
    Methods
    In this double blind clinical trial, 104 neonates with RDS were randomly allocated to two groups, one group received surfactant via an endotracheal tube (INSURE) and the other received surfactant without intubation (SWI) via a thin intratracheal catheter. Subsequently the outcomes of the two groups were compared.
    Results
    The incidence of hypoxemia during surfactant administration was significantly lower in the SWI group (11.5%) than in the INSURE group (28.8% , P< 0.05). no significant difference was observed in the need for intubation and mechanical ventilation during the first 72 hours of life, the duration of mechanical ventilation, the need for nasal continuous positive airway pressure (NCPAP), the need for oxygen, the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, pulmonary hemorrhage ,and death in the two groups.
    Conclusion
    Administration of surfactant through a thin intratracheal catheter is a safe and easy technique. This method is as effective as the INSURE method in improving the outcomes of RDS treatment
    Keywords: Neonatal respiratory distress syndrome, Surfactant, Surfactant without intubation
  • Mazyar Vakiliamini , Homa Babaei Pages 41-46
    Background
    Neonatal jaundice is a common condition in approximately 60% of term newborns during the first week after birth. Therefore, it is necessary to detect methods for the prevention of this problem.This study was conducted to evaluate the impact of massage therapy on transcutaneous bilirubin level in healthy term newborns.
    Methods
    The present study was conducted on102 healthy term newborns. The newborns were randomly assigned to massage group and control group. The massage group received daily massage for five days from the first postnatal day while the control group received only routine neonatal care (without massage). In both groups, transcutaneous bilirubin level and frequency of defecation were the main studied variables.
    Results
    The frequency of defecation in the massage group increased from 1.08 on the first day to 4.08 on the fifth day, whereas it increased from 0.865 on the first day to 2.731 on the fifth day in the control group, indicating a significant difference between the two groups (P<0.005). Moreover, transcutaneous bilirubin levels on the first and second days were not significantly different in both groups, while it was significantly lower during the third to fifth days in the massage group compared to that in the control group (P<0.005).
    Conclusion
    The results of this study revealed that massage therapy could reduce transcutaneous bilirubin level and increase the frequency of defecation in healthy term neonates
    Keywords: Bilirubin, Jaundice, Massage, neonate
  • Mitra Gorji Rad, mohsen haghshenas , zahra Akbarian rad Pages 47-52
    Background
    The transient tachypnea is a common respiratory problem in the neonate. One of the significant issues in pathophysiology of this disorder is the delayed reabsorption of the fluid by the neonate’s lungs and the effusion of fluid in the lungs. The purpose of this study is to evaluate the effects of restrictive fluid management in transient tachypnea of the neonate.
    Methods
    The present study was conducted on the neonates with the gestational age ≥ 34 weeks suffering from transient tachypnea during the first 6 h after birth. The amounts of total fluid in experimental and control groups were 50, 65 mL/kg and 65, 80 mL /kg for term and preterm neonates, respectively. In each group, a daily amount of 20 mL/kg fluid was added until 150 and 170 mL/kg for term and preterm newborns.
    Results
    This study was carried out on 70 neonates, including 34 cases and 36 controls. The mean of hospitalization period in the experimental group was less than that of the control group. The mean period of respiratory support in the experimental group was less than that in the control group.
    Conclusion
    The results of the present study revealed that the restrictive fluid management in the neonates with transient tachypnea might decrease the hospitalization period and the respiratory support period. Furthermore, it is a safe and effective method in treating transient tachypnea in neonates
    Keywords: Respiratory support, Restrictive fluid management, Transient tachypnea in neonates
  • Ashraf Mohammadzadeh , Gholam Ali Mamuri, Reza Saeidi , Shadi Noorizadeh , ahmad shahfarhat Pages 53-60
    Background
    Humidified heated high flow nasal cannula (HHHFNC), nasal continuous positive airway pressure (NCPAP), and nasal intermittent positive pressure ventilation (NIPPV) are three nasal non-invasive ventilation methods. The purpose of this study was to compare these three methods in decreasing intubation and mechanical ventilation rate in preterm neonates with respiratory distress syndrome (RDS).
    Methods
    This study was a randomized controlled study conducted on 160 neonates. The inclusion criteria for intubation in this study were persistent respiratory acidosis (arterial pH<7/2 or PCO2>60), hypoxemia, severe and repeated apnea episodes which did not respond to increasing respiratory rate and therefore required ventilation. Cranial Ultrasound was performed on the third day after birth. The data of all neonates were collected until the day of discharge and analyzed by SPSS (version 20) and statistical methods.
    Results
    Based on the results,there was no significant difference among the three randomized methods. Out of all the cases, 72% of the neonates with NIPPV had successful non-invasive ventilation (35/53), compared to 73/6% in NCPAP (39/53) and 72/2% in HHHFNC (P=0/999). Similarly, there was no significant difference among the three methods in total ventilation time and the need for supplemental oxygen.
    Conclusion
    The use of HHHFNC at birth in preterm neonates with RDS is safer than the other two methods. However, it is not more effective than the other two methods in the reduction of intubation rate.
    Keywords: Humidified heated high flow nasal cannula (HHHFNC), Nasal continuous positive airway pressure (NCPAP), Nasal intermittent positive pressure ventilation (NIPPV), Preterm neonates, Respiratory distress (RDS) Statistics
  • Fathmeh Khonamani Falahati, Alireza Ansari Moghadam , Mahmoud Imani, Simin Sadeghi, bojd Pages 61-65
    Background
    One of the recognized symptoms of phototherapy in neonates is hypocalcemia and hypercalciuria, and its etiology has not been identified yet. The present study investigated the recurrence of hypercalciuria among neonates with jaundice treated with phototherapy.
    Methods
    This cross-sectional diagnostic examination was conducted on 100 newborns with jaundice treated with phototherapy in Ali-ibn-Abi-Talib hospital in Zahedan, Iran, during 2013 and 2014. In the present study, the subjects were collected in an accessible way after agreement and considering exclusion criteria. Calcium and creatinine (Ca/Cr) proportion in urinary tests of the neonates was estimated at the baseline and 24 h after the onset of phototherapy. The information was analyzed utilizing paired t-test.
    Results
    The mean of gestational age was 38.5±2.5 weeks. Out of 100 cases, 53 newborns (53%) were male and 47 (47%) were female. The mean scores of birth weight was 2.52±0.59 kg and neonatal serum bilirubin level was 16.5±0.92 mg/dl. Ca/Cr ratios in neonates with jaundice were 0.28±0.21 and 0.40±0.34 before and after the phototherapy, respectively. Regarding that, the increase in Ca/Cr ratio was statistically significant (P<0.001). Hypercalciuria was not observed in the neonates before the phototherapy; however, it was noticed in 13 neonates after the phototherapy. Ca/Cr ratios in neonates with hypercalciuria and other newborns were 1.16±0.19 and 0.29±0.18, respectively. Furthermore, the difference between the two groups was statistically significant (P<0.001).
    Conclusion
    Based on the results of this study, it was suggested that the neonates undergoing the phototherapy were at risk of hypercalciuria and the increased amount of urinary calcium excretion by means of phototherapy
    Keywords: Hypercalciuria, Jaundice, Phototherapy
  • Ali Bazi , Alireza Sargazi, Omolbanin Sargazi Aval, Alireza Dechal, Mostafa Bazzi, Masoud Jahantigh , Iraj Shahramian Pages 66-71
    Background
    There is limited knowledge on the potential applicability of fecal calprotectin (f-CP) as an inflammatory screening parameter in infantile colic (IC). This study aimed to evaluate f-CP in neonates with IC as a useful diagnostic indicator regarding this condition.
    Methods
    The present study was conducted on 100 cases, including 50 newborns with IC and 50 non-colicky neonates. The diagnosis of IC was fulfilled by the Wessel Criteria. The level of f-CP was determined by a specific enzyme-linked immunosorbent assay kit (Calprotectin ELISA, EuroImmun, Germany). The statistical analysis was performed in SPSS software (version 19).
    Results
    Out of 100 neonates, 57 cases were male and 43 subjects were female. The age spectrum ranged from 19-90 days (40.4±15.9). Colicky newborns were slightly younger (P=0.06) with higher birth weight compared to the infants without colic (P<0.0001). The level of f-CP was significantly higher in colicky neonates (113.7±98.2 µg/g) than non-colicky cases (71.4±45.5 µg/g) (P=0.007). Overall, 37%, 30%, 26%, and 7% of the newborns showed f-CP levels<50, 50-100, 100-200, and >200 µg/g, respectively. There was a significant difference regarding the distribution of these f-CP categories between neonates with IC and the cases without IC (P=0.02). There were no significant correlations between the f-CP and newborn age, pregnancy age, present or birth weights, and number of pregnancies. Receiver operating characteristic analysis rendered an area under the curve of 0.642 (95% CI: 0.534-0.748) (P=0.01). At the cut-off value of 74 µg/g, f-CP showed sensitivity of 60% and specificity of 59% for the detection of IC.
    Conclusion
    The results of this study revealed that the f-CP might be useful in the diagnosis of the IC
    Keywords: Calprotectin, Infantile colic, Intestinal inflammation, Leukocyte L1 antigen complex Statistics
  • Khodayar Oshvandi, Younes Mohammadi, Shirin Moradkhani, Farzin Firozian , Tayebeh Gharakhani Bahar, Seyedeh Zahra Masoumi Pages 72-79
    Background
    The results of the previous studies on the effects of mint on cracked nipple are contradictory. The purpose of the present study was to compare the effects of mint tea bag, mint cream and breast milk on the healing of cracked nipple during lactation.
    Methods
    This study was a clinical trial with a control group , pre and post-test design conducted in health centers of Hamadan University of Medical Sciences, Hamadan, Iran from 2016 to 2017.Samples were divided into three groups (n=72 subjects in each group). Interventions were performed at least 4 times a day for 14 days after the start of treatment. Data were collected through the cracked nipple measuring checklist, the amount of wound and demographic questionnaire before the intervention and on 4, 8, and 14 days after the intervention. Data analysis was conducted using descriptive and inferential statistics in SPSS software (version 21).
    Results
    There was a decreasing trend in the mean score of crack pain on days 0-14 in the groups of mint cream, mint tea, and breast milk after the intervention; however, there was a statistically significant difference in the breast milk group (P<0.001). Moreover, with regard to within group comparison, there was a decreasing trend with a significant difference in the mean score of wound in three groups before the intervention (P<0.001) and on the fourth day after the intervention (P= 0.003).
    Conclusion
    The results of the present study indicated that breast milk was more effective than mint cream and mint tea in the treatment of cracked nipple
    Keywords: Mint cream, Mint tea, Cracked nipple
  • Yazdan Ghandi , Niloofar alsadat Motamedi Pages 80-83
    Background
    Neonatal pneumopericardium (PPC) is a rare clinical condition usually associated with other air leak syndromes. It increases morbidity and mortality due to cardiac tamponade.
    Case report: A preterm male neonate weighing 1260 g was born with the gestational age of 28 weeks. Cardiopulmonary resuscitation was routinely performed without any medical therapy. The newborn was transferred to the neonatal intensive care unit due to marked respiratory distress with tachypnea and cyanosis. Pulse oximetry showed oxygen saturation of 70%. A whiteout of the lung and air-bronchogram pattern was found on the chest X-ray. The arterial blood gases demonstrated PH=7.14, PCo2=51 mmHg, Po2=36 mmHg, bicarbonate=15.8 mg. The neonate was intubated with a tracheal tube size 2.5 and mechanical ventilation was initiated with 90% fraction of inspired oxygen (FiO2), PIP=14 cmH2O, and PEEP=4 cmH2O.
    After intubation, the newborn received two doses of surfactant. On the third day, patent ductus arteriosus was established and appropriate treatment was performed. After five days, the chest X-ray was repeated due to increasing respiratory distress and an increasing FiO2, which revealed a pneumopericardium with right-sided pleural effusion and left upper lobe collapse. Afterwards, pleurocentesis was performed.
    Left ventricular ejection fraction (65%) was preserved and no evidence of cardiac tamponade was observed. Serial chest X-ray and echocardiography were performed daily. After the next seven days, the chest radiograph demonstrated a complete resolution of the pneumopericardium, pleural effusion, and lung collapse.
    Conclusion
    The present case study presented a preterm neonate suffering from pneumopericardium along with pleural effusion and lung collapse. Despite the complexity, the PPC was asymptomatic and eventually resolved without pericardiocentesis
    Keywords: Air leak syndrome, Pneumopericardium, Preterm, Respiratory distress syndrome
  • Mohammad Kazemian, Minoo Fallahi* , Seyed Hossein Fakhraee, Samin Alavi, Naeeme Taslimi Taleghani, Sara Sani Pages 84-87
    Background
    Osteopetrosisis an inherited and rare bone disease, characterized by the impairment ofbone modeling and remodeling and the failure of osteoclasts to resorb bone. It also results in skeletal fragility despite increased bone mass, and may cause hematopoietic insufficiency, disturbed tooth eruption, nerve entrapment syndromes, and growth impairment. The infantile form of the disease is the most severe one with a poor prognosis. If untreated, it will result in death by the first decade of life.
    Case report: A term 10-day-old female neonate with a birth weight of 2850 grams delivered by caesarian section was reported without a history of parents' consanguinity from a healthy, gravida 2, para 1, abort 1 mother with no complication during pregnancy. The newborn admitted to the neonatal ward due to diffuse petechiae, purpura on the skin, and periorbital ecchymosis (raccoon eyes), without any other abnormal significant signs and symptoms. In laboratory findings except for frequent low platelet count as low as 10000-25000, there wasn’t any other abnormalities. Other coagulative tests were within normal ranges. In addition to antibiotics for probable sepsis, platelet transfusion was considered as the treatment, and due to the lack of proper response to the treatment, with suspicious of alloimmune thrombocytopenia, two courses of IV IgG were administered. Eventually, the persistent thrombocytopenia in spite of mentioned treatment led to further investigation , and finally osteopetrosis was diagnosed by the result of brain CTS. The patient was discharged from the hospital with a moderate thrombocytopenia while she needed frequent platelet transfusion. Eventually with bone marrow transplantation, the sign and symptoms of the disease subsided.
    Conclusion
    In persistent and unjustifiable neonatal thrombocytopenia, diagnosis of osteopetrosis should be considered
    Keywords: Neonates, Osteopetrosis, Thrombocytopenia