Iranian Journal of Neonatology
Volume:10 Issue: 4, Autumn 2019

Prolonged hyperbilirubinemia is defined as jaundice persisting more than two and three weeks of life in term and preterm neonates, respectively. In total, 15-40% of jaundiced neonates became prolonged. The most common causes of prolonged hyperbilirubinemia are breastfeeding, infection, hypothyroidism, and continued hemolysis. Given the fact that no study was conducted on the association between the serums zinc level and prolonged hyperbilirubinemia, this study aimed to compare the healthy neonates with newborns suffering from prolonged hyperbilirubinemia in terms of serum zinc level.

This cross-sectional analytical descriptive study with a control group included all neonates who had a history of hospital admission and phototherapy due to hyperbilirubinemia at Amirkola Children’s Hospital, Babol, Iran. After discharge, on the 14th day of birth, all neonates followed up at the outpatient clinic. The serum bilirubin was checked and the neonates were assigned into the case (with prolonged hyperbilirubinemia) and control (without prolonged hyperbilirubinemia) groups. Both groups were matched regarding confounding factors. Serum zinc level was measured using the colorimetric method and the two groups were compared in this regard.

In total, 60 neonates in the case (n=30) and control (n=30) groups were investigated in this study. The serum zinc levels in the case and control groups were 83.7±35.35 and 92.73±38.13 μg/dl, respectively. There was no significant difference between the two groups in terms of the serum zinc level (P=0.34).

There is no statistically significant correlation between the serum zinc level and prolonged hyperbilirubinemia in term neonates who had been treated with phototherapy.

Breast milk can be a source of toxic material, along with the transfer of nutrients needed for infant growth. This study was conducted to measure the level of lead in maternal and neonatal blood and breast milk in Tehran, Iran.

In this cross-sectional study, 150 mothers and their infants were studied. Samples of maternal blood, fetal umbilical cord blood, breast milk, and amount of lead measured by atomic absorption method were collected. Correlations between lead levels and demographic characteristics of mother and infants were assessed.

The mean levels of lead in maternal and neonatal blood and breast milk were 9.79±4.31, 8.29±4.83, and 8.65±3.67 μg/dl, respectively. The different levels of lead were associated with cord blood, maternal blood, and breast milk. No significant relationship was found between lead levels and neonatal parameters (i.e., weight, height, and head circumference). The Spearman's correlation also showed the association between different levels of lead with cord blood, maternal blood, and breast milk. Linear regression also did not show any relationship between lead levels in cord blood, milk, and mother blood with newborn growth parameters.

The present study failed to find a significant correlation between lead and newborn birth parameters. In our study, lead levels in maternal blood, breast milk, and cord blood were lower, compared those of the previous years in Iran; however, it needs to decrease, because lead even at very low concentrations may also have adverse effects.

Bronchopulmonary dysplasia (BPD) is the second prevalent lung disease and one of the care challenges of premature newborns. Different risk factors play an important role in the development of this disease. Therefore, the aim of the present study was to investigate the relationship between colonization with Ureaplasma urealyticum and BPD. This prospective cohort study was conducted in 2017 in the neonatal intensive care unit of Alzahra Hospital in Tabriz, Iran. The samples included newborns weighing less than 1500 g with the gestational age of less than 32 weeks who required intubation within 72 h after birth. Following recording the initial information, the secretions within the trachea were aspirated and Ureaplasma urealyticum was detected in reference laboratory by polymerase chain reaction. Afterwards, we completed a follow-up of 28 days after birth for BPD. Our findings demonstrated that out of 82 infants, 21 cases (26.3%) were excluded from the study due to discharge from hospital or death before the age of 28 days. Among the rest (61 newborns), three cases (4.3%) were shown to have secretions infected with Ureaplasma and 33 cases (54.1%) suffered from BPD. All the three newborns infected with Ureaplasma had BPD. However, no significant relationship was observed between Ureaplasma infection and BPD (P=0.24).According to the analysis of data, the most important factors contributing to BPD among the patients were the gestational age and birth weight. In other words, for one week increase in the age of pregnancy and for each 100 g increase in birth weight, the likelihood of BPD is reduced by 55% and 1%, respectively. In the present study, no relationship was found between Ureaplasma infection and BPD, which might be due to the low prevalence of this infection. Nonetheless, prematurity and low birth weight could be regarded as the two considerable risk factors for BPD. In order to perfectly determine the role of bacterial colonization within the trachea in BPD, collecting and analyzing various samples for the existence of other bacteria are recommended.

Ventilator-associated pneumonia (VAP) is the second common nosocomial infection in NICUs leading to some complications. Nurses are one of the main resources in health care that directly influence neonatal health care. Responsibility of most of preventive strategies related to VAP complications lies with nurses; therefore, nursing care should be assessed until the nurses show standard level of performance in hospitals. The aim of this cross-sectional study, conducted within 2015-2016, was to assess nursing care regarding VAP prevention in neonatal intensive care units (NICUs) in selected hospitals affiliated to Shahid Beheshti University of Medical Sciences. In this descriptive cross-sectional study, 100 observations of nursing care regarding VAP were selected by convenience method in NICUs of Mahdiyeh, Mofid, and Imam Hossein hospitals affiliated to Shahid Beheshti University of Medical Sciences within 2015-2016. The data collection tools included demographic information questionnaire and a developed checklist related to VAP prevention. The observations were assessed and documented with two sampling methods, including time and event sampling. The data were analyzed in SPSS software (version 16). According to the results of the current study, the rate of compliance of nursing care with the standards for prevention of VAP in neonates under mechanical ventilation in NICU with developed standards was estimated at 62.81 percent. Authorities should pay more attention to nursing cares especially incompetent cares explained in this study to increase the health of hospitalized neonates, decrease complications, length of stay, and costs. Moreover, future research is needed to investigate the reasons of this incompetency.

Infants are exposed to different painful procedures during hospitalization in the neonatal intensive care unit (NICU). Due to the harmful effects of pain on infants, NICUs require methods by the aid of which the pain in infants can be controlled. Yakson touch and oral glucose are among non-pharmacological methods for pain relief in infants. In this regard, the present study was conducted to compare the effect of Yakson touch and oral glucose on the severity of phlebotomy pain in preterm infants. In this randomized clinical trial, 99 preterm infants hospitalized in NICU were randomly allocated to three groups, including Yakson touch (n=33), oral glucose (n=33), and control (n=33). In the oral glucose group, 1 cc of 50% glucose was orally given to the infants 1 min before phlebotomy. In the Yakson touch group, touching was performed for 5 min, and then the phlebotomy was performed. The infants in the control group did not receive a specific treatment. Infant pain level was determined before and after the phlebotomy using video recording based on Neonatal Infant Pain Scale. The data were analyzed using the analytical statistical tests, including the analysis of variance, Chi-square, Wilcoxon, and Kruskal-Wallis, in SPSS software (version 20). The mean scores of pain in the two experimental groups were significantly lower than that of the control group (P=0.001), but there was no significant difference between the two experimental groups (P>0.05). According to our findings, both two methods (i.e., Yakson touch and oral glucose) can reduce phlebotomy pain in preterm infants hospitalized in intensive care unit. It is recommended to use Yakson touch in case of lack of access to glucose.

Neonatal sepsis is one of the most important causes of infant mortality in developing countries. The causative organisms for sepsis are various in different regions across the world. The aim of this study was to determine the frequency of microbial agents and drug resistance pattern of the neonatal sepsis in newborns admitted to the neonatal intensive care unit (NICU) at Alzahra Hospital Tabriz, Iran. This descriptive cross-sectional study was carried out from December 2016 to January 2018 in the NICU at Alzahra Hospital Tabriz, Iran. The medical records of all neonates admitted to the NICU were investigated using the convenience sampling method. The data were collected using a two-part demographic form. Subsequently, the data were analyzed in SPSS software (version 22.0). Out of 174 positive blood culture, 52.4% (n=92) and 46.6% (n=82) of Gram-negative (G) and Gram-positive (G) bacteria accounted for the cause of sepsis, respectively. The most common cause of early- and late-onset sepsis was Coagulase-Negative Staphylococci (CoNS), and the most common G-negative and G-positive bacteria were Acinetobacter and CoNS, respectively. The G-positive bacteria showed the most antibiotic susceptibility to Vancomycin (81.45%), Ampicillin (52.15%), and Imipenem (47.32%). On the other hand, the highest drug susceptibility in G-negative bacteria was related to antibiotics, such as Amikacin (73.64%), Imipenem (56.36%), and Ciprofloxacin (52.44%). Moreover, the most antibiotic resistance was associated with Oxacillin (100%), Tetracycline (100%), and Ciprofloxacin (44.4%). The CoNS is the main cause of early- and late-onset sepsis among the neonates admitted to the NICU at Alzahra Hospital, Tabriz, Iran. G-positive and G-negative as causative agents of sepsis showed the highest susceptibility to Vancomycin and Amikacin, respectively.

Neonatal mortality had not changed significantly in the last decade in African countries particularly in Nigeria; however, under-five mortality had reduced significantly. Nigeria with a quarter of maternal and under-five mortality is among ten countries with the highest neonatal mortality. Previous studies had shown patterns of newborn morbidity and mortality; however, no study has been conducted in this regard recently. The present study aimed to ascertain the current patterns of newborn morbidity and mortality. A retrospective review of records of all newborn admissions over a period of one year was carried out. Extracted data include age, gender, diagnosis on admission outcome, and cause of mortality. The frequency of morbidity and outcome variables were analyzed and then calculated. The major reason for admission was jaundice 29.6% followed by asphyxia 25%, sepsis 16.1%, and prematurity 9%. The neonatal mortality rate was 12.5% with more than half of the deaths occurring within 24 hours and almost all within 72 hours. Causes of death were asphyxia 58.2%, jaundice 16.4%, sepsis 10 .4%, and prematurity 3%. More than half of the neonates with asphyxia were likely to die within 24 hours. Asphyxia, jaundice, sepsis, and prematurity were the major causes of morbidity. In addition, asphyxia is still a major cause of preventable death in newborns in Nigeria.

Jaundice is one of the most leading causes of neonate hospitalization (51.8%) during the first four weeks of life, and phototherapy is one of the most common and safest methods for the treatment of jaundice. Different results have been obtained from the studies conducted on the investigation of factors affecting increased phototherapy effect on the reduction of neonatal jaundice. However, there still exist many questions concerning the methods that maximize the effect of phototherapy.The current research aimed to determine the effect of the distance between phototherapy lamps and neonate's body on the reduction of serum bilirubin and phototherapy complications in the neonates with physiologic jaundice. The study was carried out on 60 newborns with jaundice. The neonates in the intervention group were put under phototherapy within a distance of 20 cm, and the ones in the control group underwent phototherapy within a distance of 40 cm. Daily bilirubin was measured at times 0, 12, and 24, and the neonates were examined in terms of serum bilirubin reduction and phototherapy complications. The obtained results revealed that phototherapy within the distance of 20 cm causes more reduction in the total bilirubin 12 and 24 hours after phototherapy. However, there was no significant difference between bilirubin 48 hours after phototherapy and phototherapy duration and the complications between the two groups. Based on the results, the method of phototherapy distance reduction could be used as a safe and effective way for the quicker reduction of serum bilirubin level, prevention of hyperbilirubinemia complications and complications of blood transfusion in neonates with physiologic jaundice.

Respiratory distress is considered one of the most frequent causes of admission in the neonatal unit. Additionally, it is the leading cause of neonatal morbidity and mortality. This study aimed to determine the incidence of neonatal respiratory distress and its causes, risk factors, and outcomes to have a baseline data about the magnitude of respiratory distress with a further step toward the development of the neonatal field. This cross-sectional study was conducted in the neonatal care unit of Misan Hospital for Child and Maternity in Misan, Iraq, during one year. All the neonates who developed respiratory distress were included in this study according to the World Health Organization criteria. The total number of neonatal admission during the study period was 870 cases among whom 738 (84.8%) subjects developed respiratory distress. The fatality rate was 21%, and the majority of deaths were found in respiratory distress syndrome (RDS) (67.1%). The RDS, transient tachypnea, and birth asphyxia were the major causes of neonatal respiratory distress. Statistically, prematurity, type of delivery, and number of babies at the delivery time were significantly associated with respiratory distress development. The incidence rate of neonatal respiratory distress was apparently high in Misan forming the most common cause of neonatal admission associated with a high mortality rate. Efforts toward preventing the causes and risk factors for neonatal respiratory distress, as well as, improving the efficacy of neonatal care unit are the significant challenges to improve the neonatal care and outcome.

Exclusive breastfeeding is one of the most important issues for public health and Pediatricians in developing countries. Despite the importance of exclusive breastfeeding, only 39% of children in the world are breastfed during the first six months of life. This study was a Cross-sectional descriptive-analysis conducted on a total number of 396 breastfeeding mothers in 2017.The data collection tool was a structured questionnaire, including demographic information, questions about knowledge and attitude, and performance. We collected the data through face-to-face interview. Based on our results mean and standard deviation of knowledge score of exclusive breastfeeding, attitude, and performance were reported as 7.6±2.4, 43.1±3.3, and 5.1±0.9, respectively.Frequency rates of participants who had high performance, knowledge, and attitude level were, 93.4 % (370), 26 % (103), and 98.5 % (390), respectively. The present study indicated that the majority of mothers had a positive attitude and practice desired however knowledge score was low. Maternal education and relatives was one of the important determinants of exclusive breastfeeding. Health care professionals have important roles in providing suitable fields for these interventions. Using open and extensive questions in other studies can help in finding the causes of breastfeeding cessation during infancy.

Monitoring serves to maintain physiologic variables within normal limits and when a parameter crosses a set threshold, an alarm is triggered. Therefore, this study aimed to determine whether alarm limits are properly adjusted in the neonatal intensive care unit (NICU) by nursing staff or not. The data concerning alarm limits corresponding to the three shifts of nursing work were recorded for the newborns with cardiorespiratory problems, such as hyaline membrane disease, transient tachypnea of the newborns, and pneumonia, who were admitted to the NICU of Imam Reza Hospital, Mashhad, Iran during March 2016-December 2016. The findings of this study showed that 75.1% of the 95 subjects of this study were preterm infants, while the others were cases with a gestational age of more than 37 weeks. The mean birth weight of the neonates was 1939.15±899.2 g. The upper alarm limit of pulse oximetry (95%) had been set correctly just in almost 26% of the patients. On the other hand, only at about 21% of all the cases, a normal lower alarm limit (85%) was observed for this variable. Compliance with the normal lower and upper limits of alarm for heart rate (i.e., 90 and 180 beats/min, respectively) was reported only in 10.46% and 18.6% of the infants, respectively. This study revealed that the alarm limits in NICU for unstable neonates were frequently set outside the normal range.

Late preterm neonates may have the external appearance and behavior similar to their counterparts.However, they are susceptible to various neonatal morbidities , due to their physiological and metabolical immaturity.To assess the correlation between cord blood arterial lactate levels and base excess with the development ofrespiratory distress in late preterm neonates. All inborn neonates born at Kasturba hospital Manipal, satisfying the criteria of late preterm infants (34 -366/7 weeks) were included in this prospective observational study.The data recorded included gender, birth weight,multiple births, presence of major congenital anomalies, mode of delivery, APGAR score at minute 5, need forresuscitation, admission to the neonatal intensive care unit (NICU), and days of hospitalization. Lactate and base excesswere estimated using blood obtained from umbilical artery sampling. The primary outcome assessed was therequirement of delivery room resuscitation. The secondary outcomes assessed were the development of respiratorydistress, requirement of invasive/non- invasive ventilation, and respiratory support. Cord blood base excess levels were significantly higher in late preterm neonates requiring delivery roomresuscitation compared to those who did not require resuscitation (median: -8 vs -4mEq/L, p-value: 0.002).In terms ofrespiratory morbidities, cord blood base excess levels were significantly higher in neonates with respiratory distresssyndrome (RDS)(median: -8.5 vs -3.4 mEq/L, p-value 0.001), and transient tachypnea of newborn (TTNB) (median: -8vs -3.4 mEq/L, p-value 0.004), compared to those without RDS and TTNB.However,there was no signi icant associationbetween cord blood lactate levels and the outcomes assessed. Estimation of arterial base excess levels obtained from umbilical cord blood sampling during delivery mayserve as a sensitive marker for predicting respiratory morbidities in late preterm neonates.

Parents of preterm neonates are exposed to great stress that can lead to posttraumatic stress disorder. The current study aimed to assess the incidence of posttraumatic stress disorders (PTSD) in both mothers and fathers of preterm infants. A prospective cohort study was done at two Iranian hospitals in 2016. One hundred and sixty parents of preterm neonates entered the study. A questionnaire related to acute stress disorder (ASD) was completed for parents at days 3-5 after birth. One month later, the parents were asked for the second interview. Prenatal posttraumatic stress questionnaire (PPQ) for mothers and posttraumatic stress disorder checklist (PCL) for fathers were completed. Prevalence of PTSD among the mothers and fathers was compared. According to the results, 32.5% of all mothers and 4% of all fathers showed ASD. After a month, 40% of the mothers and 21.5% of the fathers showed PTSD. A significant correlation was seen between PPQ and PCL scores (P

Tremor which is the most common abnormal movement in the neonatal period might be a benign condition or the result of pathologic events and is divided into two subtypes, namely fine tremor and coarse tremor. Fine tremor is usually benign and results from some metabolic disturbance, such as hypoglycemia. On the other hand, coarse tremor is an indicator of brain insult and should be regarded as a central pathology comparable to intracranial hemorrhage and hypoxic-ischemic encephalopathy and requires further evaluations. Stroke is one of the most important associated pathologies that are readily missed in the neonatal period. The possibility of stroke should be suspected in all newborns in the presence of coarse tremor.Case report: Here, we will present a newborn with perinatal hemorrhagic stroke who was in good condition after birth with Apgar score of 9 and normal vital signs, birth weight, head circumference, length, and primitive reflexes; however, he had coarse tremor in both upper extremities in physical examination as the only sign of the hemorrhagic stroke.

It is recommended that neonates with coarse tremor be investigated more carefully to rule out the structural brain pathology.

Neonatal tumors are usually prenatally diagnosed or within the irst 30 days of life. The true incidence ofneonatal tumors is unknown as a great number of pregnancies with a prenatally diagnosed mass result in stillbirth ormiscarriage. Most solid neonatal tumors are benign whereas less than 50% of neonatal neoplasms are malignant;however, some tumors with malignant patterns may histologically show benign behaviors. The incidence of malignanttumors is 1 in every 12,500-27,500 live births, accounting for 2% of all childhood cancers. Teratomas are the mostcommon perinatal neoplasms, accounting for 25-33% of the cases. Around two-thirds of all sacrococcygeal teratomas(SCTs) are reported in the neonatal period but with a small risk of malignancy.Case report: Herein, we reported a case of SCT in a newborn leading to a complicated cesarean delivery.

In general, teratomas are embryonic typically benign tumors arising from germ cells. They usually consistof various tissues originating from two or more embryonic layers. These tumors are believed to be the most commonneonatal germ cell tumors. The sacrococcygeal region is the most common site for extragonadal teratomas formation.