Iranian Journal of Neonatology
Volume:11 Issue: 2, Spring 2020

Necrotizing enterocolitis (NEC) is a lethal disease affecting newborns with significant morbidity and mortality rates. Moreover, it is the most eminent gastrointestinal threat affecting premature newborns. Unfortunately, early symptoms and signs are usually vague; therefore, there is a special demand for sensitive biomarkers in this regard. This study aimed to investigate the role of fecal calprotectin in stage I NEC and identify specific cut off value at this stage to differentiate stage I NEC from other gastrointestinal disorders.

This cross-sectional study was conducted at New Children Hospital, Cairo University, Egypt. In total, 100 newborns were included in this study who were assigned to the patient group with stage I NEC (n=60) and control group (n=40)with age and gender-matched newborns.Fecal calprotectin level was assessed using an enzyme-linked immunosorbent assay in both groups. Follow up of the patient group was performed for the development of stage II or III NEC.

The patient group obtained significantly elevated levels of fecal calprotectin, compared to the control group (P=0.000). Within the patient group, 43 (71.66%) newborns developed stage II or III NEC, whereas 17 (28.33%) cases developed no NEC. In addition, the level of fecal calprotectin was significantly higher in the group who developed stage II or III NEC (P=0.001). According to the receiver operating characteristic (ROC) curve, the cutoff value of 109.5 μg/g feces showed 100% sensitivity and specificity, and the area under the ROC curvewas equal to 1 in differentiating NEC from other conditions.

The study showed that fecal calprotectin can be used as a sensitive and specific marker for the early detection of necrotizing enterocolitis.

Intraventricular hemorrhage (IVH) in preterm neonates is a serious problem in neonatal intensive care units (NICU) worldwide. IVH is reported in approximately 60-70% of very-low-birth-weight (VLBW) neonates. The present study aimed to assess the association of IVH with neonatal characteristics and serum markers, such as serum Interleukin-6 (IL-6) level, in preterm neonates in an academic hospital in the Northeast of Iran. In this cross-sectional study, a number of 71 VLBW preterm neonates (≤34 weeks of gestational age (GA), birth weight (BW) ≤1500g) were examined regarding the evidence of IVH up to the 40th week of GA in Gorgan, Northeast of Iran. The serum interleukin-6 (IL-6) level was measured within the first 12 hours of lifebirth. The association among the variables was analyzed in SPSS software (version 16) using the chi-square test. Out of 56 preterm neonates who survived until the 40th week, 15 (26.8%) cases demonstrated evidence of IVH at discharge, they had a significantly lower GA (29.04±2 weeks vs. 30.44±1.7 weeks; P=0.003) and BW (1075.43±208 kg vs. 1251.6±199.4 kg; P=0.001), as compared to 41(73.2%) newborns with no IVH. Preterm neonates with IVH had a significantly higher IL-6 serum level, as compared to those without IVH (224±210 pg/ml vs. 91.93±138 pg/ml; P=0.035). As evidenced by the obtained result, low birth weight and premature birth could be serious risk factors for the development of IVH. Furthermore, IL-6 concentration may play a pivotal role in the occurrence of IVH.

Congenital heart diseases, which are asymptomatic at birth, are the most important causes of infant mortality. This study aimed to evaluate the role of pulse oximetry in the early detection of congenital heart diseases among newborns. In this cross-sectional descriptive study, 1230 newborns who were born in university hospitals in an urban area of Iran were placed under the pulse oximetry of right hand and right foot. The neonates with peripheral oxygen saturation (SPO2) of less than 95% in the right hand or right foot underwent pulse oximetry of the hands and feet again after two hours. Finally, the newborns with an SPO2 of less than 95% in the second stage were subjected to diagnostic echocardiography. The results were analyzed in SPSS software (version 18). Out of 1230 neonates who underwent pulse oximetry, 417 newborns had an SPO2 of less than 95%, and their SPO2 was rechecked two hours later. Finally, echocardiography was performed for 32 newborns who had an SPO2 of less than 95%, of whom 24 infants were healthy and 8 infants (6 females and 2 males) had congenital heart disease. The sensitivity of the pulse oximetry to detect congenital heart disease was 100%, and its specificity was 98.04%. The results of this study highlighted the high sensitivity of pulse oximetry in the diagnosis of critical congenital heart disease which can be used at birth.

Bilirubin binds to cell membrane phospholipids, including N-methyl D-aspartate receptor, and causes excessive activation that can lead to neurotoxic effects. Since magnesium is an important inhibitor of this receptor, a comparison can be made between the physiological effects of magnesium and the neurological effects of bilirubin. This study aimed to compare changes in serum magnesium levels before and after phototherapy in hyperbilirubinemic newborns.

This retrospective cross-sectional study examined full-term newborns with hyperbilirubinemia. These newborns were admitted between 2012 and 2014 to the Neonatal Unit of Children’s Medical Center in Tehran, Iran. Based on the amount of bilirubin upon admission, participants were divided into three groups of mild (20 mg/dl). The total serum magnesium levels were measured before and 12-24 h after phototherapy.

A total of 143 newborns were included in this study. A significant difference was observed between serum magnesium levels before (2.42±0.46 mg/dl) and after (2.07±0.32 mg/dl) phototherapy (P<0.001). This difference was observed in all etiologies of icterus.

The magnesium level decreased significantly after the completion of jaundice treatment for all causes of the condition. These findings raise the hypothesis that an increase in the level of extracellular magnesium is a defense mechanism that reduces the neurotoxic effects of bilirubin.

Nipple fissure is one of the most common diseases in breastfeeding which leads to maternal pain and disruption of the mother-infant relationship. Since the most important consequence of nipple fissure is the deprivation of the infant from breast milk, it is very important to prevent and treat this condition. The aim of this study was to investigate the effect of the topical form of Achillea millefoliumon on nipple fissure in breastfeeding women referring to the comprehensive health centers of Hamadan, Iran. This study was a randomized double-blind clinical trial that was conducted in Hamadan comprehensive health centers in 2018. Treatment methods were taught by the researcher to 80 eligible breastfeeding women who were randomly divided into two groups of 40 subjects. After breastfeeding, the intervention group covered their own nipples with a tea bag of Achillea millefolium, while the control group applied some of their own hindmilk on their nipple. These interventions were performed at least 4 times a day for 14 days. Checklists of store fissure scale, visual analog scale, and midwifery and demographic characteristic questionnaire were completed in both groups before the treatment and 4, 8, and 14 days after starting the treatment. The data were analyzed using SPSS software (version 16). The results showed that the intensity of fissure and the mean pain score in the two groups were not statistically significant in the pre-intervention phase. However, the scores of the intensity of fissure and pain in the Achillea millefolium group were lower than those in the breast milk group on days 4, 8, and 14 after the intervention, and these differences were statistically significant (P<0.001). The results of this study showed that the topical form of Achillea millefolium was more effective than breast milk in treating nipple pain and fissure.

In order to determine the prognosis of neonates, it is recommended to use umbilical gas analysis in all high-risk pregnancies. However, utilizing umbilical gas analysis and Apgar score together is very helpful for determining the mortality rate confidence interval. Therefore, in this study, we investigated the application of umbilical gas analysis in assessing the prognosis of infants. This cross-sectional study was conducted in Hakim Hospital of Neyshabur, Iran during 2017-2018 with 100 subjects in each group of control and test. Blood samples were collected from the umbilical vein of all neonates. The data were compared between the two groups by the t-test and Mann-Whitney test using the SPSS software version 18 at the significance level of P ≤ 0.05. Our findings demonstrated that both hospitalization and the need for resuscitation had significant relationships with pH and base excess (BE) in the case and control groups (P<0.05). Moreover, 52.7% of the subjects in the intervention group and 47.3% of the participants in the control group were born through cesarean section. Therefore, the two groups were not significantly different regarding the route of delivery (P>0.05) According to the results of this study, a positive relationship was found between the neonatal prognosis and umbilical vein blood gas. Consequently, we can determine neonatal prognosis based on umbilical vein blood gas.

The aim of this study was to analyze the etiology, symptom frequency, management, and surgical outcome of gastrointestinal obstruction in the first month of life. A total of 72 neonates with gastrointestinal obstruction were reviewed over a period of 16 months. The male to female ratio was 2.4:1. In this study, 75% of the neonates were presented in the first 7 days of life. The mean gestational age was 39.25 weeks. In addition, 68 of the neonates were term babies. The most common cause of admission was anorectal malformation (22%); furthermore, small bowel atresia was observed in 15% of the cases. Vomiting was the most common symptom of gastrointestinal obstruction reported in 31% of the cases, followed by abdominal distension. In this study, the overall mortality after surgery was 17%. The significant determining cause of mortality was sepsis reported in 33% of the cases. Early referral, diagnosis, and treatment of gastrointestinal obstruction in neonates are needed to improve the survival outcome. The most common cause of neonatal gastrointestinal obstruction was found to be imperforate anus.

The skin of newborns is very thin and sensitive to burns. In this age group, the mortality rate is very high. Burns account for approximately 2 million injuries annually in the United States alone out of which 500,000 cases need medical treatment and 100,000 cases require hospitalization. This study aimed to determine the incidence and magnitude of the injury, mortality rate, and causative agent in newborns and neonates within the first 6 months of life admitted to a burn unit.

The documents of all burned infants admitted to Imam Reza hospital of Mashhad, Iran, were retrospectively analyzed within 2001-2011.

A total of 447 burns were admitted to this ward for 10 years. Twenty-five (6%) cases were in the first 6 months of life. Three (12%) cases were newborns (within the first 28 days of life). In addition, 15 (60%) cases were female. The mean age on admission was 5.3±1.2 months (a minimum of 3 days and maximum of 6 months). The mean total body surface area of burns was 23±15 percentile. The duration of hospital stay was 14±18 days, and the mortality rate was 12%. The source of burns was hot water (e.g., tea) and fire with 80% and 16%, respectively. Moreover, one (4%) case was a newborn that burnt in lower extremities due to the malfunction of the incubator.

The results of this study were the same as the findings of the studies conducted around the world. Hot water and fire were the most frequent sources of burns. Furthermore, females were injured more frequently than males.

The rate of Cesarean section is increasing which may be due to maternal and neonatal issues. Preterm Cesarean (at 38-39 weeks) has several morbidities and leads to maternal problems. The goal of this study was to compare neonatal and maternal complications following the performance of the Cesarean section after 38 weeks.

This cross-sectional study evaluated 1010 subjects with term Cesarean section that referred to Yas hospital, in Tehran, Iran during 2015-7. The participants were divided into three groups based on the week of delivery. Afterward, they were studied for different neonatal and maternal complications.

According to the findings, the risk of adverse neonatal outcomes had a statistically negative relationship with the progress of gestational age. Moreover, the rate of hypoglycemia and hyperbilirubinemia and stillbirth was higher in neonates delivered before 38 weeks. Among the maternal complications, the rate of massive bleeding during cesarean section or in the postpartum period was significantly higher in deliveries before 39 weeks, whereas the rate of pelvic infection was higher in deliveries after 40 weeks.

Based on the results of this study, the best time for the Cesarean section is the 39th week of pregnancy which led to the elimination of maternal and neonatal complications.

This study aimed to determine the effects of various positions on the arterial oxygen saturation during enteral feeding of preterm infants admitted to Neonatal Intensive Care Units (NICUs). It is assumed that different body positions influence arterial oxygen saturation during enteral feeding. This crossover clinical trial included 88 infants. The inclusion criteria were gestation age of fewer than 32 weeks, a weight of 1001-1500 gr, age of fewer than one month, 5-minute Apgar score of at least 5, exclusive breast-feeding, absence of any underlying illness, no oxygen therapy, and a minimum feed volume of 10cc for two h. The subjects were selected from the infants admitted to NICUs at Alzahra, Shahid Beheshti, and Amin hospitals, Isfahan, Iran, using a convenience sampling method. Subsequently, they were randomly assigned to four groups of 22 cases per group. The four groups were A, B, C, and D who were initially positioned on the left side, supine, prone, and right side, respectively. The arterial oxygen saturation was recorded on a minute-by-minute basis 5 min before, during, and 5 min after enteral feeding. Data were analyzed in STATA software (version 14) using a one-way analysis of variance, (ANOVA), linear mixed model, and the Chi-square test. According to the results of the one-way ANOVA and Chi-square test, no significant difference was observed among the four groups regarding the demographic characteristics. Moreover, the linear mixed model revealed no significant difference among the four groups of intervention, the four periods of the study, and carryover effect in terms of the mean oxygen saturation before, during, and after enteral feeding. The results revealed that variations in infant positions during feeding had no effects on the arterial oxygen saturation. Therefore, neonatal nurses are advised to carry out enteral feeding without unnecessary changing of the infant position, which leads to lower manipulation, and improved sleep and awakening cycle of the infants.

Length of hospital stay (LHS) is the most important and practical indicator in hospitals, which largely reflects the level of hospital performance and activity. It is also an important indicator for resource planning. Moreover, the quality of care can theoretically be related to LHS. The aim of this study was to investigate the relationship between LHS and quality of nursing care in the neonatal intensive care unit (NICU). In this descriptive correlational study, the samples were 205 premature infants hospitalized in the NICU and 80 nurses working in the NICUs of selected hospitals. They were selected based on the inclusion criteria. The data were gathered using the demographics of nurses and neonates through Quality Patient Care Scale (QUALPAC). The data was analyzed in SPSS (version 21) using Spearman correlation coefficient. The results showed that 47.5% of the nurses were within the age range of 29-36 years and 68.8% of nurses had a working experience of 1-5 years. There was an inverse correlation between the neonate's length of stay and the quality of care (r=-0.507, P<0.0001). The findings revealed an inverse relationship between the length of stay and quality of care. By improving the quality of care, we can decrease the LHS.

The goal of neonatal resuscitation is to prevent death and further complications, reestablish spontaneous respiration, and achieve sufficient cardiac output. Inappropriate or wrong resuscitation will result in the death of neonates or long-term side effects. The present study was performed to compare the effects of video-recorded debriefing and neonatal resuscitation program (NRP) workshops on the short-term outcomes and quality of neonatal resuscitation. In this semi-experimental study with three groups, 90 cases of neonatal resuscitation were videotaped at the delivery and operating rooms of Omolbanin Hospital of Mashhad, Iran. This research was conducted within three periods. In the first stage, 30 resuscitation cases were recorded as the control group. In the second stage, all the members of the resuscitation teams participated in the training workshops, and in the third stage, they participated in the debriefing sessions. The data were analyzed by the Chi-square and one-way analysis of variance using SPSS software (version 16). The results of this study showed that the debriefing method significantly improved short-term outcomes, such as the length of pulse improvement, and time to breathe spontaneously, returning duration of neonate's color to the natural state, and resuscitation quality (P<0.001). Also, the mean of Apgar scores in 1, 5, and 10 min increased in the debriefing group, compared to those reported for other groups; however, these changes were not statistically significant. According to the results of this study, despite the fact that educational workshops were held, new methods, such as debriefing, play an important role in improving the knowledge and skills of people who are involved in the resuscitation of newborns.

Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI. This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged < 28 days and had cerebrospinal fluid (CSF) culture via lumbar puncture were extracted from medical records and recorded in some checklists. A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54% of the neonates were male. Out of all neonates, 23 (14.1%) cases had positive blood culture. The positive CSF culture was observed in only two (1.2%) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50% of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50% and 24.2%, respectively; P=0.432). The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2%. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results.

Hyperbilirubinemia is a prevalent clinical problem which affects 60% of term and 80% of preterm neonates. Garlic is the most well-known remedy used in Iraq for the treatment of jaundice. To test the effectiveness of garlic necklace in the treatment of neonatal jaundice. This cohort study was conducted in the neonatal intensive care unit (NICU) of Al Zahraa Teaching Hospital within January-November 2016. A total number of 110 neonates were included in the present study out of whom 36 neonates were allocated to the test group and 74 newborns were assigned to the control group. The neonates in both groups received the common treatment of jaundice, according to guidelines adopted in our hospital. Nonetheless, the neonates in the test group wear a seven-clove garlic necklace till discharge, in addition to the common treatment. We compared the two groups regarding the length of hospital stay and the rate of total serum bilirubin (TSB) decline. As illustrated by the obtained results, a significant reduction was detected in the hours of hospitalization in the control group, as compared to the test group (P= 0.006).A significant reduction was observed in hours of hospitalization in the control group, as compared to the test group (P=0.006) suggesting the harmful effect of garlic on neonatal jaundice. This can be attributed to the long-time dependence of patients' families on garlic as a sole treatment before seeking medical help. Nonetheless, this treatment made jaundice worse needing prolonged phototherapy. The rate of decline in TSB in hospitalized patients was comparable in both groups (P= 85). This again suggests that garlic has no beneficial effect on the treatment of neonatal jaundice. Based on the results of the present study, garlic has no effect on the treatment of neonatal jaundice, rather it may cause prolonged phototherapy and hospital stay.

Congenital Hypothyroidism (CH) is one of the reasons for mental retardation and defective growth in neonates. It can be treated if it is diagnosed early. The congenital hypothyroidism can be diagnosed using newborn screening in the first days after birth. Disease mapping helps to identify high-risk areas of the disease. This study aimed to evaluate the pattern of CH using the Poisson Spatio-temporal model in disease mapping under the Bayesian paradigm. The recorded data of all infants diagnosed with CH between 2011 and 2018 in Guilan, Iran were used in this study. The Poisson Spatio-temporal model under the Bayesian paradigm was run using the Markov Chain Monte Carlo method in Open BUGS software. Moreover, the maps of the towns in Guilan were prepared via Arc GIS software. Out of 219800 live births in Guilan, Iran, the incidence of CH was 2:1000 in this time period. The pattern of disease mapping for the posterior mean of relative risk for CH was identical in this 7-year period. Furthermore, the pattern of disease mapping with spatial model excluding time dependence was similar to the maps of the Spatio-temporal model. The incidence rate of CH was approximately constant during this time, and disease mapping revealed no rising trends in this period. This probably can be due to resolving iodine deficiency as one of the main causes of CH incidence by consuming kinds of seafood and iodized salt in Guilan province.

Neonatal bronchopulmonary dysplasia (BPD) is a chronic chest disease caused by prolonged ventilation and oxygenation which leads to neonatal disability.

It was a prospective randomized clinical trial (RCT) (Study ID: TCTR20191211004) which was conducted in Tanta University Hospital (TUH) from July 2016 to March 2018 on 100 preterm neonates who exhibited severe respiratory distress (RD) on mechanical ventilation (MV). The studied neonates were assigned to two groups: group one which received melatonin supplementation and group two which did not. Urinary β2-microglobulin (B2M) and serum Krebs von den Lungen-6 (KL-6) levels were measured 3 and 10 days after hospitalization. The length of neonates’ stay in incubator was determined, and the number of newborns with established BPD was calculated.

Significant decreases were detected in urinary B2M and serum KL-6 levels of neonates in group one who received melatonin, as compared to their counterparts in group two who did not take melatonin (P< 0.05). In addition, there was a significant decline in the length of incubator stay of neonates in group one, in comparison to that of newborns in group two (P<0.05). Moreover, neonates in group one who received melatonin displayed a significant decline in the development of established cases of BPD, as compared to group two who did not take melatonin (P<0.05).

As evidenced by the obtained results, melatonin supplementation could be used as adjuvant therapy for the prevention of BPD in preterm neonates. Nonetheless, further studies involving a larger number of neonates must be performed on this topic in order to recommend melatonin administration for ventilated premature neonates who are susceptible to the development of neonatal BPD.

Preterm birth and admission to neonatal intensive care unit as stressors can cause physiologicalinstability that may lead to prolong hospitalization and mortality. This study aimed to determine the effect of artificialnights and facilitated tucking on the physiological indices of premature infants. This randomized clinical trial was conducted on 60 preterm infants admitted to the neonatal intensive careunit at Shohadaye Kargar Hospital in Yazd, Iran, during 2017-18. The infants were selected through a convenientsampling method, and were randomly assigned into three groups of arti icial nights with facilitated tucking (group 1)(n=20), arti icial nights (group 2) (n=20) and control group (group 3) (n=20). Subsequently, the physiological indices(i.e., heart rate, respiration rate, arterial oxygen saturation) were measured twice a day at 7:00 a.m. and 19:00 p.m. for3 days. The data were analyzed in SPSS software (version 20). A p-value less than 0.05 was considered statisticallysignificant. There was a significant difference among the three groups in terms of mean values of heart, respiratory, andarterial oxygen saturation rates (P<0.05). The irst experimental group obtained a greater reduction in heart rate andrespiratory rate on the third day (at 19:00 p.m.), as well as a greater increase in arterial oxygen saturation rate on thesecond (at 19:00 p.m.) and third days (at 7:00 a.m. and 19:00 p.m.), compared to the other two groups (P<0.05).Additionally, , the mean value of heart and respiratory rates were lower and arterial oxygen saturation rates werehigher in the intervention group 1, compared to the other groups. According to the results of the study, the simulation of the mother’s womb environment through creatingartificial night and maintaining facilitated tucking resulted in the improvement of physiological indices of thepremature infants. Furthermore, artificial night together with facilitated tucking leads to better results, compared toartificial night alone.

Self-efficacy and infant-care behavior are the most important indicators of the successful transition of a woman into the maternal role. This study aimed to determine the effect of counseling with the skills training approach on maternal self-efficacy and infant-care behavior. The present randomized controlled trial was conducted on 68 women visiting health centers in 2019 in Tabriz, Iran. Participants were divided into intervention and control groups through block randomization based on the number of parities (one or two parities) and type of delivery (Cesarean section or normal vaginal delivery). The intervention group received 4 counseling sessions. The maternal self-efficacy and infant-care behavior questionnaires were completed before and two weeks after the intervention. There was no significant difference between the groups in terms of socio-demographic characteristics (P>0.05). After the intervention, the mean±SD values of total maternal self-efficacy score were 35.6±5.7 and 30.9±1.9 in the intervention and control groups, respectively. Based on the ANCOVA test with baseline control, the mean was significantly higher in the intervention group than the control group (mean difference (MD): 2.9; 95% Confidence Interval (CI): 0.8-5.1; P=0.08). After the intervention, the mean±SD scores of infant-care behavior in the intervention and control groups were 78.9±3.8 and 76.2±3.6, respectively. Moreover, based on the ANCOVA test with baseline control, the mean value was significantly higher in the intervention group than the control group (MD: 2.8; 95% CI: 1.6-4.1; P<0.001). Counseling was effective in maternal self-efficacy and postpartum infant-care behavior. Therefore, it is recommended to use this method for the promotion of the health of mothers and their neonates.

Goiter is not frequently seen in the neonatal period.

We report the case of a full-term neonate who was born with anterior neck swelling and observed tosuffer from congenital goiter on examination. Thyroid function tests were within normal limits. Thyroid swellinggradually reduced in size during the 1st week of life. All the cases of congenital goiter that has been reported in theliterature are associated with hypothyroidism. To the best of our knowledge, this study was the first case of congenitalgoiter with euthyroid status.

Goiter is rarely seen in newborn infants. All pediatricians who deal with neonates with thisdisease should recognize the disease, understand its cause and prognosis, and advise appropriate therapy.

Neonatal thrombotic diseases can cause mortality or serious morbidity and disability.

In this report, we present a case of neonatal inferior vena cava thromboembolism with several underlyingfactors. Hereditary thrombophilia and genetic mutation in plasminogen activator inhibitor-1 and MTHFR A1298C genesin conjunction with cleft palate resulted in poor lactation and hypernatremic dehydration. A peripherally insertedcentral catheter in the inferior vena cava was an additional underlying factor. Thrombosis mass was dislodged to theright atrium while asymptomatic and accidentally detected during routine echocardiography.

Surgical thrombectomy was done successfully, and the mass was removed from the right atrium.