Iranian Journal of Neonatology
Volume:11 Issue: 3, Summer 2020

Sepsis in neonates presents itself with non-specific clinical features which makes early diagnosis difficult. However, procalcitonin (PCT) and other inflammatory markers have recently been considered as sensitive markers for the early detection of neonatal sepsis. Therefore, the present study aimed to determine the diagnostic value of PCT in the early detection of neonatal sepsis and compare it with C-reactive protein (CRP) and white blood cells count.

This case-control study was conducted on 40 neonates who were divided into two groups. The case or sepsis group consisted of 18 neonates with the clinical symptoms of sepsis and positive culture. On the other hand, the control group contained 22 healthy neonates with negative culture. Demographic characteristic of all the participants was recorded during the clinical follow-up. Moreover, blood samples were collected from each neonate for hematological analysis, blood culture, serum CRP measurement, and PCT analysis. Finally, all the collected data were statistically analyzed in SPSS software (version 17).

Based on the findings, the mean value of the procalcitonin level was significantly higher in the sepsis group (866.60±480.51 pg/ml), compared with that of the control group (P<0.001). Moreover, the CRP was positive in 66.7% of sepsis patients and 22.7% of the control group (P=0.006). The procalcitonin level shows higher sensitivity (94%) than CRP (66%) with the same specificity but a higher positive and negative predictive value.

Procalcitonin level was elevated in neonates with sepsis in comparison to normal neonates and it is more sensitive than CRP. The PCT could be used as a routine test for the early diagnosis of neonatal sepsis which also leads to a reduction in the use of antibiotics.

Premature birth and subsequent admission to the neonatal intensive care unit (NICU) may impair the neurodevelopment of neonates. The present study aimed to determine the effect of developmental care on neurodevelopmental outcomes of newborns.

This quasi-experimental study was conducted on 105 premature neonates (in three groups of 35 newborns). The control group received conventional care, and the intervention group 1 received developmental care beginning since admission to NICU stay. In addition, the intervention group 2 received developmental care since entering the delivery or operating room. The developmental outcomes were evaluated based on the Ages and Stages Questionnaire (ASQ) and Bayley-III Scales of Infant and Toddler Development. Moreover, magnetic resonance imaging was performed to evaluate the brain myelination at the adjusted age of 12 months.

The obtained findings showed that the frequency rates of communication and language impairment were significantly lower in the intervention group 2, compared to those reported for the control group and intervention group 1, based on the ASQ. The comparison of the scores of the Bayley subscales (i.e., cognition, language, and motor) showed that the frequency of language impairment was significantly higher in the control group, compared to those reported for the intervention group 1 (P=0.012) and intervention group 2 (P=0.024). No significant difference was observed in terms of the neonates’ brain myelination (P>0.05).

The obtained results showed that developmental care, especially when initiated since birth, may improve some aspects of developmental outcomes in preterm newborns.

Blood pressure (BP) is an important vital sign and indicator of clinical stability. Therefore, the accurate measurement and interpretation of this physiological signal is essential for the optimal management of ill newborns. In this regard, the present study aimed to determine BP values and percentiles in stable newborns in the first weeks of life and evaluate the relevant factors. This prospective observational study was conducted on 320 term and preterm newborns between 26 and 42 weeks gestational age (GA) within 2015-2017. The exclusion criteria entailed: 1) birth asphyxia,2) preeclampsia, 3) gestational diabetes mellitus (GDM) type I, 4) illicit substance use, and 5) major congenital anomaly. The oscillometric technique was used for BP measurement and systolic and diastolic BPs were analyzed by regression analysis for various percentiles (5th to 95th). The neonates in the current study consisted of 185 (57.8%) males and 135 (42.2%) females with mean (SD) birth weight of 2058.3±582.5grams. Mean (SD) gestational age was reported as 32.95(3.97) weeks. 69.1 % of neonates were delivered via cesarean section. Percentile charts (5th- 95th values) which were developed for systolic (SBP) and diastolic (DBP) demonstrated a steady rise on the respective days that were comparable between different groups. Term neonates were found to have higher BPs, compared to their preterm counterparts on the respective days. Moreover, the neonates who were delivered vaginally had higher mean BP values than neonates delivered via cesarean section. The current study provided normative BP values among neonates, especially in the first two weeks of life. Data presented in this study which include delivery-mode-specific BP percentile curves using an oscillometric method serve as a valuable reference for physicians in the management of newborns in the neonatal unit.

The present study was conducted to compare the efficiency of hydronephrosis index (HI) with those of pelvic anteroposterior (AP) diameter and parenchymal thickness in the diagnosis of fetal hydronephrosis in the prenatal period, as well as 1, 6, and 12 months after birth. This study was conducted on pregnant women with the pregnancy age of > 30 weeks whose fetus was suspected of hydronephrosis. The study participants were collected via the consecutive sampling method. The HI, pelvic AP diameter, and parenchymal thickness were measured at the baseline and 1, 6, and 12 months after delivery using ultrasound. According to the study design, the study participants were divided into three groups. Group A consisted of cases with decreased HI and higher hydronephrosis severity. Group B was composed of subjects with relatively constant HI, and group C entailed individuals with increased HI and lower hydronephrosis severity. All of the study measurements and analyses were performed on the three study groups. The results revealed a negative association between HI and pelvic AP diameter but a positive association with parenchymal thickness. On the other hand, HI showed a significant correlation with parenchymal thickness in the diagnosis and prognostic assessment of fetal hydronephrosis. The HI correlated with parenchymal thickness and pelvic AP diameter scores in all follow-up stages. Accordingly, HI can be concluded to be a good alternative to parenchymal thickness or pelvic AP diameter as a grading factor for hydronephrosis. It is suggested to perform further studies to carefully assess the efficiency of HI in the diagnosis, prognosis, and clinical outcome of hydronephrosis.

This study evaluated the effects of the maternal immune system stimulation or suppression during the pregnancy on the development of the neonate’s immune system.

A total of 20 female rats were divided into four groups. The groups were treated using Leishmania major, Salmonella typhimurium, Tacrolimus, and sterilized normal saline. The animals were mated after 3-time treatments. The neonate’s humoral immune response, total body, thymus, liver, spleen weight, and histology were determined in this study.

The spleen’s mean weight of the two-month-old samples showed a significant reduction in the Salmonella group; in addition, the Tacrolimus group had a significant reduction in liver mean weight. The Salmonella and Tacrolimus groups showed a significant reduction (P≤0.05) in the anti-sheep red blood cells antibody titer.

Stimulation or suppression of the immune responses during the pregnancy has significant effects on the neonate’s immune responses, spleen, liver, and thymus development.

Infections are one of the most important causes of death in infants, especially in developing countries. Inappropriate use and administration of antibiotics can contribute to the resistance and spread of infection. In this study, we determined the antibiotic resistance pattern of the bacteria isolated from clinical samples of blood, cerebrospinal fluid, and urine in the neonatal intensive care unit (NICU) of Ali Asghar Hospital, Iran during 2013-2015. For the purposes of the study, clinical samples of blood, cerebrospinal fluid, and urine were collected from the NICU of Ali Asghar Hospital during 2013-15. The type of bacterial strain and antibiotic susceptibility pattern was determined by routine microbiological tests. The collected data were analysed in SPSS software (version 19), using χ2, Student’s t-test, and ANOVA test for comparison. In total, 240 positive culture samples (118 blood, 117 urine, and 5 cerebrospinal fluid samples) were collected for this research. The most common isolates in the blood, urine, and cerebrospinal fluid samples were Staphylococcus epidermidis (63.6%), Klebsiella (35%), and Acinetobacter Baumannii (40%), respectively. The highest antibiotic resistance in S. epidermidis isolated from blood samples was found against amikacin and cefotaxime, while linezolid and vancomycin were the most effective antibiotics against S. epidermidis. Moreover, ciprofloxacin and nitrofurantoin were the most effective antibiotics against Klebsiella isolated from urine samples, while this bacterial strain had the highest resistance to imipenem and ampicillin. Despite the fact that A. Baumannii strains were resistant to most studied antibiotics, ceftazidime and ceftriaxone had an acceptable antibacterial effect against these isolates. Continuous surveillance for antibiotic susceptibility, rational use of antibiotics, and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.

Intraventricular hemorrhage (IVH) is one of the most serious complications of premature deliveries, especially in very low birth weight (VLBW) newborns. The current study compared the number of nucleated red blood cells (NRBCs) in newborns with and without IVH.

This cross-sectional study was carried out on 109 VLBW neonates who were referred to the Neonatal Intensive Care Unit (NICU) Department of Ghaem Hospital in Mashhad, Iran. They were investigated to evaluate the predictive value of cord NRBC in the diagnosis of IVH. To this end, 77 neonates who had normal brain ultrasonographywere assigned to the control group and 32 newborns with IVH were allocated to the case group. The percentage of NRBC per 100 white blood cells was determined by a blood sample. These neonates underwent brain ultrasonography3-5 days after the birth; thereafter, mean NRBC/100 WBC and the absolute number of NRBC swere compared in both groups.

In the current study, the mean scores of NRBC/100 WBC and the absolute number of NRBCs in neonates with IVH were obtained as 15.19 and 2272.38/μl. In the group without IVH, these values were reported as 40.95% and 5459.17/μl, respectively (P>0.05). Based on receiver operating characteristic (ROC) curve, the NRBC value does not have a diagnostic value in predicting the incidence of IVH.

As illustrated by the obtained results, the number of absolute NRBCs and the percentage of NRBC/100 WBC cannot help to predict the probability of neonatal IVH. Nonetheless, further studies are recommended in this regard.

The present study aimed to evaluate the effect of synbiotics on the intestinal colonization rate of Candida albicans in low birth weight neonates (i.e., under 2,500 g), which is one of the most important events for necrotizing enterocolitis (NEC). During one year, 106 preterm neonates with a birth weight of less than 2,500 g, admitted to the Neonatal Intensive Care Unit (NICU) of Imam Reza Hospital, affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, were randomly selected and investigated in two groups of case and control. In the case group, 5 drops of synbiotics (under the trade name of Pedilact in which 5 drops are equivalent to 2.5×108 CFU), containing three probiotics of Bifidobacterium infantis, Lactobacillus rhamnosus, and Lactobacillus reuteri, as well as the prebiotic of fructooligosaccharide, were administered. On the other hand, 5 drops of distilled water were used for the control group. In the present single-blind study, the subjects were divided into two groups using a random number table. The stool cultures were obtained on the 1st and 10th days of admission. Then, the two groups were compared in terms of the amount of positive stool culture for Candida albicans, time of feeding initiation and full nutrition, duration of hospitalization, and time of discharge. The incidence rate of positive stool culture for Candida albicans was 6.6%. A significant relationship was observed between gestational age and positive culture (P=0.009). However, there was no significant difference between the two groups in terms of the duration of hospitalization, time of feeding initiation and full feeding, good physical examination results, and wellbeing. In addition, the relationship between positive culture and birth weight was statistically significant (P=0.045) since the rates of positive culture were 57.1% and 42.9% in cases with the birth weight of ≤ 1,500 and > 1,500 g, respectively. Based on the results, synbiotic use showed no significant relationship with enteral positive cultures for Candida albicans, time of enteral feeding initiation and full feeding, and hospitalization duration.

There are many known risk factors related to maternal or neonatal problems which can predict the need for resuscitation. In this study, we evaluated the resuscitation process of preterm neonates and analyzed the impact of different risk factors on the level of resuscitation required in the patients. This cross-sectional descriptive study was conducted on inborn preterm infants with a birth weight of < 1500 g during one year. Moreover, the present study evaluated the resuscitation process of the delivery room and analyzed the association of maternal-neonatal risk factors and requirement for different levels of resuscitation. In the present study, 193 preterm neonates were evaluated. In addition, 82 (42.5%) and 110 (57%) patients were female and male, respectively. The mean values of gestational age and birth weight of the patients were 29.9±2.4 weeks and 1191.6±265.2 g, respectively. The mode of delivery in 159 (82.4%) patients was cesarean section.In the assessment of different levels of resuscitation, 84 (43.5%), 35 (18.1%), 54 (28%), 10 (5.2%), 10 (5.2%), and 9 (4.7%) neonates needed initial steps, free flow of oxygen, positive pressure ventilation, endotracheal intubation, chest compression, and drug administration, respectively. The rate of neonatal mortality was 23.8% (n=46), and hypoxic-ischemic encephalopathy was recorded in 10 (21.7%) subjects. In the evaluation of mothers, 117 (60.6%) subjects had medical problems during pregnancy. The most common problem was preeclampsia in 44 (22.8%) mothers. The lower birth weight (P<0.001), gestational age (P<0.001), Apgar score (P<0.001), and longer duration of resuscitation had a significant effect on the needed level of resuscitation in neonates. According to the obtained results, it was shown that premature neonates needed more advanced resuscitation. Therefore, improving the quality of care for mothers and neonates is necessary to obtain better outcomes. Regarding the need for noninvasive positive pressure ventilation was the second most frequent intervention, the proper use of equipment is necessary for the prevention of advanced resuscitation.

The aim of this study was to investigate the effect of bedding preterm infants in nests on their motor behaviors in a neonatal intensive care unit (NICU) in Iran.

In this randomized controlled trial, 44 clinically stable preterm infants, admitted to the NICU, were recruited and randomly divided into two groups of control and intervention. The routine of the unit was to take care of infants on a flat mattress. The intervention was a U-shaped cloth nest in which the intervention group was bedded for 7 days. The control group consisted of infants who were normally cared without any boundaries. All infants were videotaped before and on the last day of the intervention. The motor behaviors, as defined in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) sheet, were analyzed in each of the films.

To compare the number of total extensor motor behaviors between the two groups, the change score in each group was calculated and compared between the two groups. The mean change scores in the intervention and control groups were -21.36±13.5 and 2.32±7.9, respectively. Accordingly, nesting significantly reduced the occurrence of unstable behaviors in the intervention group, compared to that in the control group (P<0.001).

According to the findings, supporting the preterm infant body even by accessible materials could enhance their neurodevelopmental strengths and motor behavior stabilities.

Pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) as valuable biochemical biomarkers are used to screen down syndrome, Edwards syndrome, and Patau syndrome in the first trimester of pregnancy. Closed immunoassay analyzers are regarded as sophisticated platforms to measure biochemical biomarkers. This study compared the performance of three chemiluminescence analyzers when used for combined screening.

The present cross-sectional study was conducted on 371 pregnant women within the age range of 20-47 years during 11+0 to 13+6 weeks of pregnancy referring to Dena laboratory in Tehran, Iran, during July 2018 and August 2018 using random selection. The biochemical biomarkers of PAPP-A and free β-hCG were assayed on Cobas, Immulite, and Maglumi analyzers. Benetech software as a commercial screening software was used to calculate the risks of trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13). Deming regression, nonparametric spearman analysis, analysis of variance, and Chi-square test were performed to analyze the data.

For the screening population, although the three systems well correlated to PAPP-A and free β-hCG, the values of Maglumi were slightly higher than those reported for Cobas and Immulite. The multiples of the median (MoM) of PAPP-A and free β-hCG had a significant correlation on three platforms. There were no significant differences between the calculated risks of T21, T18, and T13 on the three systems. The sensitivity for all systems was reported as 50%. In addition, specificity and negative predictive value (NPV) were higher than 99% and 95%, respectively. Positive predictive value (PPV) was reported as less than 50%.

The obtained results of the present study demonstrated that there were significant correlations between three different systems in terms of PAPP-A and free β-hCG values and MoMs. The sensitivity of all systems for all trisomies was 50%; however, the specificity of all systems was almost the same. The best PPV and NPV for T21 were on Cobas, Immulite, and Maglumi, respectively. The PPV and NPV of all systems for T18/13 were almost the same.

Neonatal period is a susceptible time in which the newborn has to adapt to a new environment and is vulnerable to many problems. This study aimed to assess the disease outcome and associated factors among neonates. This retrospective cross-sectional study was conducted from March 15, 2018, to March 30, 2018, on neonates (n=341) admitted to the Neonatal Intensive Care Unit for two years. The systematic sampling technique was employed to perform the sampling. The data were entered the Epi-data (version 3.1) and analyzed in SPSS software (version 23). A p-value less than 0.05 at a 95% confidence interval (CI) was considered statistically significant. Finally, statements, tables, charts, and graphs were used for data presentation. Regarding the outcome, 81.52% of the admitted neonates were improved and the others (18.48%) died. Prematurity and perinatal asphyxia (PNA) were factors associated with increased risk of death (P<0.001, Adjusted Odds Ratio (AOR) =0.26, 95% CI: [0.14, 0.46]) and (P<0.05, AOR=0.44, 95% CI: [0.21, 0.91]), respectively. Prematurity, PNA, and place of delivery (i.e., outborn) were predictors of death. Therefore, the adequate resource should be put in place to improve neonatal outcomes.

Neonatal intensive care unit (NICU)Conventionally, Central Venous Pressure (CVP) monitoring has beenused by intensivists to measure intravascular volume. However, it is an invasive procedure resulting in many complications. Non-invasive ultrasonographic measurement of inferior vena cava collapsibility index (IVC-CI) is a promising alternative. Therefore, this study wasconducted to evaluate the correlation of central venous pressure with IVC-CIand establish the cut off valuesfor IVC-CI to diagnose and manage neonatal shock. The current research was a prospective longitudinal study.All sick neonates requiring intensive hemodynamic monitoring were enrolled in the study and umbilical vein catheterization was performedto measure CVP. IVC diameters and IVC-CI were measured using ultrasound. Based on CVP, the patients were classified into three categories: hypovolemic (CVP<5 cmH2O), euvolemic (CVP 5-8 cmH2O), and hypervolemic (CVP>8 cmH2O) and managed with intravenous fluid boluses and/or inotropes, accordingly. CVP and IVC-CI were again recorded after the intervention and compared with the previous values. A total of 76(62.3%) males and 46 (37.7%) females were included in the study with a mean age of 27.16±17.5 years. There was a strong negative correlation,which was statistically significant, between CVP and IVC-CI (r= -0.913, n=122, P<0.001). After luid resuscitation in the hypovolemic group, CVP improved from 2.31±0.92 to 5.88±1.79 cmH2O and IVC-CI changed from 62.39±6.005 to 33.02±2.64% which was statistically signi icant(P<0.001). After the administration of inotropes in the hypervolemic group, CVP dropped from 10.86±9.07 to 9.07±1.85cmH2O and IVC-CI changed from 11.27±4.71 to 24.3±13.3% which was again statistically signi icant(P<0.001). The receiver operator characteristic (ROC) curve analysis indicated that the IVC-CI cut-off of 55% predicted CVP <5 cmH2O with 87.9% sensitivity, 82% speci icity, 75.3%positive predictive value and 58.9% negative predictive value. IVC-CI cut-off of 20% predicted CVP >8 cmH2O with 91.1% sensitivity, 83.2% speci icity, 71.8% positive predictive value and 50.6% negative predictive value. The obtained results revealed an inverse correlation between CVP and IVC-CI, and it was concluded that IVC-CI can provide a useful guide in the diagnosis and management of shock in sick newborns.

Today, preterm birth is well known as the major risk factor for intraventricular hemorrhage (IVH). In the first week of life, some preterm infants may have grade 1 IVH extending to severe (grade 3 or 4) IVH by transfusion one or more units. Several previous studies have found that blood and blood product transfusions lead to adverse clinical outcomes in neonates. Therefore, this study aimed to explore the relationship between Red blood cell (RBC) transfusion and extension of IVH in preterm infants.

For the purposes of the study, an observational retrospective case-control design was utilized. Moreover, all the neonates with grade 1 IVH in our referral hospital were identified in the past 5 years. Afterward, the subjects with extended IVH were compared with those who had resolved IVH.

In total, 1050, 36, and 24 neonates were diagnosed with grade 1, grade 3, and grade 4 IVH, respectively. The mean values of the birth weight of extended IVH and resolved IVH groups were 1285±615 g and 1361±348 g, respectively (P=0.05). Moreover, extended IVH and resolved IVH groups were 29±3 weeks and 30±2 weeks premature, respectively (P=0.36). The low 5-minute Apgar scores of the extended IVH and resolved IVH groups were 5±2 and 7±2, respectively (P=0.000). In addition, the low cord pH of the extended IVH and resolved IVH groups were 7.29±0.1 and 7.37±0.1, respectively (P=0.005). Administration of packed RBC transfusion before and on the day of the diagnosis of grade 1 IVH had the most significant relationship with the extension of IVH (IR, 10.602; 95% CI, 2.81-39.92). The obtained results confirmed that criteria to order the transfusions were similar in both groups, based on which they did not have any proportion of the transfusions of compliance with the guidelines.

Based on the results, there was a great association between restrictive RBC transfusion and extension of a low-grade IVH into a higher grade (3 or 4) IVH. However, the statistical explanation is unclear and more studies are needed to discover the causality of this relationship.

The main definitions of bronchopulmonary dysplasia (BPD), proposed by Jobe-Bancalari, Shennan et al., and Walsh et al., focus on oxygen (O2)-need and ventilatory support for the first weeks of life and at 36 weeks of post-menstrual age (PMA). Oxygen need at 36 weeks of PMA is sometimes due to intercurrent episodes (IEs) other than BPD. The aim of this retrospective study was to characterize IEs and determine their impact on BPD in preterm infants born at < 32 weeks of gestation. O2-dependence for > 28 days and at 36 weeks of PMA (±10 days) was analyzed. We classified each infant according to the three BPD definitions. Patients requiring O2 or ventilator support at 36 weeks of PMA, with no need for O2 in the first 28 days of life, were qualified for having IEs if their O2/ventilator dependence (at 36 weeks) had a limited duration and/or could be ascribed to a known condition. Then, the contribution of IEs to the BPD rate was evaluated. Out of 1,210 patients, the BPD infants were 431 (35.6%), 169 (14.0%), and 186 (15.4%) according to Jobe-Bancalari, Shennan et al., and Walsh et al., respectively. Twenty-eight patients had IEs (16.6% of those on O2 at 36 weeks of PMA) indicating a mild BPD overestimation (P=0.065). We proposed a definition of IEs and found that IEs could lead to a potential BPD overestimation. Further research is needed to find out if patients with IE, similarly to infants with BPD, are prone to childhood complications and need preventive measures.

Phototherapy is the most effective and commonly used treatment for neonatal jaundice, which reduces the need to exchange transfusion. Today, phototherapy is widely used even in unnecessary cases; however, clinicians who use phototherapy should be aware of the possible adverse effects of this treatment to avoid unnecessary use of it. Therefore, this study aimed to evaluate the relationship between neonatal phototherapy and childhood cancer. This case-control study assessed 500 children up to 14 years of age with every kind of cancer that referred to Children's Medical Center, Tehran, Iran, during 2015-18. Moreover, 500 children without cancer referring to a General Clinic of Children's Medical Center, Tehran, Iran were included in this study as the control group. History of phototherapy and its duration evaluated in these two groups. Furthermore, demographic characteristics, including maternal age during pregnancy, birth weight, gender, smoking by father, type of cancer, age at cancer detection, and history of cancer in relatives were recorded in this study. The results of a single-variable logistic regression showed that neonatal phototherapy without any other variables was not significantly correlated with childhood cancer. However, phototherapy will increase the risk of cancer by 55% when it is accompanied by the male gender, maternal age >35 years during pregnancy, and smoking by father. The potential risk of developing cancer with neonatal phototherapy should be considered versus its benefits in reducing the bilirubin.

The 25-hydroxyvitamin D3(25-OH D3)deficiency is a common problem worldwide, and it is aprevalent incidence in neonates. Different studies investigated the relationship of vitamin D deficiency with neonatal mortality and morbidity. This study aimed to evaluate the relationship between vitamin D deficiency and respiratory distress in preterm neonates. A prospective cohort study was conducted in Alzahra Hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. In total, 160 preterm neonates with>1000 g birth weight were evaluated for the manifestation of respiratory distress during the first 6 h of life. The neonates were divided into two groups of A (n=80) with respiratory symptoms and B (n=80) without respiratory symptoms. The level of 25-OH D3 was measured in the first h of the neonate's life. All neonates were followed to reach 36 weeks of gestational age or 28th day of life. Subsequently, the two groups were compared in terms of vitamin D levels. There was a relationship between vitamin D deficiency and respiratory morbidities in group A. The mean vitamin D level was obtained at 27.42±11.25 ng/mL, and it was categorized into adequate level (n=53, 33.1%), inadequate level (n=62,38.8%), and vitamin D deficiency (n=45, 28.1%).According to the results, vitamin D level correlated significantly with birth weight and gestational age (P<0.05). Moreover, respiratory distress correlated with birth weight, gestational age, and the use of corticosteroids during pregnancy (P<0.001). The mean vitamin D level in group A (with respiratory distress syndrome [RDS]) was significantly lower than that in group B (without RDS, P<0.001).Furthermore, vitamin Dcorrelated with RDS, a need for intubation surfactant extubation, and duration of continuous positive airway pressure (P<0.05). Neonates with a low level of vitamin D are prone to manifest respiratory distress, and vitamin D deficiency is a risk factor for presenting RDS.

This study aimed to determine the clinical characteristics of the newborns born in the hospital. This study included 1199 newborns born in Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia, Africa, in 2018. The gender, birth weight and height, delivery method, health status, mother's age, as well as gravida and parity conditions were retrospectively obtained from the records of the delivery clinic. Out of 1199 newborns, 610 neonates were male (50.9%). The mean birth weight of the newborns was 2915.7±907.5 gr, and the mean birth height was 47.6±4.6 cm. Moreover, 66.6% of the newborns were born by normal vaginal delivery, and 91.8% were born alive. The mean age of the mothers was 26.3±5.4 years, and the mean values of gravida and parity were 3.8±2.5 and 2.9±2.1, respectively. There is a dearth of research regarding the evaluation of newborns in Somalia, Africa. Therefore, it is hoped that the results of this study will contribute to form standards for the follow-up of growth and development of infants living in this region and to improvematernal and child health.

Coronavirus disease 2019 (COVID-19) infection is continuing its spread across the world with nearly 13 million people involvement by 11 July 2020. It mainly causes respiratory infection and affects different people in different ways. The COVID-19 infection involves many pregnant women worldwide, and maternal-fetal transmission of viral diseases is a major concern about this virus. However, its vertical transmission has to be proven in further studies.

This study presents a COVID-19-infected woman pregnant with triplets that underwent urgent cesarean section in a tertiary center of gynecology and neonatology. Subsequently, neonatal outcomes will be investigated in this study. All neonates were born with low Apgar scores and transferred to the neonatal intensive care unit (NICU) immediately after birth. Polymerase chain reaction (PCR) test of the second male neonate was positive on days 3 and 6; however, he was finally discharged from the hospital in a good condition. It is worth mentioning that the other two newborns died. All three neonates had white lung with an unfavorable response to treatment.

In this case study, we explain and discuss the probable COVID-19 infection in another two offsprings, elaborate on the mother's risk factors predisposing her to get involved with COVID-19 infection, and recommend some suggestions to avoid such complications.

Neonatal pediculosis is a problem the magnitude of which has not been estimated; however, it is regarded as a diagnostic challenge and becomes one of the management challenges for which there are very few managementoptions in terms of age, gestation, and the potential effects of drug toxicity.

Here, we report a case of preterm who developed pediculosis capitis in the neonatal intensive care unit following contact with the mother during kangaroo mother care (KMC). She was successfully treated with a combination of topical extra virgin coconut and olive oil. Other radical treatments could not be administered due to cultural barriers.

Furthermore, maternal lice were treated with 1 % permethrin, and the KMC re-initiated. For a successful outcome, the education of the mother was equally important. The neonate was found to be free of lice on follow-up. Therefore, it is concluded that in neonatal pediculosis, topical oils are safe alternatives where drug toxicity is a constraint.

Herpes zoster occurs due to reactivation of varicella zoster-virus (VZV) that is latent in dorsal root ganglion cells after primary varicella infection. It can occur in any age but is very rare during infancy. Acquisition of this virus in utero or early after birth may result in infantile herpes zoster.

Here, it is aimed to report an infant with herpes zoster whom his mother had developed varicella two years before pregnancy.

Despite the rarity of shingles in infants after birth, any infant who has a vesicular lesion in a particular neurological dermatome should be aware of the disease.