Iranian Journal of Neonatology
Volume:11 Issue: 4, Autumn 2020

Hematological parameters can reflect potential morbidity in premature neonates. Complete blood count (CBC) is a common laboratory examination in neonatal wards, including hematological parameters. Changes may occur during the neonatal period due to gestational age (GA)-related physiological mechanisms. The purpose of this study was to examine CBC in premature neonates at birth and in the first week of life. This prospective study was performed in the neonatal ward of a general hospital in Bandung, Indonesia. A total of 53 premature neonates, including 31 males and 22 females, classified as G1 (with 28-31 weeks of gestation) and G2 (with 32-34 weeks of gestation), were examined for CBC. The sequential blood samples of both cord blood at birth and peripheral venous blood in the first week of life (i.e., days 2-7) were drawn. The obtained data were analyzed based on the GA at birth and in the first week of life. The CBC at birth and in the first week of life were also compared. At birth, younger premature neonates (i.e., G1 group) showed lower platelet counts, compared to the older ones (i.e., G2 group). In the first week of life, the G1 group showed significantly lower platelet counts and eosinophil counts, compared to the G2 group. Both groups demonstrated a significant decrease in hemoglobin, leukocytes, basophils, and neutrophils, but increased platelet counts in the first week of life. Younger premature neonates indicated lower hematological parameters at birth and in the first week of life. All the premature neonates showed a significant reduction in most hematological parameters in the first week of life.

Nigeria continues to have one of the highest rates of neonatal deaths in Africa. Hospital-based studies had implicated prematurity, neonatal sepsis, poor antenatal care, and perinatal asphyxia as major causes of neonatal mortality. This study aimed to highlight the predictors of neonatal deaths and offer solutions to reduce them. This 5-year retrospective review investigated the neonatal mortality rate at the University of Calabar Teaching Hospital from 2013 to 2018. The demographic characteristics, clinical parameters, duration of hospital stay, and challenges encountered in managing the patients were documented in this study. The obtained data were analysed in SPSS software (version 26). Neonatal mortality rate of 60 per 1000 live births was recorded in this study. The major causes of death were prematurity (n=86, 39.8%), perinatal asphyxia (n=45, 20.8%), neonatal sepsis (n=37, 17.1%), and congenital malformation (n=34, 15.7%). Low socioeconomic class and out-born were additional risk factors in this regard. The neonatal mortality rate is higher than the average national rate and the figure obtained in the same center more than a decade ago. Infrastructural decay during the study period may partly explain the high neonatal mortality rate. Enhancement of the infrastructure and use of kangaroo mother care are recommended to reduce neonatal death, especially among premature babies.

"Newborn Individualized Developmental Care and Assessment Program )NIDCAP(" is a caring approach based on individual neonatal behaviors that provides preventive measures for injuries caused by environmental stimuli. The present study aimed to investigate the barriers to the implementation of NIDCAP from the perspectives of nurses and physicians. This descriptive-comparative included 100 nurses and 21 physicians working in the Neonatal Intensive Care Unit (NICU). They were selected using a complete enumeration sampling method. Data were collected using a researcher-made questionnaire. The validity and reliability of the questionnaire were determined in this study. The data were analyzed in SPSS software (version 25) through descriptive and inferential statistics. According to the nurses' perspective, the most imperative hurdles to the implementation of NIDCAP were environmental-structural, human resources, and communicational barriers. On the other hand, environmental-structural barriers obtained the highest score by the physicians and were placed in the first rank contrary to the management and human resources barriers that were placed in the second rank with equal scores. Furthermore, family-based care and communication were not considered obstacles to the implementation of the NIDCAP. According to the findings of this study, environmental-structural barriers were considered the main hurdles to the implementation of NIDCAP. Therefore, hospital administrators should make efforts to eradicate the existing barriers by making appropriate decisions in order to improve the quality of this method of care.

The diagnosis of acute kidney injury (AKI) is focused on the measurement of glomerular filtration rate based on serum creatinine; nevertheless, due to the effects of the underlying confounding parameters, this procedure tends to have some problems. Recent findings identified neutrophil gelatinase-associated lipocalin (NGAL) to be a critical marker for predicting AKI in humans. The aim of the present study was to evaluate changes in urinary NGAL levels in neonates with AKI and those without AKI. This cross-sectional analytical study was conducted on a total of 75 neonates hospitalized for AKI and 81 neonates hospitalized for reasons not related to kidney disease. The serum concentrations of NGAL creatinine and urine were measured in both groups. The mean NGAL levels were 825.81±175.08 and 292.20±322.03 ng/ml in the case and control groups with a substantial difference, respectively. The NGAL had a sensitivity of 100%, specificity of 55.6%, positive predictive value of 67.6%, negative predictive value of 100%, and accuracy of 76.9% in predicting AKI. Assessing the region under the receiver operating characteristic curve (ROC curve) showed that measurement by NGAL effectively discriminated AKI from normal conditions (area under the ROC curve=0.899). The NGAL’s best cut-off value for predicting AKI among neonates was estimated at 427 ng/ml, resulting in a sensitivity of 100% and specificity of 67.9%. Using Pearson’s correlation coefficient test revealed a strong linear connection between the NGAL level and altered creatinine level (r=0.395; p <0.001). The measurement of urinary NGAL in predicting AKI among neonates has high sensitivity and proper specificity, compared to that reported for the creatinine level.

The first 28 days of life are the most sensitive time regarding a child’s survival and health. Neonatal death accounts for a major part of under-five deaths, especially in sub-Saharan Africa. In this regard, the present study aimed to identify the causes of neonatal deaths in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia. The present institution-based descriptive cross-sectional study was conducted on neonates admitted to the neonatal intensive care unit of Ayder Comprehensive Specialized Hospital from June 2018 to May 2019. The required data were extracted from the medical charts of the patients during admission and discharge and their death certificates. The collected data were analyzed in SPSS software (version 23) using descriptive statistics to describe the prevalence and causes of neonatal deaths. The final results were summarized using frequencies and proportions. In total, 1785 neonates were admitted during the study period and 1388 (77.8%), 99 (5.5%), and 298 (167 per 1000 live births) of them were treated and discharged, discharged against medical advice, and died, respectively. The causes of 139 (46.6%), 72 (24.2%), 63 (21.1%), and 22 (7.4%) neonatal deaths in the hospital were prematurity- related complications, neonatal sepsis, perinatal asphyxia, and congenital anomalies, respectively. The highest mortality rate was observed in neonates with respiratory distress syndrome since 89 out of 127 (70.8%) afflicted neonates died. Moreover, the second-highest mortality rate was found in newborns with perinatal asphyxia as 63 out of 174 (36.2%) afflicted newborns died. Furthermore, it was found that almost all deaths (98.3%) occurred during the first seven days after birth. Based on the results, it can be concluded that the neonatal mortality rate was substantially high among the studied neonates. Moreover, the case fatality rate of respiratory distress syndrome was alarmingly high. Therefore, all the people who are in charge must devote a considerable effort to improve the health care delivered to neonates.

Respiratory distress syndrome (RDS) is one of the major causes of morbidity and mortality in preterm newborns. The severity and treatment of RDS affect the outcomes of premature neonates in neonatal intensive care units. Some studies have claimed that hypoalbuminemia and hypoproteinemia are associated with poorer outcomes in preterm neonates. The current study aimed to assess the association of serum total protein and albumin with the presentation of RDS among this group of newborns.

This cross-sectional study was carried out on a total of 100 preterm newborns. The study population included a control group of healthy neonates (n=50) and case group of newborns diagnosed with RDS (n=50). For each neonate, a 2 ml sample of the arterial blood was taken from the umbilical artery, and laboratory indices, including total serum protein and albumin, were measured. Statistical analysis was conducted to compare potential variations between the samples of the healthy and RDS groups.

According to the obtained findings, no statistical difference was observed between the healthy and RDS preterm neonates regarding total protein (P=0.16) and serum albumin (P=0.27) levels. Total serum protein and albumin were not affected by the newborn’s birth weight and gender (P>0.05) among both the healthy preterm neonates and those with RDS. However, a significant association was observed regarding gestational age (P<0.05) for both the healthy and RDS neonates and maternal age for the healthy neonates only (P<0.05).

No difference was observed in total serum protein and albumin levels between the healthy preterm neonates and those with RDS. Furthermore, total serum protein and albumin levels were not affected by gender, birth weight, and maternal age among the RDS patients. However, they were directly associated with the gestational age at the time of birth in both the RDS and healthy groups.

The quest persists for an ideal newer antiepileptic drug (AED) with better efficacy and tolerability. Levetiracetam (LEV) is one of these AEDs with a novel mechanism of action, good pharmacokinetic profile, acceptable tolerability, and side-effect profile. The present study assessed the safety and efficacy of intravenous levetiracetam as a first-line AED in neonatal seizures. This prospective observational study was conducted on all term neonates with seizures admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care center. Neonates with hypoglycemia, hypocalcemia, hypomagnesemia, inborn errors of metabolism, or those who received other AEDs prior to admission were excluded from the study. 20mg/kg Intravenous LEV was administered as first-line AED and graded up to 40mg/kg if seizures were not controlled in 2 h; thereafter, second-line AED was added. Only 36.2% (21/58) of the cases responded to LEV as first-line AED. Hypoxic Ischaemic Encephalopathy(HIE) was the most common etiology of seizures (55.2%). Subtle seizures were most responsive to LEV (60%), while multifocal clonic seizures (22.3%) responded the least. No adverse effect of LEV was observed during the study period. Only 36.2% of the cases responded to LEV as first-line AED, and subtle seizures were the most responsive seizures. Therefore, the efficacy of LEV as first-line AED in neonatal seizures is yet to be proven by a larger study. There were no adverse effects of LEV during the study period indicating the relative safety of this drug.

Red reflex is a simple test that can detect potentially life-threatening ocular abnormalities. In 2012, a red reflex screening campaign started in Umbria, central Italy. In the present study, we report the results of eye examination in the routine first visit of newborns in a private hospital within 2014-2016. The red reflex test was carried out as a part of the first health visit of newborns in a private hospital for 2 years. The eyes of all newborns were examined on the first day of life by a handheld ophthalmoscope. The suspected cases with cataract were referred to the Ophthalmologic Department of Mashhad University of Medical Sciences, Mashhad, Iran, for the confirmation of the diagnosis. During the 2 years of the study, a total of 10,484 neonates were delivered in this hospital 10 of whom were referred for ophthalmology consultation due to suspected abnormal red reflex. In 2 cases (0.019%), the diagnosis of congenital cataract was confirmed by an ophthalmologist. The results of the current study are consistent with the findings of previous studies, although the reports on red reflex screening are sporadic in the literature. Due to low cost and easy performance and in spite of high false-positive red reflex test, it appears to be useful for the early diagnosis of congenital low-vision disease for the prevention of vision impairment. In addition, the present study confirmed that the red reflex test should become a part of the first newborn examination immediately after birth.

Respiratory distress syndrome (RDS) is a common lung problem in neonates born before 28 weeks of pregnancy. The current study aimed to assess the clinical outcomes of Nasal Continuous Positive Airway Pressure (NCPAP), as compared to humidified high flow nasal cannula (HHFNC) in the treatment of premature neonates with RDS.

This randomized control trial was conducted on 60 preterm neonates (gestation

There were no significant differences in primary and secondary outcomes, including pneumothorax, patent ductus arteriosus (PDA), chronic lung disease, surfactant injection, tracheal intubation, death, necrotizing enterocolitis (NEC), days of delay in establishing full enteral feeds, duration of hospitalization, and the number of the days for oxygen requirement between NCPAP and HHFNC groups.

HHFNC and NCPAP techniques have the same efficacy in the treatment of RDS in neonates, and there was no difference between the two techniques in terms of treatment failure and clinical outcomes. Since HHFNC is less invasive with the same efficacy compared to CPAP, we recommend that it can be used as a primary modality in preterm neonates with RDS.

The optimum nutritional support of critically ill neonates is considered an essential aspect of their medical management since they are susceptible to rapid nutritional depletion, loss of fat-free mass, organ failure, delayed wound healing, and diminished immune function in the post-gastrointestinal surgery state. Providing appropriate nutritional support for these high-risk patients is a very complex and critical process accompanied by many potential errors. To the best of our knowledge, this study has been the first attempt investigating the energy and protein adequacy and probable barriers to the achievement of nutritional goals in such patients. The present study was carried out at Akbar Children’s Hospital in Mashhad, Khorasan Razavi province, Iran, during 8 months in 2019. All the gastrointestinal surgical patients admitted to the neonatal intensive care unit (NICU) for at least 72 h were eligible for enrollment in the study. The information on age, gender, primary surgical diagnosis, route of nutritional support, adequacy of received energy and protein, probable barriers to the achievement of nutritional goals, and clinical outcomes were collected in this study. Totally, 59 eligible neonates were included in the study 59.3% (n=35) of whom were male. Among different methods of nutritional support, enteral nutrition (47.5%) was the most frequently used feeding route. Energy and protein adequacy was observed in 35.5% and 79.7% of the patients, respectively. The fluid restriction was the major barrier to the provision of optimum nutritional support, affecting 38.9% of the patients. Finally, nutritional adequacy was observed to be significantly associated with decreased infection rate and length of hospital stay. While 64.5% of the studied neonates did not receive adequate energy, almost 80% of them had adequate protein intake during their post-gastrointestinal surgery state. The awareness of the fluid restriction and non-availability of calorie-dense solutions as the most frequent barriers to the achievement of nutritional goals may lead to making reasonable and realistic decisions on the customized protocols of the NICU patients as well as medical management and insurance coverage of required nutritional products.

Peritoneal dialysis is an applicable method for children and even neonates. Moreover, it allows the quiet excretion of fluid and soluble substances without hemodynamic instability. Peritoneal dialysis can be continued easily in hospitalized infants. However, the question is whether peritoneal dialysis is an effective procedure to replace hemodialysis in neonates or not? The population of this study included all neonates who were admitted to the Neonatal Intensive Care Unit of Children's Medical Center Hospital, Tehran, Iran, and underwent peritoneal dialysis during 2012-17. The data were collected using a questionnaire. Subsequently, the underlying diseases, complications, and laboratory changes were determined before and after peritoneal dialysis. In total, 29neonates who underwent peritoneal dialysis were evaluated in this study. Peritoneal dialysis was performed on 58.6% and 41.4 % of the cases for congenital metabolic disorder and extra body fluids, respectively. Moreover, electrolyte disorders and uremia were observed in 13.7% and 13.8% of the total cases, respectively. Several indications were seen in some infants. Dialysis failure was seen in 79.3% of the cases, most of which were due to dialysis catheter obstruction; however, the mean changes in potassium, sodium, urea, creatinine, acidosis, ammonia, and phosphorus were significant72 h after dialysis. This study showed that peritoneal dialysis faced several failures in newborns; however, metabolic disorders, electrolyte imbalance, uremia, and extra body fluid were resolved. Moreover, it is considered a vital and effective way for the treatment of newborns, especially in low-resource countries in which hemodialysis cannot be performed easily.

This study aimed to report the incidence of bowel obstruction, chromosomal abnormality, congenital infection, fetal growth restriction (FGR), and otheranomalies in fetuses with hyperechogenic bowel (HEB) diagnosed during the second-trimester fetal ultrasound scan. In total, 350 fetuses with a diagnosis of HEB in our maternal-fetal medicine referral center were evaluated with a detailed fetal ultrasound examination by an experienced perinatologist. If no associated anomalies were observed, women were counseled about the risk of potential fetal disorders and offered appropriate testing, including detailed fetal sonography, karyotype, maternal cytomegalovirus (CMV), and toxoplasmosis serology,as well as serial fetal biometry and bowel diameter follow up. Altogether there were 18(5.1%) fetuses with associated problems, including major anomalies, chromosomal abnormalities, and CMV infection. Moreover, 32(9.1%) fetuses developed FGR during follow-up. An overall rate of adverse conditions of 14.2% with prenatally detected HEB serves to inform obstetricians and emphasizes the importance of careful screening fetal ultrasound studies and timely referral for an additional assessment about associated findings.It should be noted that isolated HEB has good outcomes.

Risk scoring systems evaluate neonatal outcomes using perinatal and neonatal status. The present study aimed to predict the mortality risk of preterm or low birth weight infants using the Clinical Risk Index for Babies (CRIB-II) and Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) scoring systems. This prospective cohort study investigated the preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Vali-e-Asr Hospital, Tehran, Iran, with the birth weight of ˂1500g or a gestational age˂32weeks using the CRIB-II and SNAPPE-II scoring systems within the first 12 h after birth. The area under the curve, sensitivity, specificity, positive and negative predictive values of the scoring systems, as well as the association between neonate factors and neonatal death were calculated in this study. Out of 344 neonates under study, 253casessurvived after24hof birth and 91 newborns died. The total CRIB-II scores in survived and deceased infants were 6.12 and 10.28, respectively. The area under the receiver operating characteristic (ROC) curve with a cut-off point of 8.5 was obtained at 0.838. Moreover, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 74.4%, 78.65%, 55.37%, and 89.68%, respectively, for the CRIB-II system. Total scores of SNAPPE-II in survived and deceased infants were 16.9 and 51.6, respectively. The area under the ROC curve with a cut-off point of 27.5 was determined at 0.887. Sensitivity (84.44%) and specificity (79.05%) were calculated for the SNAPPE-II. Furthermore, positive and negative predictive values were 58.91% and 93.46%, respectively. This study demonstrated that the CRIB-II and SNAPPE-II scoring systems can be useful mortality predictors for at-risk neonates.

Oxytocin and misoprostol are used to initiate labor which can sometimes cause complications to the fetus and neonate. The purpose of this study was to determine the combined effect of vaginal misoprostol and intravenous oxytocin on fetal/neonatal outcomes in primigravidas whoreferred to Shahid Sadoughi Hospital, Isfahan, Iran.

This clinical trial study was performed on 102 pregnant mothers in Isfahan Shahid Sadoughi Hospital. The participants were randomly divided into two groups of oxytocin induction with vaginal misoprostol (n=51) and oxytocin alone (n=51). Finally, fetal heart rate decline during labor and delivery, Apgar scoresat1and 5min, presence of meconium, and admission to neonatal intensive care unit (NICU)were evaluated. The data were then analyzed in SPSS software (version 22).

The results revealed that the meconium excretion was significantly higher in the intervention group than the control group (P<0.05). The frequency of early deceleration was significantly lower in the intervention group than in the control group (P<0.05). There was no significant difference between the two groups regarding the frequency of late deceleration and variable deceleration in the fetal heart (P>0.05). Frequency of late deceleration and beat-to-beat changes were quite similar in both groups. There was no significant difference in mean Apgar scoresat1 and 5 min between two groups (P<0.05). Frequency of neonatal hospitalization in the intervention group was significantly higher than the control group (P<0.05). Frequency of neonatal need for resuscitation was similar in both groups.

According to the results of this study, concurrent use of misoprostol and oxytocin increased neonatal meconium excretion and NICU admission.

Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).

This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.

The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.

Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains.

Skin is the most important defense mechanism of the neonate's body. The admission to the Neonatal Intensive Care Unit (NICU) is a risk factor for neonatal skin injuries. Therefore, to prevent these complications, it is essential to identify the risk factors. The present study aimed to investigate the incidence of skin injuries and its related factors in neonates admitted to the NICU. This cohort study was conducted in two NICUs in one perinatal hospital in Tehran, Iran, from January 2018 to June 2018. The sampling was performed using the census method. The data were collected through a demographic characteristics form, a risk factor assessment checklist, and the European Pressure Ulcer Advisory Panel (EPUAP) tool. The data were analyzed in SPSS software (version 19) through Fisher's exact test and chi-square test. Out of 368 neonates, 126 cases had skin injuries, and the others were healthy. The mean values of weight and age of the neonates with skin injuries were 796.68±1606.82 g and 5.18±30.82 days, which was significantly lower than those of the infants without skin injury (p <0.05). The results of the risk factors analysis also showed that the second-grade injuries were the most frequent. Moreover, the drug leakage (14.2%, n=33) and nasal continuous positive airway pressure (12.06%, n=28) had the highest prevalence. The results of the effect of risk factors on the wound grade also showed that drug leakage, diaper rash, and surgical injuries had a significant effect on the wound grade. The results showed that in addition to neonatal conditions, equipment, and neonatal care play a significant role in the incidence of skin injuries. Skin is the most important defense barrier of the neonate's body and it is vitally important to take care of it. Therefore, it is necessary to identify and prevent such injuries.

Smoking is very important during pregnancy because of severe fetal and maternal complications. No community-based studies have been conducted on pregnant women in Iran. This study aimed to investigate the prevalence of smoking during pregnancy, as well as maternal and neonatal complications in Mashhad, Iran, during 2017.

This cross-sectional study reviewed the information of 1140 and 92,225 smoking and non-smoking pregnant women during pregnancy, respectively, and 3-5 days after delivery using Sina Electronic Health Record System in Mashhad, Iran, during 2017. All data were extracted, encoded, and entered into SPSS software (version 16).

Out of the total of 93,365 pregnant women with a mean age of 22.36 years, the prevalence of smoking during pregnancy was significantly higher among those who live in the city (i.e., Mashhad), compared to individuals living in the suburbs or villages. The mean rates of stillbirth, prematurity, very-low-birth-weight, and low-birth-weight were higher in smoking pregnant mothers, compared to non-smoking ones (p <0.0001). The prevalence of smoking among literate and employed pregnant mothers was significantly higher than illiterate and unemployed pregnant women (p <0.0001). The mean birth weight of newborns of smoking mothers (1528gr) was less than the half mean of the birth weight (3180gr) of newborns of non-smoking mothers (p <0.0001).

The prevalence of smoking in mothers living in Mashhad, Iran, was 1.2%, which is less than the global average. The results of this study showed that smoking during pregnancy has many maternal and fetal complications.

Premature birth and hospitalization in Neonatal Intensive Care Units (NICUs) is a critical issue for parents, especially mothers. The present study aimed to investigate the effect of spiritual care on hope and self-transcendence in mothers with premature newborns hospitalized in the NICUs. This quasi-experimental, single-group study was conducted using time series analysis. The sample consisted of 30 mothers with premature neonates hospitalized in Shahid Beheshti Hospital, Maraqeh, Iran. The participants were selected through a convenience sampling method following the inclusion criteria. The data were collected using the demographic characteristic forms of mothers and the clinical status of infants, as well as the hope and self-transcendence scales of the mothers with premature neonates admitted to the NICU. The data were analyzed in SPSS software (version 19) through descriptive statistics (i.e., frequency distribution, mean and standard deviation) and repeated measures analysis of variance (ANOVA). The findings show a significant difference among the pre-test, post-test, and follow-up stages in terms of the mean scores of hope and self-transcendence using repeated measure ANOVA (P<0.001). Moreover, in examining the effect of spiritual care on hope and self-transcendence in mothers, the results of repeated measures ANOVA showed that there was a difference among the pre-test, post-test and follow-up stages in terms of the mean scores of mothers’ hope, (P<0.001, F=53.133, and Eta-squared=0.639). Moreover, a significant difference was observed among the pre-test, post-test, and follow-up phases regarding the mean scores of self-transcendence (P<0.001, F=131.239, and Eta-squared=0.814). Since spirituality can lead to an increase in hope and self-transcendence of mothers with premature infants hospitalized in the NICUs, this approach can be used as an appropriate intervention method to help improve their adaptation and peace of mind. Therefore, barriers to providing these types of care and managing them must be identified so that nurses in the NICUs can use them.

Ventricular non-compaction, which is a rare congenital cardiomyopathy, results from an arrest in normal endomyocardial embryogenesis. It is characterized by a pattern of prominent trabecular meshwork and deep inter-trabecular recesses. The clinical manifestations include systolic and diastolic dysfunctions, heart failure, ventricular arrhythmias, and cardioembolic events.

Case report: 

Here we present the case of a neonate (38 weeks, weighing 2580 gr) born to a mother with gestational diabetes (GDM) with isolated right ventricular non-compaction (IRVNC) and systolic and diastolic right heart dysfunction due to meconium aspiration syndrome and tension pneumothorax. A 4-month follow-up demonstrated a complete improvement in the newborn.

It is of paramount importance to consider RVNC cardiomyopathy a differential diagnosis of cyanosis and respiratory distress due to meconium aspiration syndrome in neonate s born to mothers with GDM. Apart from RV cardiac dysfunction, RVNC could cause such complications as pulmonary hypertension and tension pneumothorax. It can be also spontaneously improved in GMD.

Neonatal rupture of the chordae of the tricuspid valve with severe regurgitation is scarce and devastating.

Case report:

 Here, we report the case of a full-term male neonate presented with cyanosis caused by severe tricuspid regurgitation due to anterior leaflet papillary muscle rupture. Following initial stabilization by the infusion of prostaglandins E1, successful early repair was achieved.

Early diagnosis of the tricuspid valve papillary muscle rupture is critical, and early surgical repair have a good result during early post-operative period.

Paraurethral cyst or Skene’s gland cyst is a rare congenital abnormality and a rare cause of paraurethral cysts resulting from Skene’s gland, which has been reported in few studies so far. The Skene’s duct cyst can cause urinary retention or anuria; moreover, it can appear as an inter-labial mass in neonates.

Case report:

 Our patient was a one-day-old female neonate presented with anuria and an inter-labial mass found in physical examination. The patient was referred by a pediatric surgeon to our department for sonographic evaluation. We did an ultrasound examination and made a tentative diagnosis of paraurethral cyst based on grayscale appearance and ultrasonographic criteria of the cystic lesion. The patient underwent surgery, a biopsy was obtained, and the specimen was sent for pathologic evaluation to a pediatric pathologist. The result confirmed our diagnosis as a Skene’s duct cyst.

In this study, it was found that paraurethral cysts in newborns can be investigated using perineal ultrasound, which can eliminate the need for invasive surgeries.