Iranian Journal of Neonatology
Volume:12 Issue: 1, Winter 2021

The literature review has demonstrated the short-term benefits of minimally invasive surfactant therapy (MIST) in spontaneously breathing preterm neonates. This study was conducted to compare the efficacy of beractant and poractant alfa treatments performed with the MIST method in newborns with respiratory distress syndrome (RDS) and its effect on preterm morbidity and mortality. The patients diagnosed with RDS less than 35 weeks of gestational age and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room were screened retrospectively. The cases were divided into two groups of beractant (BG) and poractant alfa (PG). While the BG (n=24) consisted of patients receiving beractant treatment with MIST during nCPAP, the PG (n=34) were those subjected to poractant alfa treatment. It was found out that in PG the scores of surfactant reflux to esophagus and desaturation during surfactant administration were significantly lower (P=0.012 and P=0.009, respectively). No significant difference was observed between the two groups regarding bronchopulmonary dysplasia, sepsis, patent ductus arteriosus, pneumothorax, intubation rate in postnatal 72 h, total period of intubation, nCPAP, duration of hospitalization, and mortality rate. According to the results of this study, surfactant reflux to esophagus and desaturation during the intervention procedure were lower in the PG group, most probably due to a lower volume of poractant than beractant. However, since a small number of patients were included in this study, it is recommended to perform further studies consisting of a larger number of cases.

The majority of the neonates in the Neonatal Intensive Care Unit (NICU) would be on respiratory support either invasive or non-invasive ventilation. Therefore, it is difficult to measure anthropometries, such as weight, length, and head circumference in these sick newborns. This study aimed to determine the correlation of foot length with occipitofrontal head circumference (OFC), crown-heel length (CHL), and weight of the newborn.
A cross-sectional study was conducted at the level IIb NICU of Shri B M Patil Medical College Hospital and Research center, Vijayapur, India. The foot length, OFC, and CHL of the neonates with gestational ages of 28-42 weeks were measured between 12 hours and 7 days of life.
Out of 350 neonates enrolled, 61% and 39% of the newborns were preterm and term, respectively. The correlation between foot length and birth weight (r=0.90) and foot length and length (r=0.89) was pronounced in premature neonates. Moreover, a positive linear correlation was observed between foot length and weight in neonates of all gestational ages. To identify the low birth weight (LBW) neonates (<2500 gm), a foot length of less than 7.41 cm had sensitivity and specificity of 94% and 50%, respectively. Furthermore, foot length less than 6.62 cm had 100% sensitivity and 67% specificity to identify the very LBW newborns (<1500 gm).
Birth weight and CHL of premature newborns can be estimated from the measurement of foot length that was performed easily and rapidly. Measurement of foot length is valuable in premature neonates who are too ill at birth or those who are on ventilators. Furthermore, foot length may be used in the identification of LBW and VLBW newborns who are admitted to the NICU.

For respiratory support in premature newborns, there has been a trend toward less trachealintubation, less mechanical ventilation, and more nasal respiratory support which can result in the improvement ofsuccessful extubation rate. The two commonly known types of nasal respiratory support after extubation are thenasal continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC). The current study aimed toinvestigate and compare successful extubation using HFNC and conventional nasal CPAP after a period ofendotracheal positive pressure ventilation and detect which of these two methods is better for successfulextubation with fewer side effects.

This randomized controlled study was conducted on 210 preterm newborns in the neonatal intensive careunit (NICU) of Gynecology and Obstetrics Department of Qasr El Eyni Hospital. Post extubation failure rates werecompared between the two groups, namely (HFNC) and (nasal CPAP). The collected data were analyzed in SPSSsoftware (version 20).

Neonates who needed re-intubation within 72 h after initial extubation were higher in the HFNC group(72.7%) versus (27.3%) in the CPAP group (P-value=0.063). Moreover, 45.8% of neonates in the HFNC group neededre-intubation within 1 week of initial extubation versus 54.2% in CPAP (P-value=0.970). The mean duration ofrespiratory support using HFNC was 3.7 days, compared to 6.5 days using CPAP (P-value= 0.001). Among neonateswho suffered from nasal trauma, 90.6% of neonates belonged to the CPAP group, while 9.4% of cases belonged to theHFNC group (P-value= 0.001).

The use of CPAP and HFNC after the extubation of preterm mechanically ventilated neonates wasstatistically equal regarding extubation failure.

Severe hyperbilirubinemia is potentially neurotoxic and can lead to long-term complications inneonates. Exchange transfusion (ECT) is one of the most important treatments for hyperbilirubinemia. In thisregard, the present study aimed to determine the characteristics of hyperbilirubinemic neonates who need ECT andtheir mothers. This cross-sectional study was performed on 380 infants born after 35 weeks of gestation who were 2-14days old. The studied neonates had bilirubin levels higher than 17 mg/dl and underwent ECT in Ghaem Hospital inMashhad, Iran during 2010-20. Moreover, it should be noted that the participants were selected using the conveniencesampling method and the required data were collected using a checklist. This checklist was designed based on theneonatal examination, maternal (maternal age, parity), and neonatal status (age, gender, and weight) and seriallaboratory tests before and after ECT (total bilirubin, hematocrit, and platelet). Finally, these variables were comparedbased on the cause of hyperbilirubinemia. The mean levels of serum bilirubin were 28.5 mg/dl and 26.5 mg/dl in male and female infants (P=0.096),respectively. Furthermore, the mean levels of serum bilirubin in neonates born by cesarean section and normal vaginaldelivery were 29.5 and 28.1 mg/dl, respectively (P=0.458). Based on the findings, 60% of the neonates suffered fromweight loss and 22% had more than 3% daily weight loss. In the present study, the most prevalent risk factors amongthe studied neonates were RH incompatibility, ABO incompatibility, and G6PD deficiency, in that order. Overall, these findings suggest that normal vaginal delivery, repeated breastfeeding, prevention ofsevere weight loss, early detection of RH and ABO incompatibility, and G6PD deficiency, as well as appropriatemanagement of hyperbilirubinemia, can reduce the need for ECT and alleviate complications of neonatalhyperbilirubinemia.

Non-invasive prenatal testing (NIPT) as a novel screening method has been widely proposed to screen for common fetal chromosomal aneuploidies. The aim of the present study was to examine the possible effects of maternal age, maternal weight, fetal crown-rump length (CRL), serum pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin (free β-hCG), and fetal gender on cell-free fetal DNA (cffDNA) percentage fluctuations.

In the present cross-sectional study, 308 singleton pregnant women aged 20-47 years at 11+0 to 13+6 weeks of pregnancy referring to the DeNA Laboratory in Tehran, Iran, for NIPT test during a one-month period between July 2018 and August 2018 were selected randomly. The cffDNA was extracted from maternal plasma. Whole exome sequencing by a ion semiconductor sequencer using cffDNA was applied for all participants. The PAPP-A and free β-hCGas biochemical biomarkers were assessed using a closed chemilumine scence immunoassay analyzer. The Shapiro-Wilk test, Pearson analysis, beta regression analysis, and Mann-Whitney U test were performed to analyze the data.

In the screening population, the cffDNA percentage showed no significant correlation with CRL and maternal age (P=0.096 and P=0.881, respectively). However, the cffDNA percentage correlated well with maternal weight, PAPP-A, and free β-hCG (P=0, P=0.009, and P=0.001, respectively). Beta regression between cffDNA percentage and maternal weight, free β-hCG, and PAPP-A was significant (P<0.001). The mean cffDNA percentage between male and female fetal groups showed a significant difference (P<0.001).

This study demonstrated that the cffDNA percentage in the first trimester of pregnancy had a negative correlation with maternal weight and a positive correlation with PAPP-A and free β-hCG values. Furthermore, the cffDNA percentage in male fetuses was higher than that in female fetuses.

Infantile colic is a common condition among neonates; however, its etiology is not fully identified. Thisstudy aimed to evaluate this complication and search for treatments by investigating the experiences of Iranianphysicians.

In this review study, the infantile colic was initially studied in modern medicine. To this end, an electronicsearch was performed in databases, such as Web of Science, Medline (via PubMed), Scopus, EBASE, UpToDate(International databases), Magiran, SID, Irandoc, IranMedex (National databases), and the Google Scholar searchengines. Subsequently, this complication was investigated in the original references of Persian medicine. In this regard,the words related to the subject matter of the research were taken from the original books of Iranian medicine,including Al-Mansouri Fi Al-Tibb, Canon, Kholasatol Hekmah, and Kholasat Al-Tajarob.

The results of this study indicated that factors, such as maternal mood during pregnancy, inappropriatematernal nutrition, gastrointestinal problems, and infantile cerebral problems are some of the causes that have beenmentioned regarding infantile colic in modern and Persian medicine. Other causes, such as spinal nerve stimulation,insomnia, and sleep apnea are also raised in Persian medicine. Almost all of these causes are due to poor digestion ofmilk and pneuma in the gastrointestinal tract. Iranian physicians have considered solutions, such as massage withspecial oils, nutrition modification, and the use of hypnotics to reduce pneuma production in the gastrointestinal tractas well as its side effects. The application of these recommendations together can help better treat infantile colic. Inthis regard, the data were categorized by reviewing the works of Iranian scholars, as well as combining modernmedical findings and Iranian experience. Accordingly, a new definition of colic can be provided and some newtreatments are added for infantile colic based on modern and traditional medicine

Since the positive role of some measures, such as massage and swaddling in modern medicine isconfirmed, the investigation and recommendations of Iranian physicians in the field of infantile colic seem to be able tocompensate for the gap in identification, prevention, and treatment of this complication.

Asphyxia is a medical situation resulting from the deprivation of oxygen to a newborn lasting long enough during the birth process to cause physical harm, especially to the brain. Human umbilical cord blood (UCB) is a well-established source of hematopoietic stem/progenitor cells (HSPCs) for allogeneic stem cell transplantation. A low level of O2 in neonates with asphyxia during labor can affect proliferation and differentiation of stem cells in cord blood.

The quality and colony-forming ability of hematopoietic stem cells in the cord blood of neonates with severe asphyxia with Apgar score 3-5or need to cardiac pulmonary resuscitation 5 min after delivery were compared with the group with normal Apgar score. Thereafter, hematopoietic stem cells were isolated, and cells were cultured in an enriched media (MethoCult H4435) special for HSPCs for 7 days to assess the growth and colony formation.

Based on the results, there was a significant difference in the number of colonies of RBC (P=0.0016) and WBC precursor (P=0.006), in a plate with 104 cord blood hematopoietic stem cells in newborns exposed to hypoxemia during labor.

Umbilical cord blood is valuable for its content of stem cells. Severe hypoxia in the perinatal period does not negatively affect the viability of UCB-derived HSPCs to grow and form colonies. Furthermore, it was found that transient severe asphyxia does not exert negative effects on the banking quality of HSPCs for likely problems in the future.

Jaundice is a yellow discoloration of the skin and eyes caused by hyperbilirubinemia. Jaundice usually becomes visible on the sclera at a level of 2 to 3 mg/dL. Each year, about 1.1 million neonates develop hyperbilirubinemia in the world the vast majority of whom live in sub-Saharan Africa and South Asia. In 2016, neonatal jaundice was estimated to account for about 8 under-5 mortalities per 100,000 live births worldwide. This study aimed to assess the prevalence and associated factors of hyperbilirubinemia among all the inborn and outborn neonates at University of Gondar Comprehensive Specialized Hospital in Gondar, Ethiopia. The current institutional-based retrospective cross-sectional study was conducted on 399 case files of all the admitted inborn and outborn neonates at University of Gondar Comprehensive Specialized Hospital within March 2017 to March 2019. The extracted data were entered into Epi Info software (version 7.0) and exported and analyzed using SPSS software (version 21.0). Variables with a p-value of less than 0.2 in the bivariate analysis were included in the final model, and the statistical significance was declared at less than 0.05. Both the size and statistically associated factors affecting the results of neonatal hyperbilirubinemia were the main outcome measures in this study. Overall, 31.6% (n=126) of the admitted neonates developed hyperbilirubinemia. Maternal and neonatal Rhesus (RH) incompatibility, ABO incompatibility, low birth weight, hypoglycemia, and birth trauma were the main statistically significant factors associated with neonatal hyperbilirubinemia. The prevalence of neonatal hyperbilirubinemia in this study was high in comparison to that reported for other studies carried out on neonatal hyperbilirubinemia in some parts of Ethiopia. The major factors causing hyperbilirubinemia in neonates were RH incompatibility, low birth weight, birth trauma, and hypoglycemia. Therefore, by the early prevention and prompt treatment of hyperbilirubinemia in neonates, it is important to prevent or reduce both short-term and long-term complications related to this condition.

Nowadays, the promotion of cardiac care programs for infants in need of specialized heart care has improved the survival of these patients. This study aimed to explain the experiences of healthcare staff regarding angiography in pediatric patients. This study was conducted based on qualitative content analysis. The data were collected through in-depth, semi-structured, face-to-face, and individual interviews. In total, 20 participants (9 nurses, 4 radiologists, and 7 pediatric cardiologists) were included in this study. According to the results, three main categories were found in this study, including the need for specialized skills (along with three subcategories of the need for knowledge skills, communication skills, and experience), lack of pediatric angiography facilities (along with three subcategories of a shortage of specialist and pediatric nurses, as well as lack of space), and lack of providing care to caregivers (along with three subcategories of intensive shifts, suffering from aggressive pediatric procedures, and environmental vulnerability). Health care staff working in the field of angiography in infants are experiencing numerous mental and psychological problems; however, the health system has not taken supportive measures for such personnel. The result of this study can help future interventions develop supportive programs for healthcare staff working in this unit.

Despite advances in perinatal care, perinatal asphyxia (PA) remains one of the most important causes of mortality and morbidity at birth. Asphyxia is associated with the dysfunction of different organs of the body. Therefore, this study aimed to investigate the urinary biomarker of beta-2 microglobulin in neonates with asphyxia.

This case-control study was performed on neonates admitted to the Neonatal Intensive Care Unit of AL Zahra and Shahid Beheshti hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during 2017-18. On the second day of birth, beta-2 microglobulin was measured in urine samples using the enzyme-linked immunosorbent assay technique.

The mean level of beta-2 microglobulin in the group with asphyxia (9.91±6.16) was significantly higher than that in the control group (3.83±4.03) (P=0.001). Moreover, analysis of beta-2 microglobulin level in the group with asphyxia showed that the mean serum level of neonates with acute renal failure (13.14±6.27) was significantly higher than that in newborns without acute renal failure (6.68±4.24) (P=0.02).

The results of our study suggest that the beta-2 microglobulin level can be evaluated as a marker of neonatal asphyxia. Furthermore, its level was significantly associated with acute kidney injury. It is suggested that further studies be conducted with a larger sample size.

The risk of developing metabolic syndrome and diseases, such as diabetes mellitus, has been increased as a worldwide rise in obesity. Gestational diabetes mellitus (GDM) or maternal hyperglycemia is a risk factor for cardiac dysfunction in neonates. The present study compared the QT interval in neonates with maternal GDM and healthy mothers. This case-control study was carried out on term neonates with maternal GDM (case group; n=42) and healthy non-diabetic mothers (control group; n=42) in Sayyad-e-Shirazi hospital in Gorgan, Northeast of Iran, within March 2016 and February 2017. A pediatric cardiologist evaluated septal hypertrophy by Doppler echocardiography (Zonare ZS3) during the first 2 weeks after birth. A standard 12-lead electrocardiogram was recorded for 10 sec, and a corrected QT (QTc) value was calculated. The data were analyzed by the latest version of SPSS software (version 16) using the Chi-square and t-test for the assessment of the differences in the QT values and other indices between the two groups. P-values less than 0.05 were considered statistically significant. The results of the present study showed congenital heart diseases (CHDs) in six neonates. Significantly higher QT (249±36 and 245± 28 ms), septal thickness (6.09±1.07 and 5±1 mm), and lower QTc value (382±44.06 and 392± 34 ms) were observed in the case group, compared to those reported for the control group (p <0.001). The QTc dispersion was significantly different between the subjects under insulin therapy and participants receiving an antihyperglycemic oral regimen. In this study, significant thicker cardiac septum and higher QT interval were observed in the neonates born from mothers with GDM in comparison to those from healthy mothers. This could suggest close cardiac monitoring of these neonates due to the higher probability of CHDs.

Respiratory disorders are recognized as a leading cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is used  by pediatricians both for diagnostic and therapeutic indications in children. Nonetheless, there is a paucity of data regarding the diagnostic utility and safety of FOB in neonates, and it has remained relatively under-used in the care of neonates. The present study provided a practical overview of the wide diagnostic aspects of the FOB in newborns hospitalized in the Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to the quick management of  neonates with respiratory disorders.
This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over 5 years within 2013-2018. All subjects underwent FOB and bronchoalveolar Lavage (BAL) using a bronchoscope of 2.8 (EVIS EXERA III Olympus bronchoscope).
The greatest indications for performing FOB entailed hypersecretion in 138 (92%) cases, prolonged mechanical ventilation in 108 (72%) neonates, and persistent radiological finding in 97 (64.6%) subjects. Bronchoscopy detected various airways anomalies, such as Laryngomalacia (72%), Tracheobronchomalacia (64%), subglottic stenosis (26%), vocal cord paresis (18%), tracheoesophageal fistula (6.7%), laryngeal cleft (6%),  and laryngeal web (4%). BAL results demonstrated that the cultures were positive in 20 (13.33%) neonates. Acinetobacter was the most commonly reported bacterial infection observed in 8% of neonates.
As evidenced by the obtained results, when performed by an experienced and well-trained person and in an environment with appropriate facilities, FOB can be a safe and efficient tool for the early diagnosis of numerous airway disorders among neonates admitted to NICUs.

The development of the teeth is affected by gestational age, and premature neonates are at greater risk for developing dental problems. In the present study, the deleterious effects of preterm birth on orodental tissues and structures were reviewed.

A detailed research was carried out on MEDLINE, PubMed, and Google Scholar databases. English articles up to June 2019 were included and the search process was performed using the following keywords: “Dental outcomes”, “Tooth”, “Preterm”, “Prematurity”, and “Neonate”.

Literature review has revealed that alteration of tooth crown sizes, quantitative loss of enamel (i.e., enamel hypoplasia), and qualitative change in the enamel opacity (i.e., translucence appearance), or a combination of all are common in premature newborns. Delayed eruption of the first deciduous tooth is frequent among preterm neonates. Prematurity may also influence dental occlusion development, asymmetry in the jaws, and lateralization. Neonates with immature organs and enzymes are at greater risk for some complications, such as hemolytic jaundice and cholestasis. These complications, in addition to hyperbilirubinemia, may result in yellow, brown, or dark green discoloration in the primary teeth.

Some measures can be adopted to improve dental outcomes in premature neonates, including prevention of preterm birth, avoiding problems associated with oral intubation, gentle passing and moistening oral tube feeding, and oral care with colostrum and soft swabs.

Peers are influential people who can enhance self-efficacy (SE) factors by verbal encouragement and common experience sharing and affect maternal SE in promoting and maintaining breastfeeding (BF). This study aimed to determine the effect of peer education on BF SE among primiparous mothers.

This randomized clinical trial study was conducted on nulliparous mothers with hospitalized neonates in the neonatal ward of Amirkola Children's Hospital, Mazandaran Province, Iran, within May-September 2018. The statistical population of this research (n=120) was selected using the convenience method and randomly divided into two groups of intervention and control (n=60 each). The control group received the usual and standard center's education. However, the mothers in the intervention group received, two one-hour sessions of BF education from peers in addition to the usual training. These peers were qualified and experienced in two years of successful BF. The tools used for data collection were the demographic form and Breastfeeding Self-Efficacy (BE SE) Scale. The BE SE questionnaire was completed at the time of enrollment and the eighth week after primiparous delivery. The collected data were analyzed in SPSS software (version18) using an independent t-test and paired t-test. A p-value of less than 0.05 was considered significant.

The two groups were similar in demographic variables. The mean score of BF SE after the education in the control and intervention groups were obtained as 48.38±7.85 and 60.25±8.32, respectively, which was significant (P<0. 001).

Based on the results, breastfeeding through peer education increased SE in primiparous women. Therefore, it is recommended to adopt it as an appropriate educational method to improve the quality of BF education among mothers with newborns hospitalized in the neonatal ward.

Congenital hereditary endothelial dystrophy (CHED) is a rare disease of the corneal endothelium. It is a nonprogressive clouding of the corneal, presenting at birth in most cases or shortly after it. This disease is categorized as an autosomal recessive disorder, which manifests with diffuse corneal edema, Descemet membrane thickening, and lack of endothelial cells. The primary abnormality in CHED is a degeneration of endothelial cells during or after the fifth month of gestation. The literature review has shown that CHED can occur with progressive, postlingual sensorineural hearing loss in Harboyan syndrome; however, it is not associated with any systemic abnormality.

Case report:

 Our study reports a case of CHED and valvular heart disease in a neonate. To the best of our knowledge, no research has been performed to investigate the relationship between CHED and valvular heart disease. In addition, the patient’s mother had vaginal discharge in the fifth month of gestation, which was, as stated in the previous studies, the period during which the abnormality occurs in CHED. The two aforementioned issues highlight the need for performing the present study.

Occurrence of CHED and heart disease has not been reported, there is a need for more research into this subject.

Herpes simplex virus (HSV) is one of the main causes of neonatal meningitis; nonetheless, it usually goes unreported. A lumbar puncture is needed to accurately differentiate between viral and bacterial meningitis. The cerebrospinal fluid can be analyzed to exclude bacterial meningitis; nevertheless, the identification of the specific viral cause may be beneficial. Viral diagnosis determines prognosis, improves the care of the patient, decreases hospitalization duration, and reduces unnecessary use of antibiotics. In young infants, the herpes simplex virus infection is responsible for serious complications leading to morbidity, mortality, and permanent sequelae in survivors. The clinical findings of this infection usually include tremors, seizures, lethargy, irritability, poor feeding, temperature instability, and a bulging anterior fontanel, which are common in almost all forms of meningitis. These similarities make the differential diagnosis rather difficult.

Case report: 

We report and discuss the case of an an11-day-old neonate girl who presented with fever and negative test results, as well as our challenges that finally led to the diagnosis of HSV-related meningitis and its management.

It could be managed to reach a firm diagnosis confirming the initial differential diagnosis through additional and repetitive testing. Therefore, it is concluded that clinical judgments may be more reliable than paraclinical results in the individual approach for each patient. Furthermore, HSV infection should also be considered for patients with a persistent fever of unknown origin. It is also recommended to adopt separate procedures for the suspicion of HSV type 1 and HSV type 2.

Pentalogy of Cantrell (PC) is an extremely rare congenital anomaly which was first described in 1985. The incidence of the PC has been reported to vary from 5.5-7.9 cases per million live births. This anomaly involves diaphragmatic pericardial defects, lower sternal defect, intracardiac anomalies, ventral abdominal wall abnormality, and anterior diaphragmatic defect. Considering the number of presented anomalies, PC is classified into three groups of certain, probable, or incomplete pentalogy. Although the etiology of PC is unknown, it has been assumed that abnormalities in intra embryonic mesodermal differentiation formation and migration at around 14-18 days after conception are responsible for the anomalies observed in PC. The prenatal diagnosis of the PC can be made via prenatal two-dimensional or three-dimensional ultrasound.

Case report: 

This case report investigated an Iranian 2-hour-old full-term neonate who was referred to Imam Reza Hospital, Kermanshah, Iran, due to respiratory distress and abdominal wall defect. The patient was finally diagnosed with a probable PC, although his prenatal investigations were considered normal.

Although ultrasonography is a widely available tool for prenatal diagnosis of PC, as in our case, the absence of ectopic heart and omphalocele makes the prenatal diagnosis of PC via ultrasonography less possible. 

Neonatal sepsis is a leading cause of mortality and morbidity in the first month of life. The underlying risk factors for early-onset infection (in the first 3 days of life) are prematurity, low birth weight, maternal history of infection, difficult delivery, male gender, twin pregnancy, and congenital malformations. Acinetobacter is a nosocomial infection and rarely caused the early-onset-sepsis and meningitis. The most common neonatal tumor is neuroblastoma; however, it is not defined as a risk factor for early-onset sepsis.

  Case  report: 

A 13-day-old newborn female was referred to our hospital due to ventriculitis, persistent meningitis, and an abdominal mass. She was a term neonate delivered by cesarean section from a mother with a nearly normal pregnancy with no complications, such as chorioamnionitis, prolonged rupture of membrane, urinary tract infection, preeclampsia, and diabetes.  A fetal abdominal mass was detected on the left kidney in prenatal sonography. The patient was admitted to the Neonatal Intensive Care Unit in the first minutes of life because of respiratory distress and cyanosis. Subsequently, mechanical ventilation, endotracheal surfactant instillation, and antibiotic therapy were prescribed. Due to the deterioration of the general condition, fever, seizure, and hematuria on the third day, sepsis workup and changing the antibiotics were performed. Blood culture and cerebrospinal fluid (CSF) were positive for Acinetobacter baumannii. Persistent positive CSF culture led to the diagnosis of ventriculitis which was confirmed by brain computed tomography scan (CTS) and ventricular tap. The condition of the patient got better after intraventricular amikacin injection in addition to intravenous colistin and piperacillin.  Postnatal sonography and CTS confirmed the abdominal neuroblastoma. Chemotherapy was initiated after the complete treatment of sepsis, meningitis, and ventriculitis. This case report presents a term and female neonate with early-onset neonatal sepsis and  meningitis, caused by an unusual microorganism, and a prenatal history of abdominal neuroblastoma.

By this case report, the clinicians are suggested to consider the Acinetobacter baumannii as the cause of fulminant sepsis and meningitis in a term neonate with no underlying risk factors for infection.   Keywords

Bronchogenic cysts (BCs) are congenital abnormalities of the primitive foregut, which are commonly found in the lung and mediastinum; however, they may rarely occur in the retroperitoneal region.

Case report:

 We present a case of 20-day-old male newborn with a prenatal diagnosis of an abdominal mass who was referred and admitted to our hospital for further evaluation. Abdominal ultrasound and computed tomography scan demonstrated a retroperitoneal ill-defined solid mass locating on the upper ridge of the left kidney in close contact with the posterior wall of the stomach and pressure effects on the spleen hilum. Concerning presumptive diagnosis of neuroblastoma, less likely Wilms tumor, and subdiaphragmatic sequestration, surgery was carried out, and the mass removed completely. Pathological examination revealed a multiloculated cystic-solid mass with cystic spaces which was lined by respiratory epithelium, and the underlying fibrotic stroma contained islands of mature cartilage consistent with the diagnosis of bronchogenic cyst.

Although BCs rarely occur, they should be considered in the differential diagnosis of a retroperitoneal mass in the neonates.