Iranian Journal of Neonatology
Volume:13 Issue: 2, Spring 2022

Respiratory distress in neonates is the most common condition of preterm infants receiving treatment in the neonatal intensive care unit. As a clinical assessment of respiratory distress, the Downes score can predict the risk of respiratory failure. The present study aimed to determine the survival of respiratory failure in the first 72 h in preterm infants with respiratory distress based on the Downes score assessment. A prospective cohort survival analysis was performed at three hospitals in Indonesia (Al-Islam Hospital, Bandung, Al-Ihsan Hospital, Bandung, and Cibabat Hospital, Cimahi) from April to July 2021. Subjects were infants aged 28-36 weeks, with respiratory distress based on the Downes score within the first 2, 6, 12, 24, 48, and 72 h after delivery. The analyzed variables included birth weight ([BW], <1500 vs. 1500-2500 g), gestational age ([GA], 28-32 vs. 32-37 weeks), and 5-min APGAR score (<7 vs. >7). Bivariate and multivariate analyses were conducted with Cox regression proportional hazard and the Kaplan-Meier estimate of survival rate was also performed. In addition, the adjusted hazard ratio (aHR) was calculated, and a P-value of less than 0.05 was considered statistically significant. Of the 89 subjects who met the criteria, 20 (22.47%) experienced respiratory failure. The multivariate analysis including BW (aHR: 1.846, 95%CI: 0.570-5.979, P> 0.05), GA (aHR: 2.273, 95 %CI: 0.697-7.416, P>0.05), and the 5-min APGAR score (aHR: 2.049, 95%CI: 0.811-5.179, P>0.05) estimated the survival rate for respiratory failure at the age of 72 h at 74.7% (standard error: 0.05%). A GA of <32 weeks, a BW of <1500 g, and the condition of asphyxia simultaneously increased the aHR of respiratory failure, with an estimated survival rate of 74.7%.

This study aimed to examine the effects of nursing interventions on high-risk neonates in neonatal intensive care units by systematic literature reviews.

Data were gathered in compliance with preferred reporting items for systematic reviews. The systematic review method proposed by Whittemore and Knafl guided this review of studies conducted from 2006 to 2020. The studies were identified in eight electronic databases and scholarly websites. Finally, 15 studies met the inclusion criteria.

The results of a content analysis of the studies on nursing interventions for high-risk neonates led to the identification of the following nursing interventions: kangaroo care, massage therapy, Yakson, playing mother’s voice, olfactory stimulation by breast milk, playing mother’s heartbeat sound, playing mother’s singing, sensory stimulation, and cycled lighting and auditory stimulation.

The findings suggested that these interventions were appropriate interventional methods to step up the growth and development of high-risk neonates in neonatal intensive care units.

Neonatal seizures are the most prevalent neurological disorders. In Egypt,  the characteristics and neurodevelopmental outcomes of neonatal seizures have not been sufficiently explored.
The present study was conducted on 120 full-term and preterm newborns from  October 2016 and October 2020.  The adverse outcomes of cerebral palsy, mortality, developmental delay, and/or epilepsy have been considered. The associations between adverse outcomes and 13 variables were analyzed.
Hypoxic-ischemic encephalopathy (HIE) (34.2%) was the most common etiology for neonatal seizures, followed by intracranial hemorrhage (25.8%). The predominant seizure type was subtle (57.5%), preceded by clonic seizure (16.7%). Moreover,  72 neonates had a normal outcome, 14 (60%) cases had minor functional disabilities, and 27 (22.5%) newborns survived with one or more neurodevelopmental abnormalities (6 cases had cerebral palsy, and 21 newborns had global developmental delay), with a 17.5 % mortality rate. Based on the univariate analysis, 10 variables were associated with an unfavorable outcome; nonetheless, only three variables, namely metabolic acidosis, abnormal cranial ultrasonography findings, and the presence of congenital heart disease, were independent predictors as illustrated by multivariate logistics.
As evidenced by the obtained results, HIE and intracranial hemorrhage were the most common causes of neonatal seizures. Perinatal insult, prematurity, seizure onset <24 hours, low Apgar score at 1 min, myoclonic or mixed seizure, the efficacy of the anticonvulsant therapy, abnormal cranial U/S, metabolic acidosis, abnormal electroencephalography (EEG)  pattern, and the presence of congenital heart disease were the most reliable predictors of adverse outcome.

The measurement of total serum bilirubin is a stressful diagnostic method; therefore, it is necessary to measure bilirubin levels using non-invasive ways. The present study aimed to assess the relationship between bilirubin levels measured using three methods of transcutaneous, serum, and Kramer’s scale in term neonates with jaundice.
This descriptive-analytical study was conducted on 180 full-term neonates admitted to Imam Ali Hospital in Alborz province, Iran. Bilirubin level was measured by three methods of serum, transcutaneous (using MBJ20, B&M Technology Co., China), and Kramer’s scale (based on the appearance) before phototherapy. Thereafter, the relationship between serum bilirubin levels using transcutaneous and Kramer’s scale was determined by the Pearson and Spearman correlation coefficients.
The correlation coefficient between serum bilirubin and transcutaneous bilirubin (TCB) was obtained at 0.915 before phototherapy. Furthermore, the correlation coefficients between serum bilirubin and TCB were calculated at 0.881 and 0.77 in the covered and uncovered areas after phototherapy, respectively. The correlation coefficient between TCB in the covered and uncovered areas was 0.81. The mean difference between serum bilirubin and TCB was 0.42±1.25 before phototherapy. Moreover, the mean difference values between serum bilirubin and TCB were reported as 1.36±1.37 and 83.1±63.4 in the covered and uncovered areas after phototherapy, respectively.
As evidenced by the obtained results, there was a significant correlation between TCB and serum bilirubin before the initiation of phototherapy. Therefore, it is recommended to use TCB instead of repeated blood sampling to follow and monitor neonates.

According to the Centres for Disease Control and Prevention, central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 h of central line placement. Central line-associated bloodstream infection in the Neonatal Intensive Care Unit contributes to increased morbidity and hospital mortality. This study aimed to prove the relationship between peripherally inserted central catheter dwell time and the incidence of CLABSI among neonates at our tertiary center hospital in Bali, Indonesia.

This study was conducted based on a prospective cohort study design. The subjects were neonates admitted in levels 2 and 3 of the neonatology wards of Sanglah Hospital, Bali, Indonesia, between November 2018 to December 2020. The cases were followed during the insertion of a central catheter. Statistical analysis was performed using the Chi-square test and logistic regression with a p-value of < 0.05.

Subjects were recruited consecutively and fulfilled the research criteria as many as 114 people. A total of 63 subjects were excluded, and none of the cases was lost for follow-up. The incidence rate of CLABSI was obtained at 19.2‰ among the 114 subjects. The patients with a catheter dwell time of ˃ 14 days, compared to those with a catheter dwell time of ≤ 14 days, had a 2.9-fold risk of experiencing CLABSI (95% confidence interval: 1.191-7.497, P=0.02). No other risk factors were found for CLABSI development.

The results of this study demonstrated that the risk of CLABSI in subjects with a catheter dwell time of ˃ 14 days was 2.9. Therefore, the implementation of the CLABSI bundle is necessary to decrease CLABSI incidence in neonates.

Jaundice is the most common problem among neonates. Although neonatal jaundice is highly prevalent in Iran and the prevention and treatment of this disease is incredibly important, few studies have been conducted on the effect of probiotics in the prevention of hyperbilirubinemia in Iran so far. Considering the contradictory results in this regard, this study was conducted to investigate the effect of probiotics in preventing jaundice among neonates.

The statistical population of this three-blinded clinical trial on the first of January 2021 consisted of 196 neonates who were divided into two groups of placebo and intervention. The neonates with a gestational age of more than 37 weeks, birth weight of more than 2,500 grams, and without risk factors for jaundice were included in the study after that the research objectives and procedures were explained to their parents and their informed consent was obtained. Patients were randomly divided into the intervention and placebo groups. The intervention group underwent treatment with probiotics (1010 Saccharomyces boulardii daily for 5 days), while the other group received treatment with a placebo. The level of bilirubin was measured with a skin bilirubin meter and, if necessary (i.e., bilirubin more than 15), a blood test was administered before the intervention and on the third and fifth days after the intervention. The effect of probiotics on jaundice was compared in the two groups.

Based on the study results, the level of forehead and chest bilirubin was not significantly different between the study groups before the intervention and 3 and 5 days after the intervention (P> 0.05). In cases that skin bilirubin levels were higher than 15 on the fifth day ,the mean serum bilirubin level was obtained at 15.71±0.99 mg/dl and 17.42±1.17 mg/dl in the intervention and placebo group, respectively, which was statistically significant (P = 0.03).

 The results of this study showed that the use of Saccharomyces boulardi decreased the level of serum bilirubin (P=0.03).

The short interpregnancy interval is a frequent clinical situation with adverse fetal, neonatal, and infantile outcomes. The present study aimed to assess the fetal and neonatal consequences of closely spaced pregnancies.
This retrospective study was conducted on 162 mothers, 81 of whom had an inter-pregnancy interval of fewer than 18 months, and 81 cases had an inter-pregnancy interval of more than 18 months. These participants had given birth at the Souissi Maternity Hospital in Rabat during the last 12 months. The socio-economic data, obstetrical history, as well as fetal and neonatal data, were extracted from medical records via a pre-established questionnaire. Statistical analysis was performed in SPSS software (version 20.0).
The mean scores of the inter-pregnancy interval were reported as 11.83±3.08 and 29.83±9.83 in the groups of closely spaced pregnancies and inter-pregnancy intervals of more than 18 months (P=0.03). The number of illiterate women was significantly higher in the group with a short interpregnancy interval, compared to that in the group with an interpregnancy interval over 18 months (46.9% versus 9.9; P<0.001). Almost one-third of women with a short interpregnancy interval had a premature birth. Other adverse fetal outcomes, including low birth weight and respiratory distress, were detected with prevalence rates of 21% (p<0.001) and 9.9%, respectively (P=0.04).
As evidenced by the results of this study, it is essential to inform families and mothers about the fact that a reasonable delay (> 18 months)  between pregnancies reduces the risks for both mother and child.

The provision of spiritual care along with holistic and comprehensive care is an important need for families with children hospitalized in an intensive care unit. This study aimed to explore the perceptions of healthcare providers regarding the spiritual care of parents with a newborn in a neonatal intensive care unit (NICU) in Iran.
This study was conducted using conventional qualitative content analysis, which adopts open coding, classification, and abstraction. A total of eight nurses and one doctor participated to be interviewed.
Based on data analysis, three categories of nursing support needed for spiritual care as well as the necessity of changes in structural conditions were identified in this study.
Hospital administrators must undertake measures to change circumstances in NICUs. In addition, nurse managers should plan training courses on the importance of providing spiritual care to patients and their families.

Despite the numerous advances in newborn care, neonatal mortality and morbidity remain high, especially in developing countries, which requires us to find a way to improve facility-based care. The present study investigates the pattern of diseases and mortalities among these neonates admitted to the Neonatal Intensive Care Unit of Hue Central Hospital, Hue city, Vietnam, and explores the factors associated with the mortality.
A cross-sectional study was carried out at the Neonatal Intensive Care Unit of Hue Central Hospital between January 2019 and December 2019. Factors including age, sex, gestational age (GA), weight, diagnosis, and causes of neonatal death were studied. Each case was analyzed regarding factors affecting neonatal mortality.
A total of 724 neonates were enrolled in this study. Of them, 403 (55.7%) were male, and 321 (44.3%) were female. Early-onset neonatal sepsis was the most frequent problem (49.9%), sequentially followed by late-onset neonatal sepsis (35.5%), congenital anomalies (14%), hyaline membrane disease (12.6%), unconjugated hyperbilirubinemia (12.2%), and asphyxia (10.2%). Moreover, the mortality rate was reported as 13.2%. The factors associated with mortality included GA, birth weight, multiple anomalies, critical congenital heart defects, asphyxia, hyaline membrane disease, cerebellar hemorrhage, and early-onset neonatal sepsis.
Neonatal sepsis was the primary cause of morbidity in the neonatal care unit in Vietnam. Preterm birth, asphyxia, and multiple anomalies were the main risk factors associated with mortality. Early management of preterm births and neonatal diseases should be given priority for improving neonatal outcomes.

There is still controversy on the importance of soft markers on the fetus and neonatal outcomes. This study aimed to determine the mentioned outcomes in the fetuses with soft markers detected by ultrasound screening.

This prospective study was conducted on 461 pregnant women who were referred to the prenatal clinics of hospitals affiliated with the Tehran University of Medical Sciences, Tehran, Iran, in 2021. The study outcomes included incidence of abortion, preterm birth (PTB), cesarean section (CS), low birth weight (LBW), neonatal admission rates, and neonatal mortality.

The most frequent soft marker in the present study was echogenic intra-cardiac foci (EIF) (32.5%), followed by choroid plexus cyst (CPC) (30.6%), pyelectasis (25.2%), and echogenic bowel (EB) (15.8%), respectively. Spontaneous abortion, PTB, CS, LBW, neonatal department admission, neonatal intensive care unit (NICU) admission, stillbirth, and fetal distress, and death occurred in 10 (2.1%), 52 (12.5%),  316 (76%), 35 (7.6%), 28 (6.7%),  42 (10.1%), 13 (3.1%),  26 (5.6%), and one (0.24%) cases, respectively.Poor neonatal outcomes were significantly associated with EIF (P=0.007), CPC (P=0.045), echogenic bowel (P=0.031), pyelectasis (P=0.026), and single umbilical artery (P=0.010). In addition, the fetuses with synchronous CPC and IEF and also synchronous pyelectasis and IEF were at significantly higher risk of poor neonatal outcomes (P=0.037).

The study results showed that although poor neonatal outcomes were associated with some soft markers, most fetuses with soft markers had desired outcomes in the absence of structural or chromosomal abnormality.

Cytomegalovirus (CMV) is a pathogenic virus that is found everywhere. The serovirulance of this virus varies widely among different communities. The present study was conducted to investigate the frequency of CMV serovirulance in mothers and their very low birth weight (<1,500 g) neonates.

This descriptive cross-sectional study was conducted on 234 serum samples (117 maternal and 117 neonatal samples) for 12 months in Mahdieh Hospital, Tehran, Iran, from March 2019 to March 2020. The enzyme-linked Immunosorbent assay technique was used to evaluate specific antibodies (i.e., immunoglobulin G [IgG] and immunoglobulin M [IgM]) of CMV. Statistical analysis was conducted in SPSS (version 23).

Based on the results, the seroprevalence of CMV IgG was 98.2% (115 cases) in mothers and 84.6% (99 cases) in neonates. The seropositivity rate of CMV IgM was reported at 1.8% (2 cases) in mothers and 0.9% (1 case) in neonates. It was found that the relationship between the mean scores of maternal CMV IgG and the number of live births was statistically significant (P=0.002). However, there was no statistically significant relationship between some maternal factors (e.g., age, occupation, living place, number of pregnancies, deliveries, abortions, and education) and maternal CMV IgM seropositivity. Furthermore, neonatal gender and gestational age showed no statistically significant relationship with maternal and neonatal CMV IgG and IgM seropositivity.

According to our findings, the serovirulance of CMV in mothers and their neonates was significant, whereas active CMV infection in both groups was highly unusual. Additionally, the transmission rate of CMV IgG and CMV IgM from the mother to her neonate was incomplete.

The first two years of life is of paramount importance for child development, and the acquired skills during this period will be the basis for success in the future. Postpartum depression as one of the common mental health issues in mothers may be associated with child development.
This cross-sectional study was conducted on 366 women (aged 18-45 years) referred to health care centers. Demographic characteristics form, Edinburg postnatal depression scale, as well as ages and stages questionnaires, were used for data collection. The collected data were analyzed in SPSS software (version 18) at a significant level of less than 0.05.
The mean maternal depression score in an abnormal state was higher, compared to that in the normal state, requiring the follow-up situations in communication, fine motor, and personal-social domains. Moreover, the ANOVA test demonstrated a statistically significant difference between the maternal depression score in various situations of mentioned domains (P=0.03, P=0.016, and P=0.018). There was no statistically significant difference between maternal depression scores in various situations of gross motor and problem-solving domains (P=0.503 and P=0.145).  Furthermore, Pearson test results pointed to a significant relationship between depression scores and the state of development in communication, fine motor, and personal-social domains.
As evidenced by the obtained results, health care providers should consider postpartum depression in order to maintain and improve children’s development. The provision of adequate information regarding child development can improve the quality of care for the children whose mothers suffer from postpartum depression.

The present study aimed to assess the effectiveness of oral nystatin as antifungal prophylaxis in the prevention of fungal colonization in premature neonates admitted to neonatal intensive care units (NICUs).
This randomized controlled trial was conducted on 106 neonates admitted to NICUs in the first 72 h of their life with gestational age, gestational age of fewer than 32 weeks, and birth weight of less than 1500 g. The neonates were randomly assigned to two groups: the case group (received nystatin, n=53) and the control group (did not receive nystatin, n=53). After one week, swabs were prepared from the oral and rectal mucosa of the subjects for smear and fungal culture.
The results obtained from the culture revealed that nystatin prophylaxis significantly decreased the colonization of Candida in premature neonates (P=0.03). Moreover, nystatin prophylaxis was significantly associated with Candida colonization in preterm infants with the following characteristics: a gestational age of 28-32 weeks (0 (0.0%) vs. 5 (10.9%)) (P= 0.05), very low birth weight (VLBW) infants (0 (0.0%) vs. 8 (16.0%))  (P=0.007), neonates born via normal vaginal delivery (NVD) (1 (11.1%) vs. 8 (72.7%)) (P=0.01), infants born after preterm rupture of the membrane (PROM) (1 (10.0%) vs. 6 (75.0%)) (P=0.01), and neonates taking broad-spectrum antibiotics (1 (3.7%) vs. 7 (26.9%)) (P=0.02).
The present study demonstrated that nystatin prophylaxis might be considered an effective drug in the prevention of Candida colonization and might lower the risk of SFIs; nonetheless, it had no significant effect on extremely low birth weight (ELBW) neonates. Since nystatin is safe, well-tolerated, affordable, and effective, further studies are required to confirm it as a therapeutic option for ELBW newborns with Candida infections.

The present study aimed to assess the correlation of spiritual well-being with parental stress and coping strategies in mothers with preterm neonates hospitalized in neonatal intensive care units (NICUs).

This prospective cross-sectional study assessed Spiritual Well-Being (SWB), parental stress, and coping strategies in mothers (n=200) of preterm infants admitted to NICUs. Mothers were further divided based on socio-demographic characteristics, such as mother’s age, gestational age, average scores at school, mothers’ literacy level, the birth rank, cesarean or vaginal delivery, number of children, job, and duration of hospital stay.

The results pointed out that 46.6% and 53.4%of mothers had moderate and high levels of SWB, respectively. Moreover, the religion domain (53.30±7.33) had a higher score, in comparison with the existence domain (46.03±7.15). The planful problem-solving was the most frequently used (46.02±11.46) strategy. Religion domain had a significant positive and negative correlation with planful problem-solving strategy (r=0.439**; P≤0/000) and emotional-driven coping strategy (r=-0.420**; P≤0/000), respectively. There was a significant negative correlation (r=-0.322**; P≤.0/000) between the existence domain and the emotional-driven coping strategy.

Regarding the close interrelationship between mothers and NICU nursing staff, it is clear that nurses can help mothers to cope with stress more quickly and efficiently using accurate assessment and appropriate intervention in terms of their spiritual and religious beliefs.

Respiratory distress syndrome (RDS) is one of the major causes of mortality in preterm newborns. Regarding the close association between inflammatory pathways and the occurrence of RDS, the present study aimed to determine the serum level of interleukin-10 (IL-10) in premature neonates with and without RDS.
In this case-control study, the serum level of IL-10 was assessed by immunoassay method in both groups of 30 premature neonates with RDS and 28 newborns without RDS as controls. Statistical analysis was conducted to compare potential variations among premature neonates with or without RDS.
The mean level of IL-10 was significantly higher in neonates with RDS, compared to the non-RDS group (41.20±75.78 pg/ml versus 7.73±14.31 pg/ml, P=0.014, respectively). The IL-10 was significantly higher in non-survived neonates, compared to survived newborns (178.76±69.67 pg/ml vs. 6.81±4.06 pg/ml, P=0.0001). In multivariate linear regression analysis, the presence of RDS was associated with the increased level of serum IL-10 (Beta=1.038, P=0.001).
This study revealed that the increased serum levels of IL-10 in premature neonates with RDS might be considered an early indicator of fatal outcomes with high specificity.

Persistent pulmonary hypertension of the newborn (PPHN) is caused by the inability of the pulmonary arteries to dilate at birth, which leads to severe hypoxemia. Several risk factors have been identified in association with its occurrence and prognosis. The present study aimed to determine the incidence of PPHN, describe neonates’ characteristics, and evaluate the etiology, as well as mortality risk factors in newborns hospitalized due to PPHN at Bahrami Children’s Hospital, Tehran, Iran, from 2017 to 2020.

A total of 49 neonates were included in the present study. The PPHN diagnosis was based on clinical criteria and echocardiography provided by neonatologists. Therefore, a complete history, physical examination, and laboratory data were gathered. Afterward, PPHN etiology was determined, and the patients were followed up for six months. Finally, PPHN prevalence was calculated and probable risk factors for its complications were investigated by using logistic regression analysis.

The findings revealed that the prevalence of PPHN was 3.5% in the center under study, and the mortality rate, as well as complete recovery, were 24.5% and 63%, respectively. It was also found that factors, such as male gender, abnormal Apgar score at birth, and cesarean delivery, were high in a percentage of PPHN patients; however, they were not associated with PPHN mortality and morbidity. The only variable that had a significant association with mortality and morbidity was an abnormal white blood cell count.

The need for inotropic support was associated with poor outcomes. From the aspect of etiology, there exists higher mortality rates, complications, and poor prognosis among PPHN patients with underdevelopment, compared to the ones with maldevelopment.

Hyperbilirubinemia, a common illness in neonates, imposes a risk of arrhythmia and sudden death, particularly during blood transfusions. The present study aimed to evaluate the electrocardiographic parameters in term newborns with hyperbilirubinemia in Gorgan, northeast Iran.
This cohort study was conducted on 101 term neonates admitted to our academic hospital with hyperbilirubinemia (direct bilirubin> 20 mg/dL). Those with sepsis, TORCH[(T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex], congenital heart disease, polycythemia, and asphyxia were excluded. An electrocardiogram (ECG) was taken before the initiation of phototherapy, and heart rate, PR interval, QRS duration, QTc interval, and ST-T changes were recorded after every 8 h during the phototherapy.
In this population of neonates with a mean age of 6.09±3.57 days, the results demonstrated that after 32 h of phototherapy, bilirubin decreased to less than 20 mg/dL. Following that, intensive phototherapy was replaced with the conventional method. Changes in ECG parameters were not significantly related to changes in bilirubin levels (P> 0.05).
As evidenced by the results of this study, there was no significant relationship between ECG parameters and serum level of bilirubin; nonetheless, changes in cardiovascular parameters along with bilirubin levels were remarkable.

Aplasia Cutis Congenita (ACC) is a rare malformation characterized by localized congenital absence of the skin which was first described by Cordon in 1767. ACC is estimated to occur in approximately 1 to 3 cases in 10000 live births. Many factors can contribute to developing ACC among which antithyroid medications were the strongest risk factor. A total of 61 cases of ACC were reported due to Methimazole/Carbimazole.

 We report a female infant with ACC whose mother received Methimazole during pregnancy. Two small, punch-out lesions of the scalp were observed in diameters from 1.5 cm to 2 cm. The patient was treated with conservative care. Crusting and scab formation began on the fifth day. Minor, atrophied and hairless scars were found at the previous location of lesions by reexamining after 12 months.

The etiology of ACC has not yet been clearly defined. Methimazole may be a factor associated with this disorder. Management of ACC includes conservative care and surgery depending on the location and size of lesions, associated anomalies, and health of the infant.

Rubinstein-Taybi syndrome is a rare disorder characterized by broad thumbs and great toes, short stature, dysmorphic facial features, eye abnormalities, cryptorchidism, and moderate to severe intellectual disability. Renal, cardiac, and dental anomalies as well as obesity may be associated with the syndrome. The patients may also have behavioral problems. They have a weak laryngeal wall that can easily collapse resulting in swallowing and breathing problems.

We report a case of an infant with Rubinstein-Taybi syndrome. The present case had typical facial features, broad thumbs and great toes, right corneal opacity, and bilateral vocal cord abductor paralysis. To the best of our knowledge, no study has been conducted on bilateral vocal cord abductor paralysis in Rubinstein Taybi syndrome. In addition, the infant recovered with symptomatic treatment without tracheostomy.

Rubinstein-Taybi syndrome is associated with various congenital anomalies, however further studies are required to investigate the rare association between Rubinstein-Taybi syndrome and bilateral vocal cord abductor paralysis in future cases.

Neonatal neck masses usually fall into three categories: developmental, inflammatory, and neoplastic. Malignant neck masses are rarely observed in neonates; nonetheless, If malignancy is suspected, the patient should be evaluated urgently. In this paper, we describe the case of a neonate with a very rare congenital neck tumor, nasal glial heterotopia, which was first described by Reid in 1852, and only 20 cases have been reported in the parapharyngeal space in an article published in 2005.

 This case report presents a 3-month-old girl misdiagnosed with cystic hygroma at one month. She finally underwent surgery due to the progress of symptoms, airway obstruction, and mass neck enlargement. The pathological diagnosis confirmed a rare case of parapharyngeal neuroglial heterotopia.

One case of glial heterotopia of the parapharyngeal space was included and presented in the present study. Glial heterotopias are very rare in the parapharyngeal space. Histopathology and immunohistochemistry are essential to diagnose this lesion.