Iranian Journal of Neonatology
Volume:13 Issue: 4, Autumn 2022

Patent ductus arteriosus (PDA) is associated with morbidity in preterm neonates. This study aimed to compare the efficacy of oral versus intravenous Ibuprofen in preterm neonates with PDA.  80 low birth weight neonates (gestational age

In 2020, neonatal sepsis was recognized as the leading cause of neonatal death. The birth route canaffect the variety of microbial flora in neonates. Microbial colonization through the birth canal is vital to reducesusceptibility to infection. This study aims to identify the association between the birth route and early and late-onsetneonatal sepsis in term infants. This hospital-based case-control study was carried out on term infants diagnosed with neonatal sepsis at theNICU of a tertiary referral hospital in East Java from 1 January 2019 to 31 December 2019. Preterm neonates wereexcluded as they may be more likely to develop neonatal sepsis. The Chi-square test and odds ratio (OR) with aconfidence interval of 95% (CI=95%) were used to analyze data. P-value <0.05 was considered statistically significant.  Of 54 patients with neonatal sepsis recruited, the majority had early-onset sepsis (63.0%) and cesareansection (C-section) delivery (66.7%). A significant association between birth route and neonatal sepsis onset (p=0.046)was found. However, no significant association was observed between birth route and neonatal sepsis (p=0.321). Terminfants born via C-section were 3.25 times more at risk (95% CI 1.00 – 10.60) of early-onset neonatal sepsis thaninfants delivered vaginally.  C-section delivery can increase the risk of early-onset neonatal sepsis in term infants.

The prenatal diagnosis of coarctation of aorta (CoA) remains a major challenge, as the false-positive diagnosis is fairly common. The purpose of this study was to find some useful prenatal sonographic markers compatible with the postnatal diagnosis of CoA.
The study included fetuses suspected of CoA in the second and third-trimester ultrasound tests. All cases were examined by fetal echocardiography at a single ultrasound clinic between 2019 and 2020. The proportion of right and left ventricular size was assessed and ductal/isthmus diameter ratio was measured. A comparison was drawn between the results of neonates with neonatal CoA and neonates without CoA.
Of 20 fetuses with suspected prenatal CoA, 3 (15%) had neonatal CoA. The mean ductal/isthmus ratio was significantly higher in the neonates with CoA (1.96 vs. 1.46; p< 0.001). The diagnostic power of ductal/isthmus ratio to detect CoA with a cut point of 1.53 had a sensitivity and specificity of 100% and 70.6%, respectively, a positive and negative predictive value of 37.5% and 100%, respectively, and an overall accuracy of 75%.
The ductal/isthmus ratio diameter and ventricular disproportion are significant sonographic markers for the prenatal diagnosis of CoA, and the ductal/isthmus ratio has high sensitivity and specificity compared to postnatal findings.

Intratracheal intubation is associated with many side effects. Different groups of drugs have been used to control these side effects, but there is still no consensus on the most suitable drugs.
This study aimed to compare the effect and possible side effects of fentanyl, remifentanil, and atropine plus remifentanil on the vital signs of preterm infants in non-emergency intratracheal intubation.
In this randomized clinical trial study, 75 neonates with a gestational age of 27 to 34 weeks who required temporary intubation were included in the study and divided into three groups by computer randomization. Then, the effects and possible side effects of remifentanil, fentanyl, and remifentanil with atropine on clinical parameters (blood pressure, heart rate, and arterial oxygen saturation) were investigated.
A total of 75 neonates with a mean gestational age of 30.4 weeks were studied. There was no significant difference between study groups in terms of changes in the systemic blood pressure and heart rate, but the mean oxygen saturation in all three groups was significantly different at different measurement times (P-value: 0.036). The group receiving remifentanil plus atropine reported minimal changes in oxygen saturation and their oxygen saturation was significantly higher than the other groups 30 min after extubation.
The use of remifentanil with atropine in preterm infants is associated with lower changes in oxygen saturation and higher arterial oxygen saturation 30 min after extubation. The use of remifentanil or remifentanil with atropine or fentanyl has no significant effect on the blood pressure and heart rate of neonates in non-emergency intratracheal intubation.

Rhesus D-antibodies and maternal red blood cell alloimmunizations are the major causes of fetal anemia, which can cause hydrops and perinatal death if not treated through intrauterine intravascular blood transfusion (IUT). This paper sought to report the short-term neonatal outcomes after IUT in a referral academic center.
The population of this retrospective cohort study comprised all pregnancies that underwent IUT between March 2014 and March 2019. The maternal obstetrics characteristics as well as blood group, antibody screen, and titers were reported. Indeed, the fetal and neonatal outcomes and complications were described either.
A total of 141 IUTs were performed in 58 women. Of all, 15 fetuses were hydropic at the first transfusion. The mean±SD (standard deviation) of gestational age and hemoglobin at the first transfusion was 27.06±4.25 weeks and 6.62±2.91 g/dL, respectively. The range of transfusions was 1.8 per woman and the mean±SD amount of blood transfusion in IUT was 84.03±48.79 cc. 7/58 (12%) intrauterine and 6/58 (10%) neonatal death were reported, of which, four cases were hydropic and the others suffered from severe anemia. The mean±SD of gestation age at delivery was 33.6 ± 3.33 weeks. A significant difference was observed between mean fetal hemoglobin levels before and after performing the IUT procedure (p< 0.01). Also, middle cerebral artery (MCA) Doppler assessments showed anemia severity decreased following IUT
It seems Intrauterine transfusion is a lifesaving procedure that can boost perinatal survival in fetuses with anemia.

The evidence for the effect of corticosteroid administration on neonates in pregnant women who tested positive for COVID-19 is rare. This study aims to evaluate the effect of the administration of corticosteroids on pregnant women with COVID-19 on neonatal metabolic outcomes of hypoglycemia and hyperbilirubinemia. The present retrospective cohort study was conducted on pregnant women with COVID-19 referred to Mousavi Hospital in Zanjan, Iran in 2020. We compared post-delivery complications in women who had received corticosteroids with a control group. The data were extracted from the medical records of the patients by a resident of the gynecology. The chi-square test was used to compare the rate of hyperbilirubinemia and hypoglycemia between groups. Of a total of 71 investigated patients, only 32 received non-steroidal anti-inflammatory drugs (NSAIDs),. The mean age of the patients was 29.77±6.87 years and there was not a significant difference between the two groups in terms of age, BMI, education, blood sugar, bilirubin, neonate weight, and 1 and 5-minute Apgar score (P>0.05). In the corticosteroid-receiving group, a significantly higher rate of hypoglycemia (37.5% vs. 7.69%, P=0.002) and hyperbilirubinemia (25% vs. 5.13%, P=0.02) was reported. The results suggested that the administration of corticosteroids as a treatment modality for pregnant women with COVID-19 is associated with an increased rate of neonatal hypoglycemia and hyperbilirubinemia. Therefore, glycemic control is necessary for neonates born from pregnant women with COVID-19 exposed to corticosteroids during the pregnancy.

Although the incidence of neonatal hemochromatosis (NH) is not known exactly, it is one of the causes of acute liver failure in the newborns. NH is a rare iron metabolism disease characterized by excessive iron accumulation in the tissues that onsets in-utero. Here, a patient diagnosed with NH who developed ascites while investigating the etiology of cholestasis has been presented.

Case report: 

A 35-week-old premature female baby was referred us to investigate the etiology of cholestasis. She had a sibling who died at 34 days of age due to liver failure. Abdominal examination revealed a palpable liver 4 cm from the costal margin. On laboratory, aspartate transaminase was 111 U/L (range 9-80), alanine transaminase 62 U/L (range 8-32), total bilirubin 12.6 mg/dL, and direct bilirubin 5 mg/dL. Prothrombin time was 18.4 sec (range 10-14) and INR 1.86 (range 0.8-1.2). Magnetic resonance imaging revealed a diffuse reduction in liver density due to iron accumulation. Focal iron accumulation consistent with NH was observed in hepatocytes in liver biopsy. In the clinical follow-up, the patient developed abdominal distension. Abdominal ultrasonography showed excessive fluid accumulation in the abdominal cavity. Following intravenous immunoglobulin (1g/kg, single dose) and antioxidant cocktail, her abdominal distension subsided and liver function tests regressed. The patient has been discharged on the postnatal 67th day with planned liver transplantation.

Neonatal hemochromatosis should definitely be kept in mind in newborns with hepatic failure. As seen in this case, NH should also be considered in the differential diagnosis of ascites in newborn infants.

A very uncommon manifestation of newborn adrenal hemorrhage is scrotal hematoma, it can mimicking event of acute scrotum. To our knowledge, there is no published large-scale clinical trial on neonatal scrotal hematoma caused by an adrenal hemorrhage. This is the first case of neonatal scrotal hematoma caused by an adrenal hemorrhage described in Iraq. We aimed to present a newborn diagnosed with adrenal hemorrhage presenting as a scrotal hematoma, based on history, clinical examination, lab tests, and colour Doppler sonography of both the testicles and the abdomen.

Case report: 

We present a term male, with left scrotal swelling and red discoloration were noted six days after delivery. An enlarged and bluish-discolored left hemiscrotum was detected throughout a physical examination. A left scrotal complicated haematoma was detected by an emergency scrotal ultrasonography. Bilateral adrenal hemorrhages were detected via abdominal ultrasonography. The diagnosis of a left scrotal hematoma due to bilateral adrenal haemorrhage was considered, and nonoperative therapy was chosen as the course of treatment. After two months, the hematoma had resolved.

One of the possible differential diagnoses for acute scrotum and a cause of misdiagnosis is scrotal hematoma brought on by newborn adrenal hemorrhage.