Iranian Journal of Neonatology
Volume:14 Issue: 1, Winter 2023

Retinopathy of prematurity (ROP) is a disease of the retinal vessels in premature newborns and can lead to a wide range of vision disorders from minor correctable visual acuity defects to retinal detachment. The present study aimed to determine the efficacy of oral propranolol in the prevention of severe ROP. This randomized clinical trial study was conducted on 50 preterm newborns with retinopathy stage I or II without plus disease hospitalized at Imam Reza Hospital of Kermanshah city, Kermanshah, Iran. The samples were randomized into two groups (n=25 each). The intervention group received 0.5 mg/kg propranolol orally every 8 hours and was continued until retinal vascularization completion or the need for treatment by laser therapy or Avastin injection. In contrast, the control group received only routine care without receiving propranolol. Afterward, the two groups were compared in terms of progression to stage III and above of retinopathy, plus disease, retinal detachment, need for laser therapy or Avastin injection, and the duration of the retinal vascularization completion. Adverse events related to propranolol, such as hypoglycemia, hypotension, and bradycardia, were continuously monitored during the study. Finally, the data were entered into SPSS24 software and analyzed. The two groups did not differ significantly in terms of demographic variables at the beginning of the study. The means of gestational age and numbers (%) of boys were 29±1.29 vs. 29.20±1.35 and 14 (56%) vs. 11 (44%) in the intervention and control groups, respectively. After the intervention, the duration of the completion of retinal vessels (day) was shorter in newborns receiving oral propranolol (61.04±6.13) than in the control group (70.08±5.72) (P<0.001). Moreover, the recovery rate from retinopathy and the incidence rate of plus disease were 88% vs. 68% and 4% vs. 12% in the intervention and control groups, respectively; however, this difference was not statistically significant (P>0.05). No adverse events related to propranolol were observed. Although the duration of the completion of retinal vascularization was shorter in newborns receiving oral propranolol, it was not effective in preventing severe ROP. Multicenter clinical trial studies with a higher sample size are recommended.

There is a paucity of RCTs that have systemically evaluated the effects of L.GG on the prevention of NEC and LOS in preterm neonates.To study different incidence rates of NEC and LOS. Secondary outcomes were the incidence of hyperbillirubinaemia, mortality, side effects and weight gain. This is an open labeled RCT. Preterm infants with a gestational age of < 35 weeks were assigned to three groups: A(L.GG sachet 6 billion organism), B(L.GG drops 2 billion organisms), C (no probiotic) using fixed block randomization. Probiotic was administered till the neonate reached the corrected gestational age of 36 weeks or a maximum of 4 weeks. Of 123 neonates, NEC developed in 2(4.88%) in group A versus 1(2.38%) in group B and 0 (0%) in group C (p value- 0.37). LOS also developed in 5(12.2%) in group A versus 3(7.14%) in group B and 3(7.5%) in group C (p-value 0.7). Moreover, 92.68% of subjects were successfully discharged in group A, 95.24% in group B and 90% in group C ( p-value 0.55). A significant difference was found between the incidence of hyperbilirubinemia (21.95% in group A versus 47.5% in group C (p-value 0.02) and 28.92% in Group A+B versus 47.5% in group C (p-value 0.04). There was a significant difference in weight gain at 1 month of age; 9.65±3.72 grams/kg/day in group A versus  6.58±3.86 grams/kg/day in group C (p-value 0.002) and 8.98±4.49 grams/kg/day in group B versus 6.58±3.86 grams/kg/day in group C (p-value 0.03). L.GG alone as a single strain administered in both high and low dosages has no significant effect on reducing the incidence of NEC, LOS and yielding immediate outcomes. A larger sample size and a blinded study are required to draw more accurate conclusions.

Neonatal mortality is a major public health problem and concern worldwide. Despite significant improvement, the neonatal mortality rate is still high. The present study aimed to determine the factors associated with neonatal mortality in the Neonatology Department of the regional hospital center, Agadir, Morocco. This is a retrospective case-control study in which the records of newborns admitted during 2019 (from January 1 to December 31), in the neonatal department of the regional hospital of AGADIR were studied. Neonatal and maternal characteristics were collected from the medical record using a pre-established exploitation form. A total of 760 mother-infant pairs were selected. The association between death and study variables was evaluated using the bivariate analysis conducted by the Chi-square test. Subsequently, multivariate analysis was performed using binary logistic regression to assess the effect of each factor. Significant associations were found between the onset of neonatal death and several factors such as distance traveled to the hospital facility (AOR = 3.588, 95% CI:1.952-6.594); multiparity (AOR = 3.301,95% CI: 1.919-5.680); the number of prenatal visits (AOR = 3.608,95% CI: 2.293-5.678); low birth weight (AOR = 0.314, 95% CI: 0.184-0.535); referral act  (AOR = 0.368, 95%CI: 0.208-0.652); 5-min Apgar Score (AOR = 0.104, 95%CI: 0.42- 0.257) and gestational age (AOR = 1.788,  95%CI: 0.608- 5.257). Neonatal mortality is associated with several preventable factors. Further preventive measures for these risk factors are required, especially in terms of pregnancy monitoring, delivery conditions, and infant management at birth.

Neonatal mortality remains one of the most pressing concerns in the world despite enormous improvements in neonatal intensive care. Although there is a decline in neonatal death in Ethiopia, it is still a major problem. In this study, the prevalence and contributing factors of neonatal near-misses were investigated in neonates admitted to sampling public hospitals in Addis Ababa, Ethiopia. A facility-based retrospective cross-sectional study of 367 participants was conducted. An interviewer-administered, pre-tested structured questionnaire developed from pertinent literature was used to collect data on mothers by phone. The secondary data were gathered from the mothers' and the newborn's medical records using a pre-tested standardized checklist. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to determine the level of significance. Neonatal Near Miss [NNM] prevalence was 25.6% (95% CI 21.0-30.5). The NNM was associated with the mother's work (AOR: 0.123, 95% CI: 0.018-0.859), as well as previous preterm deliveries (AOR: 11.83, 95% CI: 1.856- 75.398), Cesarean section (2.39 AOR, 95% CI: 1.229-4.652), pregnancy-related hypertension (2.67, 95% CI: 1.343-5.324), and infection (AOR (AOR 8.925, 95 % CI 2.580 - 30.873). More than half of newborns [51.0 %] were male. In terms of newborn presentation, 91.8 % of newborns had a cephalic presentation, while Breech presentation accounted for 6.9 %. Twenty-seven [7.4%] of the research participants had birth injuries, and 74% suffered from subglacial hemorrhages. Most of the near-miss variables that can be altered or prevented are obstetric, medical, and neonatal-related. Early detection and treatment of the problems may help to improve neonatal outcomes. The Ethiopian government should pay greater attention to the health sector to expand prenatal care visits. Further prospective research is also required to look into additional reasons for newborn mortality.

Mental disorders can significantly impact maternal health and neonatal health and development. This study investigated maternal anxiety, depression, and stress during pregnancy concerning their children's development. In this follow-up study, all pregnant women with gestational age > 12 weeks referring to an obstetrics and gynecology clinic affiliated with Shahid Sadoughi University of Medical Sciences over six months were included. Data on mothers were collected using a personal information questionnaire and the Depression Anxiety Stress Scale (DASS)-42 standard questionnaire. Finally, based on the inclusion and exclusion criteria, the children of 73 mothers were included in the study. Infant development was assessed based on the Persian version of the Ages and Stages Questionnaire (ASQ) at six months postpartum.Data analysis was conducted using the Pearson correlation test and multiple regression analysis. Statistical analyzes were carried out using SPSS 21. A P-value <0.05 was considered statistically significant. In this study, 39.7%, 63%, and 56.2% of women suffered from depression, anxiety, and stress, respectively. In this study, a significant relationship was found between antenatal maternal depression and gross motor (P: 0.022), fine motor (P: 0.003), personal-social (P: 0.009), and communication skills (P: 0.0180). Moreover, there was a significant relationship between maternal anxiety and personal-social (P: 0.012) and gross motor domains (P: 0.008). Also, a significant association was observed between personal-social skills and maternal stress (P: 0.030). As shown by the results, antenatal maternal mental illness can interfere with the development of children. Therefore, paying attention to the mental health of pregnant women is necessary.

Cardiac troponin I (cTn I) has been demonstrated as a possible useful biomarker for myocardial injuries. The present study aimed to evaluate potential relationships between this biomarker and neonatal morbidities among preterm neonates.

This cohort study was carried out at an Iranian Hospital (Tehran-Iran; 2021). Newly-born preterm neonates entered the study. Blood sampling was performed immediately after neonatal intensive care unit (NICU)  admission and sent to the laboratory to detect levels of plasma cTnI. The correlations between the levels of plasma Tn I and each neonatal outcome were evaluated as the primary outcome.

A total of 101  NICU hospitalized neonates with the mean gestational age, 1st, and 5th minutes Apgar scores of 33.750±2.125 (Range: 29-37) weeks, 7.6471±1.766, and 9.188±1.205 entered the study. The mean and median of Troponin I levels were 0.131±0.126 and 0.0920 ng/ml. The results pointed out that neonates who died during hospitalization or required CPR (cardiopulmonary resuscitation) had lower troponin I in comparison with their controls; nonetheless, the differences were not significant (P=0.950 & P=0.557). The mean±SD of troponin I was not significantly different between neonates with and without PDA (p=0.741), asphyxia (P=0.298), and intubation (P=0.212). The occurrences of necrotizing enterocolitis, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis were not also significant factors for the alteration of troponin I (P>0.05).

Since there were no relationships between cTn I and neonatal outcomes, great caution should be implemented regarding the use of single cTn I value as a diagnostic marker for short-term neonatal adverse outcomes. Further investigations with larger sample sizes are strongly suggested.

Maternal iron status is a vital determinant of feto-maternal iron transfer to ensure the adequacy of neonatal iron. Hemoglobin measurement is often used in pregnancy as an iron status parameter. However, evidence on the association between maternal hemoglobin and newborn iron status is still inconclusive. This study aims to assess the association between maternal hemoglobin and neonatal iron status. We conducted a cross-sectional study involving 84 neonates and their mothers in three hospitals in Central Java, Indonesia. Maternal hemoglobin was measured as a proxy for maternal iron status. Neonatal iron status was measured using hematologic markers (red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution) and biochemical markers (serum iron, soluble transferrin receptor/sTfR, and cord blood hepcidin). Neonatal iron status was compared between the two groups of maternal iron status followed by sensitivity analysis. Maternal hemoglobin was not significantly associated with neonatal hematologic markers or biochemical markers. Sensitivity analysis did not reveal any associations in multiple tests conducted by various categories. Maternal hemoglobin was consistently not associated with neonatal iron status, as measured by both hematologic and biochemical markers. The use of maternal hemoglobin as a single parameter proxy for maternal and neonatal iron status is likely inaccurate and can potentially underestimate the actual maternal and neonatal iron status.

Earmuffs can be worn to reduce the noise exposure of premature infants. The results regarding the use of earmuffs to provide physiological stability and reduce the stress level in preterm infants are not precise.The present study aims to examine the effect of providing noise control using ear muffs on premature infants’ physiological parameters and stress levels in the neonatal intensive care unit. A prospective randomised trial was conducted including 100 premature infants for a one-year-period. After randomisation, the infants included in the study were evaluated for two consecutive days and checked twice a day for a total of four times. The infants in the study group wore earmuffs twice a day, in the supine and prone positions. The infants in the control group were followed up without earmuffs. There was a statistically significant difference between the post-procedural stress scores of the study and control groups (p<0.05). The stress scores of the infants in the study group were significantly lower than those in the control group. Two hours after wearing earmuffs on the first and second days, a statistically significant difference was found between the respiratory rates of the two groups, being significantly lower in the study group (p=0,030). According to the results of our study, using earmuffs in premature infants decreased the stress score and respiratory rate; however, this intervention did not affect other physiological parameters.