Iranian Journal of Neonatology
Volume:14 Issue: 2, Spring 2023

Congenital hyperinsulinism (CH) is a well-known cause of the persistent neonatal hypoglycemic state that may lead to irreversible neurological damage. While medical therapy can improve the condition in some cases, refractory cases require further investigation to identify focal or diffuse pancreatic lesions. Surgery is the main treatment for refractory cases and can improve the neurological and glycemic status of patients. The study aimed to evaluate the short-term outcomes of surgical intervention in cases of CH who underwent surgical treatment.
A multicenter cross-sectional survey was conducted to review cases of CH that underwent surgery between 2018 and 2020. Focal cases were treated with simple enucleation or distal pancreatectomy, while diffuse cases underwent near-total pancreatectomy. The glycemic and neurological states of the patients were evaluated and the results were analyzed.
Among the 56 neonates who underwent pancreatic surgery, 48 (85%) had diffuse disease, and the remaining cases suffered from focal lesions. All focal cases achieved normoglycemia, while 24 (50%) of the diffuse cases achieved normal glycemic levels (P≤0.003). Additionally, the incidence of irreversible neurological deficits was higher in the diffuse group (P=0.029).
The focal form of CH seems to be totally curative by surgical operations. However, the proper management of diffuse form is still demanding. Although in our study, we had an acceptable success rate in the short-term, lifelong euglycemia may not be obtainable in these patients.

Respiratory distress is a serious condition affecting preterm neonates. The present study was designed to evaluate the association between mean platelet volume (MPV) and adiponectin (APN) levels and the development of respiratory distress syndrome (RDS) in preterm neonates.
This prospective cohort study was conducted at a tertiary hospital. The target population was preterm neonates (≤ 34 weeks) admitted to the incubator and diagnosed with RDS. A control group was recruited and composed of age-matched neonates seen at the delivery room and required no admission or ventilatory support. Blood samples were withdrawn on days 1 and 7 of life for a complete blood count and another one for APN level measurement .
The study group showed a higher MPV at day 1 and day 7 than the control group (P<0.001) and lower mean APN at day 1 and day 7 than the control group (P<0.001). The MPV had cut-off levels of more than 7.7 (sensitivity of 86.96% and specificity of 100%) and 8.15 (sensitivity of 78.26% and specificity of 91.3%) on days 1 and 7, respectively, to predict RDS. The APN had cut-off levels ≤ 37 (sensitivity of 86.96% and specificity of 60.87%) and ≤ 22.4 (sensitivity of 82.61% and specificity of 69.57%) on days 1 and 7, respectively, to predict RDS.
Based on the findings of the present research, the MPV significantly increased while APN levels were lower in preterm neonates with RDS. Both markers predicted RDS development significantly.

The worldwide pandemic imposed by SRAS-CoV-2 affected all aspects of daily life including those of pregnant and breastfeeding women. This work aims to explore the impact of socio-economic determinants and mental health on breastfeeding practices among a group of Moroccan women during this pandemic. This is a descriptive and observational study carried out over 6 months in a maternity hospital. Data relating to the practices and the state of stress of women were collected via an interview and a questionnaire on post-traumatic stress disorder (PTSD). Early breastfeeding and skin-to-skin practice were significantly elevated among educated women (p <0.001) and housewives (p = 0.028). Compliance with respiratory and body hygiene rules was significantly higher among women: of urban origin, educated, housewives, and those with medium or high socioeconomic levels. The study of the impact of stress on breastfeeding practices revealed a statistically significant difference in early breastfeeding (p = 0.004), compliance with respiratory and body hygiene rules (p <0.001), and skin-to-skin practice (p <0.001) between the group of normal women and the group of stressed women.Our results showed the impact of socio-economic determinants and mental health on breastfeeding practice during this pandemic. This represents a great challenge for the health system to promote breastfeeding and reduce the consequences of psychological disorders for mothers and unborn children in Morocco.

The umbilicus is the fibrous remnant of the fetal attachment of the umbilical cord. Ultrasonography is the preferred imaging modality for the evaluation of umbilical lesions. We present our experience and a review of ultrasound findings of umbilical lesions in children that may differentiate these lesions.

A query was conducted on online databases to identify and review articles in English studying umbilical lesions and their ultrasound features in children until September 2022. In some cases, the authors' unpublished experiences were also used due to insufficient ultrasound information in the literature.

The thickness of the normal urachus is 2.5- 4 mm in newborns, and after the infancy period, it reduces to less than 2 mm. An increase in its thickness, generally or focally, indicates a patent urachus or urachal sinus. The normal cord or its remnant is observed as a hypoechoic mass surrounded by an elevated skin ring during infancy. The abdominal extension of the cord remnant suggests a patent urachal or omphalomesenteric remnant. On ultrasound, umbilical polyps are deep-seated lesions with mixed or hyper-echoic echo texture that can help differentiate them from umbilical cord remnants or umbilical granulomas. Ultrasonographic findings of omphalitis or the infected cord remnant are enlarged umbilicus as a large mass-like lesion associated with edema of peri-umbilical skin and subcutaneous tissues.

As evidenced by the results of this study, ultrasound can be used as a valuable complementary assessment tool for clinicians, allowing for assessing umbilical lesions and choosing the correct approach to treating these lesions.

Zinc deficiency often occurs in preterm and low-birth-weight neonates. The present study aimed to assess the effect of zinc supplement provision on increased body weight, body length, and head circumference, as well as neurodevelopmental parameters of preterm neonates. A true experimental study with a double-blind, randomized clinical trial (RCT) was conducted involving 30 preterm neonates with 30-34 weeks of gestational age who were assigned to two groups, i.e., zinc supplements and placebo, and followed until the three months of corrected age. The mean score of zinc level in all subjects was 34.47±12.00 µg/dL. There were significant differences in serum zinc level at birth compared to the corrected age of three months, both in the supplement group and placebo (P< 0.001, each). Zinc level showed a significant positive correlation with body weight, length, and head circumference at the corrected age of three months (r=0.469, P=0.009; r = 0.428, P= 0.018; r = 0.549, P=0.002). Zinc levels had a significant, positive correlation with BINS at the age of 3-4 months (r = 0.594; P=0.001), IGF-1 (r = 0.496; P< 0.001), body weight (r=0.469; P=0.009), length (r =0.428; P=0.018), and head circumference (r =0.549; P=0.002) at corrected age of three months. The provision of zinc supplements could positively affect the growth of preterm neonates in the form of body weight, body length, head circumference, IGF-1, and neurodevelopmental improvements.

The survival of premature infants has improved in the recent era due to advances in perinatal and neonatal healthcare practices. These infants are at risk of neuro-sensorimotor impairment, as well as learning and behavioral disorders. A longitudinal follow-up study was planned over 6 months at a High-Risk Clinic, Civil Hospital, Ahmedabad, India, to conduct the neurological examination and hearing assessment of premature infants born with gestational age less than 32 weeks. Infants who were born preterm at <32 weeks of gestational age and those attending the high-risk clinic at 3, 6, 9, and 12 months of corrected gestational age were enrolled in the study. These infants were assessed for tone via the Amiel-Tison method and hearing impairment via BERA. During the study period, 69 infants were included with a mean gestational age of 30.4±1.2 weeks. On the assessment of tone, at 3 months of corrected age, 3 and 1 infants had hypertonia and hypotonia, respectively. At 6 months of corrected age, 4 and 3 infants had hypertonia and hypotonia, respectively. Moreover, 1 and 2 infants had hypertonia and hypotonia at 9 months of corrected age, respectively, and 1 infant had hypertonia at 12 months of corrected age. Out of 69 enrolled infants, 5 (7%) infants had hearing loss at 3 months of corrected gestational age, whereas 64 (93%) infants had normal hearing assessment via BERA at the corrected gestational age of 3 months. Preterm infants are at very high risk of neurodevelopmental impairment and need frequent follow-up visits and early intervention.

Low birth weight neonates have low energy reserves; thus, postpartum feeding is required to meet their ongoing nutritional requirements. Total parenteral nutrition (TPN) provides critical nutrients for the metabolism and development of neonates; however, few studies have investigated the effect of TPN on the early growth patterns of neonates. The present study examined the effects of TPN on preterm neonate anthropometric characteristics using two commonly used TPN calorie introduction techniques.

This randomized clinical trial studied preterm neonates with birth weights of less than 1500 g. Calories were initiated at a rate of 3 g/kg for lipids and 3.5 g/kg for amino acids in the intervention group. In the control group, the amino acid solution was begun at 1 g/kg/day and the lipid solution at 0.5 g/kg/day, and both were increased daily by 1 g/kg to a maximum of 3.5 and 3 g/kg/day for amino acids and lipids, respectively. In this group, all neonates reached full calorie intake at 3 to 5 days of age. The trend of change in the anthropometric parameters was evaluated and compared.

Although both groups showed an increase in neonatal weight, length and head circumference, no statistically significant difference was observed between them. Both groups had similar lengths of hospital stay.

Based on the findings of the present study, TPN feeding done using two approaches to amino acid and lipid administration had no significant influence on hospital stay, TPN duration, or growth indices in preterm neonates weighing less than 1500 g.

Arrhythmia detection in neonates is substantially different from that in older children. The natural history of arrhythmias in the neonatal age group also differs markedly from other ages. Neonatal Cardiac Arrhythmias are found in 1% to 5% of newborns during the first 10 days of life. Most are premature supraventricular tachycardia (SVT) beats that will disappear over the first month of life. The most common symptomatic arrhythmia in the neonatal period is SVT, which has an incidence of 1/25,000. Idiopathic neonatal atrial flutter (AFL) is a rare rhythm disorder usually occurring in the first days of life and characterized by sustained tachycardia in newborns and infants with an atrial rate of often at around 340-580 beats/min. AFL may manifest as asymptomatic tachycardia, congestive heart failure, or hydrops and may be life-threatening and fatal.

Case report: 

We reported a 38-weak-female baby presented with tachycardia during the first physical examination. The patient underwent adenosine therapy twice, and when the electrocardiogram demonstrated atrial flutter, the next choice was cardioversion. After using cardioversion with a dose of 2 J, the rhythm converted to the normal sinus and the following clinical and laboratory tests showed no abnormality. With early prenatal diagnosis and prompt therapeutic approaches, most of the patients showed good prognosis and there was no need for chronic therapy.

Since AFL may result in severe heart failure and even death, it should be noted that careful clinical examination and on-time diagnosis of cardiac arrhythmia are of significant importance.

. Hemophagocytic lymphohistosis (HLH) is a life-threatening clinical syndrome that involves liver dysfunction and can range from mild dysfunction to severe fulminant insufficiency. Cholestasis, which is a frequent finding in many severe newborn illnesses, may also be a symptom of HLH. Therefore, HLH should be considered in the differential diagnosis of all cholestatic patients with cytopenia. In this report, we identified a case of HLH with cholestasis. The patient met at least seven out of the eight requirements of the HLH-2004 criteria. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils (PMNs), more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of HLH with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours.

Case report:

 The patient was a 21-day-old infant with a birth weight of 3450 g. He developed fever and jaundice 10 days after a normal delivery, and he was referred to Sarakhs Hospital when he was 14 days old and hospitalized for 3 days. Later, he was sent to Ghaem Hospital and admitted to the Neonatal Intensive Care Unit. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. According to his mother, there was no history of any problems from birth, and the baby's jaundice started after the first week. Examinations showed abdominal distention and hepatosplenomegaly. Due to neonatal cholestasis and fever, he underwent a complete sepsis workup with vancomycin and cefotaxime. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils, more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein, and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of hemophagocytic lymphohistiocytosis (HLH) with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours.

HLH is uncommon in the neonatal stage, and aberrant clinical and laboratory findings suggestive of HLH can be found in a variety of conditions. The severity of this condition makes it crucial to get a diagnosis as soon as possible. In the presence of additional variables, such as cytopenia and hyperferritinemia, HLH should be considered in the differential diagnosis of cholestasis in a neonate.