Iranian Journal of Neonatology
Volume:14 Issue: 3, Summer 2023

Foreign body aspiration (FBA) is an emergency condition in children, potentially leading to  life-threatening events. The gold standard for FBA management typically involves rigid bronchoscopy (RB). Since RB is performed under general anesthesia (GA), it exposes the child to the risk of GA and perioperative complications. Therefore, the current study aimed to examine the association of clinical and radiological signs with RB results.
This cross-sectional study was conducted at Imam Reza Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. A total of 86 children suspected of FBA were included in the study. All patients underwent RB under GA after a thorough evaluation, including a detailed medical history, physical examination, and poster anterior chest X-ray (CXR).
Of 86 patients, 55 (64.0%) were male and 31 (36.0%) were female. The mean age of participants was 3.40 ± 1.41 years (1 to 7 years). The history of coughing and crepitation were the most common symptoms (100%). Among 86 patients who underwent RB, 52 (60.0%) had FBA in their airway, while 34 patients (40.0%) had negative RB results. The most frequently aspirated foreign body was sunflower seeds, observed in 25.0% of cases. The right main bronchus was identified as the most common site of the foreign bodies, accounting for 48.1%. The coughing and crepitation had a very high sensitivity of 100%, whereas hypoxemia had the highest specificity of 13.3%.
None of the clinical symptoms, such as coughing, demonstrated high sensitivity or specificity individually or in combination. Therefore, it is of utmost importance to educate children and parents about preventive measures to reduce the risk of FBA and to provide a comprehensive understanding of the potential consequences associated with FBA.

Renal microlithiasis includes renal hyperechogenic deposits in the calyces, pelvis, or ureter with a diameter of less than 2-3 mm by ultrasound. Currently, there is no information about the outcome and possible complications of renal calcification in premature infants in Iran. The current study aimed to evaluate its outcome in preterm infants. A total of 50 preterm infants with microlithiasis and nephrocalcinosis enrolled in study. The follow-up ultrasound was evaluated 2, 6, and 12 months after diagnosis. Following the diagnosis, infants were assessed for nephrocalcinosis progression. The group was termed unrecovered if the issue persisted during follow-up, and it was considered recovered if it disappeared on follow-up ultrasound. The neonatal data included gestation age, birth weight, length of hospital stay, age at diagnosis of microlithiasis, and used medications. A total of 50 premature infants with microlithiasis and nephrocalcinosis, including 14 females (28%) and 36 males (72%), were born with an average gestation week of 30.78 ± 2.78. The mean age of diagnosis was 2.60 ± 1.11 months. The average hospital stays at the neonatal intensive care unit) NICU (and neonatal ward were 27.38 ± 16.06 and 10.50 ± 9.57 days, respectively. At the end of the 12-month study period, renal calcification recovered in 40 (80%) patients. There was no significant difference between the two groups of patients with sustained and recovered microlithiasis in terms of gender, age of onset of renal calcification, gestational age, mean hospital stay in NICU and neonatal ward, use of antibiotics, potassium citrate, and hydrochlorothiazide. A p-value of less than 0.05 was considered statistically significant for all statistical analyses. The obtained results of the study reveal that a high percentage of premature infants with nephrocalcinosis recovered at the end of the 12-month period, indicating this phenomenon is benign. Keywords: Aminophylline, Kidney function, Microlithiasis, Nephrocalcinosis, Premature infants

Preterm neonates routinely undergo many painful procedures in the neonatal intensive care unit. Due to their nonverbal state, these neonates are unable to express their pain, resulting in underestimation and insufficient pain relief. Neglecting pain may lead to complications affecting neurodevelopment and causing permanent injuries to the brain. Music therapy provides sensory stimulation to preterm neonates, resulting in improved physiological and behavioral responses and reduced pain perception. To assess the impact of music therapy on alleviating pain in preterm neonates during painful medical procedures. The study utilized a quasi-experimental research design with a two-group post-test-only approach.
In the present study, a total of 60 preterm neonates were divided equally into a control group and an experimental group (30 participants per group). The intervention and control groups were matched before the intervention. The experimental group received music therapy during painful procedures, while the control group received routine care during the same procedures. The Neonatal Pain Agitation and Sedation Scale (NPASS Tool) was used to measure pain levels during painful procedures.
The intensity of pain in both groups was the same before the intervention. In this study, the mean±SD values of intra-test pain level were 8.63±0.56 and 2.96±0.89 in the control and experimental groups, respectively. Moreover, the mean±SD values of the post-test pain level in the control and experimental groups were 7.53±0.89 and 1.1±0.88, respectively. The obtained t-test value in the intra-test was obtained at 29.57 (P<0.05), thereby stating that music therapy was effective in the reduction of pain levels among preterm neonates during painful procedures. 
This study has important implications for healthcare professionals who care for infants and should prompt the integration of music therapy into routine care for this vulnerable population.

Tooth development involves reciprocal interactions between the oral epithelium and ectomesenchyme. The inner layer cells of the enamel organ (EO), known as the inner enamel epithelium (IEE), undergo differentiation into preameloblasts and subsequently mature ameloblasts. These ameloblasts play a crucial role in the secretion of enamel matrix proteins, including amelogenin. This experimental study aimed to analyze the expression profile of amelogenin in various histological structures of human primary developing teeth, employing a relatively large sample size.
This experimental study included 33 human fetuses aged between 13 and 23 weeks, with three samples obtained from each gestational age. The samples were categorized into three age groups of ≥13 and <16 gestational weeks (g.w.), <19 g.w., as well as ≥19 and ≤ 23 g.w. Hematoxylin and eosin staining, as well as immunohistochemistry staining, were performed on the samples. To assess the expression level of amelogenin in different histological structures of human primary teeth, a two-way ANOVA test was employed. The statistical significance threshold was set at P≤0.05.
There were statistically significant differences regarding the expression level of amelogenin in various histological structures of human primary teeth in different fetal ages (13-23 weeks), except for the maxillary central incisor and mandibular central incisor.
Due to the profile of expression of amelogenin, it can be concluded that amelogenin expression could be associated with ameloblast and odontoblast differentiation, as well as enamel and dentin matrix deposition. In addition, the results of this study may shed light on the role of the cervical and coronal portions of the EO as stem cell reservoirs.

Neonatal mortality rate accounts for 20.3 per 1000 live births in India. One of the significant predictors of neonatal mortality is low birth weight. Weight is the most extensively used parameter. However, there are alternate anthropometry parameters, such as mid-arm circumference, mid-thigh circumference, and mid-calf circumference, which can be used to assess newborns' growth and identify the newborns at risk. The current study aimed to determine the correlation between limb anthropometric measurements and gestational age and to derive the mean and standard deviation for all limb anthropometric measurements of the newborn with gestational age.

The study included 400 live newborn babies admitted to the NICU/PNW at the Aarupadai Veedu Medical College and Hospital for routine observation from December 2020 to October 2022. Within 48 hours after birth, newborns were evaluated for anthropometric measures using standard techniques.

All limb anthropometric measurements increased as gestational age increased to 39-40 weeks, which began to decline after 40 weeks. There was a strong correlation between limb anthropometric measurement with gestational age (p < 0.001), with mid-thigh circumference exhibiting the highest correlation (r=0.652).

The findings of the current study suggest that besides birth weight, other basic anthropometric parameters, such as limb anthropometry (e.g., mid-thigh circumference), can be effectively used to quantify prenatal development and identify infants at risk.Conducting an analysis of anthropometric measures after delivery allows for a rapid assessment of infants with atypical growth patterns, making them more susceptible metabolic complications.

Breastfeeding self-efficacy (BSE) refers to a mother's confidence in her ability to breastfeed her baby and it is a key factor during breastfeeding. The current study aimed to investigate the relationship between BSE and its related factors with the history of COVID-19 during childbirth in breastfeeding mothers.
The present ambidirectional cohort study was conducted on 60 breastfeeding mothers who were divided into two study and control groups. Participants were selected randomly from referrals to Shahid Sadoughi Hospital, Yazd, Iran. To collect data, a BSE questionnaire a checklist consisting of midwifery-demographic and baseline characteristics were completed through interviews. Chi-square test, t-test, univariate binary, and multivariable logistic regression were applied for analysis. P value less than 0.05 was considered statistically significant.
Although the study and control groups were homogeneous in terms of baseline characteristics, they differed significantly in terms of delivery type of, NICU admission, and skin contact as midwifery-demographic factors (P<0.01). Breastfeeding self-efficacy mean score (BSES) in the control and study groups were 52.33 and 39.56, respectively, showing a significant difference between the two groups (P<0.01). According to univariate binary logistic regression analysis, type of delivery, NICU admission, and COVID-19 were significantly related to poor BSE (P<0.05). Based on multivariable logistic regression analysis, a positive test result for COVID-19 during childbirth was the only statistically significant predictor of BSES (P=0.02).
In the present study, the positive test result for COVID-19 was the only significant predictor of BSE during childbirth.

A high level of hemoglobin at birth is one of the iron reserves needed by infants to deal with iron deficiency anemia. This study aimed to assess the iron status in neonates born by cesarean section and the effect of maternal characteristics and other laboratory measures on neonatal iron levels. Moreover, it was designed to investigate anemia and identify its factors. This descriptive correlational study was conducted in 2022 on 50 neonates by caesarean section in Babylon Hospital, Iraq. Serum ferritin and other laboratory parameters from neonatal umbilical cord blood were measured in addition to others that had been recorded for both neonates and their mothers. The data were analyzed using the t-test. Out of 50 neonates, 8 infants had low serum ferritin levels and 4 of these 8 had anemia, and 6 of them were born to mothers from rural areas. The mean maternal age of neonates with low serum ferritin was significantly higher than those with normal or high serum ferritin. The results showed that the place of residence and its clean climate and healthy nutrition can have a direct effect on the ferritin level. No significant effect of serum ferritin on WBC, reticulocytes, and platelet counts was observed in this study. Anemia is significantly associated with low serum ferritin neonates; in addition, maternal age and residence have significant effects on neonatal serum ferritin. Considering the high prevalence of iron deficiency anemia in mothers and even in mothers with proper nutrition, iron deficiency in the mother leads to a decrease in the baby's reserves and makes him susceptible to iron deficiency in the first months after birth. The importance of using iron supplements during pregnancy becomes clearer, and one should not be satisfied only with diet. Due to the adverse effects of increasing the number of pregnancies on the mother's iron reserves, appropriate spacing should be observed.

Neonatal danger signs contribute to the high mortality of neonates in developing countries. Delays in recognition of danger signs and the decision to seek care contribute to most neonatal deaths in Ethiopia. Therefore, the current study aimed to assess mothers’ knowledge and associated factors on neonatal danger signs in Nekemte town, Western Ethiopia.
The current community-based cross-sectional study was conducted in Nekemte, Ethiopia, in March 2019. The sample included 727 mothers who had given birth within the past 12 months. A multistage sampling technique was utilized to recruit participants and data were collected using face-to-face interviews. The collected data were entered into EPI info (version 7.2.0.1) and analyzed using SPSS (version 23). To evaluate the knowledge of neonatal danger signs, a median score was used as the cut-off point. Mothers who spontaneously mentioned at least five danger signs were considered to have good knowledge of neonatal danger signs. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with knowledge of danger signs.
Of 727 participants, 707 mothers were interviewed, yielding a response rate of 98.3%. The median age of the participants was 27  years, with an interquartile range of ± 5. The result of the study indicated that 55.6% [95%CI (52.1% - 59.3%)] of mothers had good knowledge of neonatal danger signs. The adds ratio of having good knowledge of neonatal danger signs were associated with being married [AOR=2.87, 95%CI (1.27, 6.52)], mother’s educational status of secondary level or higher [AOR= 1.71, 95%CI (1.03, 2.84)], antenatal care visits of four and more [AOR=1.58, 95%CI (1.09, 2.31)], and postnatal follow-up [AOR=2.13, 95%CI (1.39, 3.27)]. Furthermore, delivery at health institutions [AOR=3.11, 95%CI (1.10, 8.76)], access to TV [AOR=1.58, 95%CI (1.05, 2.37)], and Internet use [AOR=2.39, 95%CI (1.52, 3.77)] were also significantly associated with good knowledge.
The proportion of mothers with good knowledge of neonatal danger signs was found to be low. Therefore, it is recommended to enhance counseling services during antenatal care and strengthen  community-based health information dissemination efforts related to neonatal danger signs.

Sirenomelia is a rare congenital anomaly characterized by the fusion of two lower limbs, resulting in the mermaid’s tail appearance. Sirenomelia is a very rare syndrome and can be fatal to the infant. This syndrome might be sporadic or have a genetic basis. The etiology of sirenomelia is unknown but said to be multifactorial. Some maternal factors associated with sirenomelia include diabetes melitus, maternal age under 20 years and monozygote twinning.

Case report: 

This report presented four cases of sirenomelia that occurred during 2006-2019 at Fatemieh Hospital, a tertiary maternal-neonatal center, Hamadan, Iran. All of the pregnancies were complicated by oligohydramnios. None of the mothers were younger than 20 years, and none had diabetes mellitus. Moreover, their drug history during pregnancy was negative. All newborns had low Apgar scores and died a few minutes after birth, indicating their poor outcomes. None of the cases were diagnosed prenatally, and all newborns were firstborn infants.

Sirenimelia is a rare lethal condition, which requires prenatal diagnosis for abortion planning.