Iranian Journal of Neonatology
Volume:14 Issue: 4, Autumn 2023

Despite numerous clinical strategies performed over the years, Bronchopulmonary dysplasia (BPD) still remains a common disease with considerable long-term adverse effects in very premature infants. This study investigated the effect of budesonide-instilled surfactant on the incidence of BPD in preterm infants. In this clinical trial, a total of 190 neonates with a gestational age of less than 30 weeks, who were identified as candidates for surfactant therapy, were randomly assigned to two groups. The control group (S) received surfactant at a dosage of 200 mg/kg for the initial dose and 100 mg/kg for subsequent doses. In cases where it was deemed necessary (n=95), the intervention group (BS) received surfactant along with budesonide, instilled once at a dose of 0.25 mg/kg (n=95). The primary outcome was the occurrence of BPD, and the combined incidence of BPD and death Secondary outcomes encompassed other complications related to prematurity and adverse effects associated with corticosteroid use. Demographic characteristics of the neonates were comparable between the two groups.  Although a slight reduction was seen in the incidence of BPD in the group receiving budesonide, BPD rates remained statistically unchanged after the intervention (48.4% in the BS group vs 50.5% in the S group, P value = 0.772). The combined outcome of BPD and death was insignificantly different between the two groups (61.1% in the BS group vs. 63.2% in the S group, P value = 0.765). The addition of budesonide resulted in an increased incidence of sepsis and pneumothorax in the control group. However, secondary outcomes such as IVH (Inra ventricular Hemorrhage(, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, and hyperglycemia were unaffected. Duration of total parenteral nutrition and hospitalization time were longer in the BS group than in the S group. The addition of budesonide to surfactant in very premature neonates at gestational age <30 weeks who were candidates for surfactant therapy did not prevent BPD. Conversely, it led to an increase in certain secondary morbidities such as sepsis and pneumothorax. Furthermore, it extended the duration of hospitalization.

Drugs cause approximately 20%-40% of acute kidney injuries (AKI). Amikacin (AMK) is one of the common medications used as empiric therapy for severe infections, such as sepsis in neonates. One of the newly recommended biomarkers in AKI is Kidney Injury Molecule-1 (KIM-1). In this study, we evaluated the use of KIM-1 for diagnosing tubular injury in neonates treated with Amikacin in the neonatal intensive care unit (NICU) of our educational hospital in Gorgan, Iran. This cross-sectional descriptive study was conducted at the NICU of the two educational hospitals affiliated to the Golestan University of Medical Sciences, Gorgan, Iran. There were two groups of patients, namely neonates treated with Amikacin plus Ampicillin (group A; n=45) and neonates treated with Ampicillin plus Cefotaxime (group B; n=45). Demographic characteristics were recorded. Blood and urine samples were collected in both groups. The urinary secretion of KIM-1 was determined using an ELISA kit. The total number of patients in both groups was 45, 26 (57.8%) of whom were male, and 19 (42.2%) cases were female. The mean age was obtained at 5.25±1.47 days in group A and 5.15±1.5 days in group B. None of our patients had AKI. There was no difference between leukocyte count and platelets on the first and seventh day. There was a significant difference among K, Na, urine specific gravity, C-reactive protein, Cr, and BUN on the seventh day, compared to the first day. The difference between urinary levels of KIM-1 in the two groups was not statistically significant. We have not found a significant relationship between urinary KIM-1 and AKI in our patients.

Vaginal delivery may cause stress for all newborns; therefore, it is the responsibility of nurses to provide physiologic stability and first care of the preterm after birth. This study aimed to examine the effect of facilitated tucking (FT) after vaginal deliveries on stress, comfort, and physiologic parameters of late preterm infants. This randomized controlled study was conducted with late preterm infants. The sample size was calculated using a computer program. A total of 60 preterm infants were included in the study, assigned to the FT group (n=30) and the control group (n=30). A newborn information and registration form, the Newborn Comfort Behavior Scale (NCBS), and the Newborn Stress Scale (NSS) were used to collect data. The mean NSS score was lower in the FT group and preterm infants showed less stress symptoms; however, the difference was not significant. The mean NCBS score was statistically significantly lower in the FT group, showing that the preterm babies were more comfortable in this group. It was determined that FT, which is one of the individualized developmental care practices, provides physiologic stability, comfort, and reduced stress for late preterm infants after vaginal deliveries.

Transcatheter closure is the most common treatment for patent ductus arteriosus (PDA); however employing large PDA is difficult because there are few closure devices, and surgical treatment is risky, especially in young infants with low weight and adults with calcified PDA. This study examines transcatheter closure and pulmonary artery (PA) pressure reversibility in large PDA with severe pulmonary hypertension.
A prospective research examined high PA pressure in 34 patients with big PDA and severe pulmonary hypertension (PHT) who were closed with various occludes. Clinical and transthoracic echocardiographic follow-up at 4 weeks, 3 months, 6 months, and 12 months post-closure measured PA pressure and closure effectiveness.
In total, 34 big PDAs with significant PHT were transcatheter-closed in 723 individuals. Patients were from a few months old to adults and weighed from 4.25 to 61kg, which were tested by using ADO1, MVSD, AVP2, ASDO, and a stent-closed PDAs. After the intervention, the PA systolic, mean, and diastolic pressures were 36.85±11.12mmHg, 29.24±10.09mmHg, and 23.35±8.82 mmHg, respectively. Moreover, after the intervention, the aortic systolic, mean, and diastolic pressures were 112.38±16.97mmHg, 76.00±9.73mmHg, and 61.88±8.73mmHg, respectively. Two instances showed rebound PA pressure 3 months after effective treatments that did not respond to pulmonary vasodilator therapy. The median size of PDA in 10 cases closed by MVSD was 11.59±3.15mm, and the device size was 16.20±3.46mm; moreover, the defect size in 15 cases closed with ADO I device was 9.19±3.46mm, and the median size of occluder was 11.07±4.06mm. In 4 cases, the median size was 5.15±0.65mm, mostly in infants closed by an AVP2 occluder with a device size of 8.50±1.00mm.
Transcatheter closure of large PDA with severe PHT using the off-labeled device is feasible and effective. Meticulous and continuous assessment and evaluation of PHT response for closure is mandatory to confirm longstanding efficacy and safety.

Magnesium (Mg) is a vital element which plays a significant role in the human body. Respiratory distress syndrome (RDS) is one of the most common problems in preterm neonates. The current study aimed to investigate the role of serum Mg level as a prognostic factor in neonates diagnosed with RDS.
This case-control study was performed in Vali-e-Asr Hospital, Tehran, Iran, for two years. A total of 100 preterm infants (50 cases, 50 controls) admitted to NICU were enrolled in this study. Demographic data, serum magnesium level, therapeutic interventions, and neonatal outcomes were investigated and the obtained data were analyzed using SPSS software. P-value less than 0.05 was considered significant.
Of 100 neonates, 52% were male. The mean gestational age and birth weights were 33.4 ± 2.4 weeks and 2062 ± 72 gr, respectively. The findings revealed that the mean serum magnesium level in neonates with RDS was 2.02 ± 0.57 mg/dl, while it was 2.35 ± 0.67 mg/dl for neonates in the control group (P-value=0.001). Additionally, the calculated odds ratio of 2.38 indicated a correlation between reduced serum Mg levels and the occurrence of RDS.
The serum level of Mg among neonates with RDS was significantly lower, but the lower level of Mg was not associated with adverse outcomes in neonates.

Being toxic to the developing central nervous system, hyperbilirubinemia may cause neurological damage or developmental delay. This study aimed to assess the relationship between hyperbilirubinemia and developmental delay at six months of age in infants with neonatal severe hyperbilirubinemia. A prospective cohort study was conducted on infants with a gestational age of >35 weeks and hyperbilirubinemia from 2014 to 2020. The neurodevelopmental assessment was performed using the Denver Developmental Screening Test II (DAS II). The collected data were statistically analyzed by SPSS software (version 26). Among the three main causes of hyperbilirubinemia, 9.6% of the neonates had blood group incompatibility; ABO, Rh, and ABO +Rh were observed in 7.5%, 1.6%, and 1.1% of the neonates, respectively, and 1.1% of the infants were diagnosed with glucose-6-phosphate dehydrogenase deficiency.  The correlation between hyperbilirubinemia and developmental delay in all four domains according to the DAS II test was statistically significant (P<0.001). Moreover, the severity of hyperbilirubinemia was proved to have a positive correlation with the severity of the developmental delay. Furthermore, this study found a significant correlation (P<0.001) between the causes of icterus and the probability of neurodevelopmental delay at six months of age (Correlation Coefficient=0.470, sig=0.000). There is a strong correlation between hyperbilirubinemia and developmental delay at six months of age in infants with neonatal hyperbilirubinemia. The severity of hyperbilirubinemia is significantly associated with the cause of jaundice. It is also demonstrated that the severity of hyperbilirubinemia has a positive correlation with the severity of the developmental delay.

Feeding difficulties and dysphagia can lead to malnutrition, dehydration, pneumonia, prolonged hospitalization, and even death in neonates. Accordingly, it should be recognized as soon as possible to provide necessary medical care, nursing, and rehabilitation. This study aimed to translate the Neonatal Feeding Assessment Scale (NFAS) into Persian and determine its psychometric properties in Iranian neonates. After receiving permission from developers, the main version of NFAS was translated into Persian. Face validity of NFAS was assessed by 10 qualified speech and language pathologists in the field of pediatric swallowing. In order to define the internal consistency of the items, 52 infants were evaluated using the Persian version of NFAS, and the correlation between the items was determined using Kuder-Richardson 20. The test-retest and inter-rater reliabilities were also calculated by Cohen's Kappa coefficient in 30 and 40 infants, respectively. The convergent reliability between NFAS and Early Feeding Skills (EFS) was calculated by point-biserial correlation in 30 infants. According to experts, all translated items were transparent and understandable. The internal consistency score was obtained at 0.76. Moreover, Cohen's Kappa coefficients were calculated at 0.96 and 0.87 for test-retest and inter-rated reliabilities, respectively. Point biserial correlation between Persian NFAS and EFS was estimated at 0.63. Persian version of NFAS is a valid and reliable tool to assess feeding problems and oro-pharyngeal dysphagia in infants and make clinical decisions.

Nasal Continuous Positive Airway Pressure (N-CPAP) is the standard method of respiratory support in neonatal intensive care units, and this method is used for almost all infants with respiratory distress syndrome (RDS) for respiratory support. The position of infants under N-CPAP (prone and supine) affects the amount of blood supply. This study aimed to compare the prone \\and supine positions, followed by the investigation of their effects on various respiratory parameters and prematurity complications in premature infants with RDS treated with N-CPAP. This randomized clinical trial was conducted on 127 premature infants under N-CPAP treatment in the neonatal intensive care units of Al-Zahra and Shahid Beheshti hospitals, Isfahan, Iran. Babies were placed in two groups of 68 and 59 cases with supine and prone positions, respectively. The duration of N-CPAP, the number of prescribed doses of surfactant, the need for mechanical ventilation, time to full feed, and positive end-expiratory pressure (PEEP) were investigated in this study. The obtained data were then analyzed using SPSS software (version 22). The mean±SD values of gestational age and birth weight of the neonates were 31.88±1.30 weeks and 1672.40±443.67 g, respectively. The frequency of using different modes of mechanical ventilation was significantly lower in the prone position group, compared to the supine position group ([17% vs. 32.4%], X2[3, N=127]=7.95, P<0.05). There was a significant correlation between position and using mechanical ventilation during the first 72 hours (P=0.04, Correlation Coefficient=0.182). Multivariate analysis indicated a significant correlation between position and mean time of PEEP (P<0.001, F=13.67), mean of surfactant use (P=0.013, F=6.38), and time to full feed (P=0.002, F=10.29). The results of this study showed that placing preterm infants with RDS who are treated with N-CPAP in the prone position reduces complications related to being preterm or using N-CPAP.