Iranian Journal of Neonatology
Volume:2 Issue: 1, Autumn 2011

ObjectiveAbout 1 % of infants are of very low birth weight. However, they comprise about 50% of infant mortality. We compare the effects of continuous versus intermittent feeding on physical growth, gastrointestinal tolerance and macronutrient retention in low birth weight infants (<1.5 Kg).MethodsA prospective randomized trial clinical trial was performed from 2004-2005. Very low birth weight neonates (n=73) stratified by birth weight were randomly assigned to either the continuous (24- hour) pump group (n=37) or intermittent (every 2 hours) nasogastric tube feeding group (n=35). Weight was measured and recorded on the 3rd, 7th, 10th, 13th, 16th, 19th, 22nd day and at discharge. Data was analyzed via SPSS software, t-student and chi-square tests.ResultsThere were no significant differences in birth weight, gestational age, first feeding age and weight at beginning study. Of the 73 neonates, 61 neonates were discharged from hospital, 11 neonates died and one of them dropped out of the study because of early discharge. There were no significant differences in weight gaining, feeding tolerance, discharge weight (p=0.33) or severity of respiratory distress between the groups.ConclusionThis study showed that there were no differences in infant growth relative to the type of feeding.

ObjectiveThe purpose of this study was to assess the frequency of complications of endotracheal intubation (ETI) in neonates.MethodsThe newborns that were admitted and needed urgent or semi-urgent intubation were enrolled in this study over a 1 year period. Route for intubation in all cases were orotracheal. Cases were not routinely sedated or paralyzed. The patients were clinically and radiographically assessed.ResultsOf 233 newborn infants who were admitted to the neonatal intensive care unit (NICU) at the Children’s Medical Center, 60 infants were intubated. A total of 131 attempts were documented.Unsuccessful attempts with difficult intubation were 17(13%); successful intubation attempts were 114(87%). Complications were detected in 69 cases (61%). The most common complication was laryngeal injury (24%). Accidental extubation was the most frequent event (12%).Tube blockage 7% and endotracheal tube (ETT) malposition was 3%. The complications were less during placement of ETT (12%), but were high during maintenance (61%) and removal of the endotracheal tube (28%). 47% of patients required repeated intubation. There was a significant statistical differencebetween complications of medicated and unmedicated patients. There was no significant statistical difference relative to gestational age, route of delivery, sex, birth weight, and length of time the ETT remained in place.ConclusionTrauma to the larynx and vocal cords were the most common complications. Difficult and repeated intubation played a major role. Premedication for non-urgent or semi-urgent intubation was safer and more effective than awake intubation. We did not assess long-term outcomes associated with endotracheal tube intubation; this was a limitation of the present study. Operator skill and postoperative care are confounding variables that may influence the results.

BackgroundSystemic carnitine deficiency may present with apnea, hypotonia, and poor growth. Premature infants often manifest these symptoms and are at risk of developing carnitine deficiency because of immaturity of the biosynthetic pathway, lack of sufficient predelivery transplacental transport, and lack of sufficient exogenous supplementation.ObjectiveThis study was undertaken to examine the effect of carnitine supplementation on hypoglycemia, apnea and sepsis in premature infants.MethodsIn this clinical study 60 preterm infants less than <1500 g birth weight were enrolled. The subjects in the carnitine group received 20 mg/kg/day oral supplemental by nasogastric tube in addition t routine nursing care within 96 hours of birth. Episodes of apnea, hypoglycemia and sepsis were the primary outcome measures recorded. The control group received routine nursing care.ResultsEpisodes of apnea and the hypoglycemia were similar between the two groups. (P=0.55 and 0.69 respectively). In this study treatment with carnitine supplementation had no effect on apnea, hypoglycemia and sepsis in very low birth weight neonates.

ObjectivesThis study sought to evaluate the effect of intravenous immunoglobulin (IVIG) in neonatal sepsis in preterm babies.MethodsThis clinical trial was done at the NICU of Imam Reza Hospital in Mashhad (Iran) from September 2006 to September 2007. We used a dosage regimen of 1g/kg/day. In this study we had 50 patients with documented sepsis; 25 of them received antibiotics (controls) and 25 of them received antibiotic and IVIG as adjuvant therapy. Finally we compared the outcomes of both groups.ResultsIn this study all septic newborns had positive blood cultures. The most common cause of sepsis in our study was klebsiella (56% of control and 36% of case groups). In both groups we found 62% early onset sepsis. There was no statistically significant difference between mortality rate in two groups (52% VS 48% of case and control, P>0.05).ConclusionThis study did not find any significant decrease in mortality rate with IVIG therapy in neonatal sepsis.

IntroductionMinerals and trace elements such as zinc and copper have significant influence on development and growth of the fetus and newborn. The purpose of this study was to determine the relationship between low birth weight and maternal and neonatal zinc, copper levels.Materials and MethodsThis case – control study was done from September 2006 to Sep 2007 consisted of 65 infants with birth weight < 2500 g and 65 infants weighing ≥ 2500g. Cord and maternal blood samples collected at delivery were analyzed by atomic absorption spectrophotometry for zinc and copper levels.ResultsMean serum zinc levels in maternal (P=0.001) and the cord blood (P=0.49) were 6.35 ± 2.09 μmol/l, 12.77±3.83 mol/l and 7.57±1.75 μmol/l, 13.18±2.69 μmol/l of cases and control groups, respectively.The mean copper levels in maternal (P=0.62) and cord blood (P=0.005) were 21.82±4.45 μmol/l, 5.12±1.54 μmol/l and 21.19 ± 5.34 μmol/l and 3.65±2.04 μmol /l of control and case group, respectively.ConclusionThis study indicated that there is a relationship between birth weight less than 2500 gr and maternal zinc levels (P<0.001). Mothers with zinc levels less than 6.4 mol/l were 3.8 time more at risk of having an infant with birth weight less than 2500 g. Lower maternal weight (less than 55kg), was associated with 4.2times increase risk of having low birth weight infants.

BackgroundOne of the most important cause of severe neonatal hyperbilirubinemia is hemolysis including Rh incompatibility. The aim of this study was to assess the rate of hyperbilirubinemia due to hemolysis in Rh positive neonates born to Rh negative mothers.MethodsIn this retrospective study from March 1998 to February 2003, 60 icteric Rh positive newborns that were born to Rh negative mothers, were studied. The data of patients were gathered from questionnaires sheets.ResultsThe rate of hemolysis due to Rh incompatibility was 18.3%. The mean age of mothers was 31.9 years (SD:4.6). The mean level of hemoglobin in these patients was significantly lower (P=0.009) and serum bilirubin levels higher than nonhemolytic icteric neonates (P=0.007). The mean age of onset of jaundice in hemolytic neonates was 1.55 days (SD: 618) and in nonhemolytic patients 2.08 (SD:1.03) days. Exchange blood transfusion was performed for 23 neonates (38.3%). In 61.7% of cases no history of anti-D immunoglobulin given during pregnancy or at delivery was present.ConclusionDue to poor prenatal care consisting of inadequate provision of anti-D immunoglobulin in Rh negative mothers, sensitization to Rh antigen in our Rh negative mothers was considerably high.

ObjectiveConjunctivitis is a common disease in neonates. Several bacterial and viral infectious agents may cause it. Tear circulation and blinking has protective effects from bacterial colonization in the conjuntival sac. Reduced blinking increases the possibility of bacterial conjunctivitis. We studied the effect of eye patches on bacterial colonization of the conjunctival sac.MethodsIn 100 icteric neonates who needed phototherapy and occlusive patches for their eyes during the procedure we did conjunctival bacterial culture before and after 48 hrs after occlusive patches. The results of two cultures were analyzed with statistical tests, McNemar, chi- square and, binominal with SPSS V18 software.ResultsIn 100 neonates there were 51 (51%) males 49 (49%) females. The mean birth weight was 2578±736 g. Culture before ophthalmic patches showed 20 (20%) cases with positive conjunctival cultures and 76 cases (76%) with positive culture 48 hrs after use of eye patches.ConclusionEye patches during phototherapy increase bacterial colonization in the conjunctival sac. We must be aware of this complication during phototherapy.

IntroductionPreterm birth is still a major health problem throughout the world. Preterm birth results in 75% of neonatal mortality. We sought to identify risk factors which cause preterm birth.Materials and MethodsThis cross-sectional study assessed all preterm neonates born in Asali Hospital in Khorram Abad (either by NVD or C/S) during the first 6 months of 2007. Sampling method was census. Fetal sex, maternal disease, maternal addiction to cigarettes, maternal age, placental problems, number of gravidities, PROM, preeclampsia, multifetal gestation, Apgar score, uterine anomaly were the variables studied in this survey. Questionnaires were used to collect the data and the data was analyzed with SPSS software.Results183 of 2179 live neonates borne in Asali hospital were preterm (8.4%). The most common factors related to preterm birth were: Primigravidity(56.3%), PROM(35.5%), preterm labor pain(33.8%), maternal disease(22.4%), preeclampsia(21.9%), multifetal gestation(19.7%), previous abortion(18.6%), previous preterm delivery(9.8%), high risk maternal age(10.4%) and placental problems(7.7%). Preterm labor pain was significantly more common among multiparus women in comparison with nulipara ones(x2=16.5, p=0.000049) but occurrence of PROM(x2=0.57, p=0.45), preeclampsia(x2=0.8, p=0.37), maternal chronic disease(x2=0.55, p=0.46) and multifetal gestation(x2=0.01, p=0.91) was not significantly different among multipara and primipara women.ConclusionSeveral factors related to preterm birth can be prevented by health modalities. Maternal education and giving advanced information to mothers in prenatal health care visits, preterm birth and its side effects may be reduced.

Umbilical and supraumbilical catheter insertion is a common procedure performed in the NICU. It is a safe and usually easy procedure devoid of serious mishaps, morbidity and mortality.Complications such as hemorrhage, infection, hernia, evisceration, omphalitis, portal veinthrombosis and portal hypertension may occur after umbilical catheter insertion. Other uncommon and rare complications reported in the literature includes: Hepatic laceration, pleural effusion, necrosis of the buttock, severe ischemic injury of the extremities, gastric outlet obstruction, cardiac tamponade, pericardial effusion, atrial flutter, liver abscess, neonatal bladder rupture and intrahepatic hematoma. In this article we present a case of catheter migration in a preterm infant into the neck removed successfully via jugular venotomy.

Human papilloma virus (HPV) infection is a very common infection of skin and mucosa ofchildren and adults (1- 6).Anogenital warts are a common type of HPV infection in sexually active adults, however it is seen in any age. The importance of presence of genital warts is different between adults and children in respect to differential diagnosis, associations, complications and also treatment options. We report a 3 month-old child with a giant genital wart treated via cryotherapy.