Iranian Journal of Neonatology
Volume:3 Issue: 2, Summer 2012

ABO hemolytic disease of the newborn is most common cause of neonatal jaundice; previous studies have shown a poor correlation between serologic tests and clinical course in affected infants. The aim of this study was to identify the value of direct and indirect Coombs’ immunohematological tests, to identify the incidence of hemolytic disease in newborns (ABO-HDN). This two-year retrospective study of 1800 jaundiced term-neonates studied 355 cases due to ABO incompatibility divided into two groups: with and without hemolytic disease. Relation of laboratory parameters and immunohematological tests to severity of disease were studied. We did not analyze the maternal antibody titer or elusion test, and this was a limitation of the study. In this study, 355 (19.7%) of all jaundiced newborn infants were ABO incompatibles; 98 (27.6%) of the newborns who had ABO incompatibility showed ABO-HDN (5.4% of total icteric patients). The positive direct antiglobulin (direct Coombs’ test) and indirect antiglobulin (indirect Coombs’ test) were diagnostic in 18.2% and 25.5% respectively in affected infants. The overall prevalence of immunohematological tests associated with ABO-HDN was 43.7%. There was significant correlation between positive antiglobulin tests and severity of jaundice (P=0.000); also there was a significant difference between indirect and direct Coombs’ test and severity of jaundice (P= 0.002). The antiglobulin tests, namely the indirect Coombs’ (IC) test and direct Coombs’ (DC) test are very useful to detect the newborns liable to serious jaundice.

Group B streptococcus is the main reason of neonatal infection in developed countries and causes a widespread clinical indications. In developing countries such as Iran, its rate of appearance is not determined. With regard to colonization and the relative high epithelia of group B streptococcus, it is likely that the incidence of group B streptococcus in neonatal sepsis is so high.In the present study, we attempted to use the molecular methods to identify this bacterium and develop the culture environments as well. In the present study, a hundred below three months year old infants with sepsis hospitalized in ICU sector of Ghaem hospital for one year were studied since Khordad 1388 (June 2010). After getting consent from the infants’ parents, three blood samples of these patients in the sterile container with lid were transferred to the laboratory (two samples for culturing in normal environment and the other for PRC). All of the information was filled out by doctors in the incidence. SPSS 11.5 and descriptive-analytic tests were used for data analysis. The findings have shown that 100 below three months year old infants with sepsis clinical symptoms were studied. In none of the environments, the B group Streptococcus grows. For identifying the group B streptococcus, PCR were positive in 3% of infants, but other germs have grown in 5 % of normal culture, and 6 % of developed culture environment. Findings have also shown that 64 % of mothers took antibiotic before delivery. With regard to the high rate of anti-biotic consumption by mothers before delivery, it is necessary to use more sensitive methods like PCR to identify the Group B Streptococcus.

After the introduction of surfactant, the survival rate of preterm neonates has increased significantly. This issue attracted much attention towards this fragile population. Many studies have demonstrated that massage plays a role in the weight gain of preterm infants. This study compares the effect of massage therapy on infants who were massaged by a nurse or their mother with those who did not receive massage therapy at all. This randomized clinical trial was conducted on three groups:(1) The infants who only received routine care and no massage,(2) Those who received massage by an expert nurse and (3) Those who received massage by their mothers. We recorded daily weight gain, the length of hospital stay and fluid intake of infants. Kruskal Wallis test and SPSS software were used for statistical analysis. The gestational age of infants ranged between 28 to 34 weeks. At the end of the fifth day the group massaged by a nurse had significantly more weight gain compared to the other two groups (6.5+1.5 in the nurse group, +4.6 1 in the mother group and +3.7 1.5 in the control group, p-value = 0.001). Those who were massaged by their mothers also gained weight significantly more than the control group (P-value=0.05). There was no significant difference in the length of hospital stay among the understudy groups. Our study showed that the five-day massage therapy is a safe technique mothers can perform for stable preterm infants to facilitate weight gain in neonate.

Newborn screening is a systematic application of tests for early detection, diagnosis, and treatment of certain genetic or metabolic disorders that may lead to mortality and morbidity if untreated. As stated by WHO, each year over 330,000 babies are born worldwide with a severe form of hemoglobinopathy. Newborn screening for hemoglobinopathies could become one of the most important methods of decreasing mortality and morbidity and mitigating rising healthcare costs. The diversity and heterogeneous distribution of hemoglobin disorders make it necessary to develop strategies at the country level. Overall, 499 healthy full term Iranian neonates were screened for hemoglobinopathies who were originated from Fars province in southern part of Iran. The screening was performed on cord blood samples collected on EDTA. Following sample collection, complete blood cell count cell indices, osmotic fragility test and hemoglobin electrophoresis were performed. Total prevalence of significant hematologic abnormal findings was 12.4% in this study, the most prevalent one was Alpha thalassemia (6.4%) followed by hereditary spherocytosis (4.8%), and sickle cell anemia (1.2%). The total analysis for detection of Alpha thalassemia by mean corpuscular volume (MCV) ≤ 94, mean corpuscular hemoglobin (MCH) ≤ 27, and hemoglobin level ≤ 14 indicated failure and these results were not appropriate to this discrete population. We suggested the new cut off points for neonatal screening programs of the Iranian population be MCV≤96 and MCH ≤31 for Alpha thalassemia. A successful disease prevention strategy could lead to significant savings in spiraling healthcare costs and mitigate the scarcity of blood products. The healthcare budget savings realized from preventive screening justifies the spending on such a national thalassemia program. We recommended a neonatal screening program for southern Iranian population and also designed a new format for neonatal discharge summary.

Low birth weight (LBW) is one of the main factors accounts for neonatal mortality and morbidity. Many factors are related with low birth weight. The present study was conducted to identify the prevalence and related factors of LBW in Mashhad, northeast of Iran. This cross-sectional study was performed in all medical health centers of Mashhad during the first six months of 2010. Data collection was performed by scale, meter, and a questionnaire including two sections of neonatal factors and maternal factors. The questionnaire was completed by measuring neonates’ height and weight, interviewing with their mothers, and investigating mothers’ and neonates’ health files. Data was analyzed by descriptive statistics, chi-square, Fisher, independent T, and Man-witney tests by SPSS (11.5). Among 2674 alive births, 297 neonates had the weight The prevalence of LBW in our study suggests that a greater emphasis should be placed on related factors of LBW for the early detection and prevention.

Zinc is one of the essential elements of body which has an important role in natural growth, development, and many biological performances. Zinc deficiency is a major health problem and pregnant women are at high risk. 82% of pregnant women worldwide suffer from zinc deficiency. Zinc deficiency during pregnancy has dangerous and irreparable effects such as growth impairment, spontaneous abortion, congenital malformations, intrauterine growth retardation (IUGR), low birth weight (LBW), preeclampsia, premature labor, prolonged labor, postpartum bleeding, delayed neurobehavioral development, delayed immune system development, and leads to increase of mortality rate. Therefore, the importance of proper nutrition during pregnancy and fetal period, because of lasting effects of these periods are far more than other parts of life. Data gathered from human studies indicate that using zinc supplements have contradictory effects on pregnancy period and growth, survival and neurobehavioral development of the embryo, but the supplements can also have beneficial effects on neonatal immune system and decrease of infants morbidity rate resulted from infectious diseases. Hence, focus on functional outcomes of using supplements such as rates of survival, congenital malformations, embryo growth, pregnancy duration, neurobehavioral development, and also considerations on the micronutrients interferences are suggested for further research.

We screened the KCNJ11 gene from 35 individuals clinically diagnosed with type 1 diabetes mellitus under the age of 6 months in 3 years duration. Six different heterozygous missense mutations were found in 7 of the 35 probands, which accounted for 20% of all individuals. A novel mutation W68R (No Locus, GU170814; 2009) was identified in the kir6.2, the pore-forming subunit of the KATP channels from pancreatic β-cells. Our results demonstrated that activating mutations in KCNJ11 gene could cause Permanent Neonatal Diabetes Mellitus (PNDM) with onset prior to six months.

Hemoglobin Constant Spring (Hb CS), a abnormal Hb characterized by elongated α-globin chain resulting from mutations of the termination codon in the α2 - globin gene, is the most common nondelitional α-thalassemic mutation and is an important cause of HbH like disease in Southeast Asia. Case Report: A 9- years-old female with immune hemolytic anemia and splenomegally and abnormal hemoglobin in Hb electrophoresis is reported. The first presentation of our patient was weakness and dark urine. She had a hemolytic anemia with normal MCV and positive direct coombs. In Hb electrophoresis, she had abnormal hemoglobin near the A2 region and slow moving component. PCR testing showed homozygous mutation in codon 142. Hb CS-containing RBCs have membrane pathology and these pathology lead to destruction of her RBCs in reticuloendotelial system and she had a RBC sick syndrome resemble thalassemia intermedia.