Iranian Journal of Neonatology
Volume:4 Issue: 4, Winter 2014

photoreactor using solar radiation. The effect of various parameters such as pH, initial concentration of pollutant, catalyst dose, oxidant, and time variation were studied. The determination of the best catalyst was studied amongst the four catalysts (TiO2, ZnO, PSA and SSA). The kinetics of degradation of isooctane was also studied. The results showed that TiO2 was the best catalyst with a degradation rate of 57%. Also, the optimum conditions for the degradation of the isooctane were; 50mg/L of initial concentration, pH 8 and catalyst dose of 4.0g/l. The kinetics analysis for the degradation of isooctane revealed that it follows pseudo – first‐ order reaction kinetics. The Langmuir – Hinshelwood model showed a better fitting with reaction rate and adsorption equilibrium constants of 3.0 mg/L.h and 1.53 × 10‐3 L/mg respectively and the regression was 0.979. Finally

Assistant Professor, Pediatrician and Neonatologist, Al- Zahraa Teaching Hospital, Department of Pediatrics, College of Medicine, University of Kufa, Kufa, Iraq Abstract The fetus needs a considerable amount of cholesterol for the development of tissues and organs. Studies have suggested that genetic and environmental factors influence the composition of cord blood lipoproteins. In this study, we aim to assess the effect of gestational age, sex and birth weight on the cord blood lipoproteins. We collected umbilical cord blood samples from 91 newborn infants, delivered normally, or by caesarean section. According to their gestational age, the samples were divided into 3 groups: the premature (≤ 34 weeks of gestational age), the near-term (35 – 37 weeks of gestational age), and the term group (≥ 38 weeks of gestational age). Serum was used to measure cholesterol, triglycerides and high-density lipoprotein (HDL) by the enzymatic auto-analyzer. SPSS 17 software was used for ANOVA test, Student t-test and Spearman correlation test. P-value less than 0.05 was regarded as significant. The results of this study indicate that gender has no effect on the level of lipid in the samples; it doesn’t affect the subgroups, either. The serum level of cholesterol is inversely correlated with neonatal gestational age, and the neonatal body weight (P < 0.05). Only in the term subgroup, high positive correlation is observed between the triglyceride level and gestational age (P <0.05). All other subgroups show no significant correlation between the lipids and age or weight. The cord blood cholesterol, triglyceride and HDL are not affected by the gender of the newborns. Cholesterol level is inversely correlated with the gestational age and birth weight, and this could be regarded as a risk factor for atherogenic lipoprotein metabolism, later on in life.

Jaundice is considered as a common clinical condition during infancy. Prevention of severe hyperbilirubinemia (jaundice) is safer and easier than current therapies, like phototherapy or blood exchange. In some animal studies, zinc was found effective in reducing jaundice. In this study we evaluated the effect of zinc sulfate on neonatal hyperbilirubinemia. This randomized, double-blind clinical trial was performed on healthy term (35 weeks of age and more) neonates. Eligible newborns were randomly allocated to two groups: group A (receiving zinc sulfate, n=57) and group B (receiving placebo, n=74). They were screened for indirect bilirubin by BiliCheck at the end of the first, third and seventh day of age. We evaluated various characteristics such as weight, clinical signs, maternal and neonatal histories, and laboratory results. Mean bilirubin values of the 3rd and 7th day were determined as (12.9±3 vs. 12.6±2 mg/dl, p=0.473), and (12.4±3 vs. 12.4±4, p=0.989), respectively. The incidence of hyperbilirubinemia (Bil>15) among group A and group B was reported 26% and 22%, respectively. The rate of admission due to hyperbilirubinemia and phototherapy was significantly higher among the newborns in placebo group, (p=0.043). Weight gain between the 3rd and 7th day of infant’s age was more significant in the zinc group, (p=0.039). The current study showed that the administration of zinc sulfate neither affected hyperbilirubinemia, nor delayed the jaundice appearance; although fewer admission and phototherapy duration were reported in the zinc group in comparison with the placebo group. Weight gain between the 3rd and 7th day was more significant in the zinc group.

The aim of this study is to compare significant post-phototherapy bilirubin rebound in two groups of neonates, with two levels of bilirubin, at discontinuation of phototherapy. One hundred and fifteen neonates ≥35 weeks of gestationl age (GA), admitted due to hyperbilirubinemia in the Neonatal Ward of Valiasr Hospital, were randomly divided into two groups: group A and group B. In group A, phototherapy was discontinued when bilirubin level reached 11 mg/dl, or the 40th percentile of the Bhutani nomogram, while in group B, it took place at bilirubin level of 13 mg/dl or the 75th percentile. After 24 hr, total serum bilirubin was measured. Significant post-phototherapy rebound was defined as bilirubin increase of more than 2 mg/dl or the 95th percentile. A total of 13 (11.3%) neonates out of 115 participants developed significant rebound, 9 of which (69%) were in group A, and the rest (21%) were in group B, which was not considered a significant difference (p=0.13). Comparison of the two groups showed no significant difference concerning the correlation between rebound and the infant’s age, in hr of starting phototherapy. However, the number of neonates in group B, who received phototherapy before 48 hr of age, was too small to draw reliable conclusions. Logistic regression analysis showed that intravenous serum therapy was the only risk factor significantly associated with rebound (p=0.005). According to this study, it is shown that discontinuation of phototherapy in hyperbilirubinemia, at lower bilirubin levels, would not prevent rebound. Moreover, no association was found between the known risk factors and rebound.

Due to the significant differences between the physiology and pathology of adults and neonates, clinical guidelines for adults are not directly applicable to children. This study was performed to evaluate the effects of high- and low- dose captopril on the neonates with large left-to-right shunts. The study was conducted on 20 neonates with congenital heart disease, left-to-right shunt, and cardiac failure. Based on the Ross scoring system, the neonates were clinically evaluated by measuring renin, aldosterone, and B-type natriuretic peptide, and performing echocardiography. For each neonate, the treatment of heart failure started with digoxin and frusemide, and reevaluation was conducted 3 days after the treatment. Afterwards, the neonates were randomly divided into 2 groups; low- (0.03mg/kg) and high-doses (0.5mg/kg) of captopril were administered, and the reevaluation was carried out, after one week of therapy. The study revealed higher reduction of the Ross score in the high-dose group; however, the change was not statistically significant (P=0.56). B-type natriuretic peptide and aldosterone reduced further in the high-dose group; again the changes were not statistically significant (P=0.4). Moreover, the treatment with captopril increased the pulmonary blood flow (QP), and pulmonary-to-systemic blood flow (QP/QS) in both groups; though the changes were not significant. According to the present study, although high-dose captopril can decrease B-type natriuretic peptide and the neonates'' clinical symptoms, the resultant changes are not statistically significant. Therefore, clinical decision making should follow a case-by-case basis for each neonate, in order to select the effective dose of captopril.

Optimal growth and development of infants requires correct nutrition, and suitable alimentary habits. Mothers’ wrong use of supplementary nutrition and their lack of knowledge is one of the most important causes of malnutrition. This study was conducted in order to determine the knowledge and practice of supplementary nutrition among mothers with 6 -12 months old infants. In this cross-sectional descriptive study, 180 mothers with6 -12 month old infants, who were referring to health centers of Yasuj University and Medical Sciences, were selected by randomly sampling in 2008.Researchers attended different clinics in the morning shifts, and the questionnaires, which were used as data collecting tools, were completed by conducting interview with mothers. Afterwards, the collected data was analyzed by SPSS 17 software, using descriptive statistics, and Chi-square. As the results show, the majority of mothers (78.3%) had sufficient knowledge of supplementary nutrition. Also, there were no significant differences in mother’s knowledge based on their age, occupation, educational level and birth order. Other results show that the majority of mothers (62.8%) had good practice regarding the nutrition of their infants (P = 0.03). Also, there was appositive relationship between mother’s knowledge and practice of supplementary nutrition (P = 0.04). According to this study, it can be concluded that the knowledge and practice of majority of mothers about supplementary nutrition sufficient. Moreover, in order to broaden the knowledge of the personnel in health centers, mass media must be used to find the important related issues.

Infantile colic has been defined as episodes of excessive and persistent crying without known medical cause. Kangaroo mother care is a new method for case of newborn with several advantages. This study designed for evolution KMC and its effect on infantile colic. This study is a randomized controlled trial, from 1th may 2008 to 1th may 2009 a total of 70 children, aged 3-12 weeks with persistent colic symptoms that referred to sheikh children hospital (Clinic). Normal mother-infant pairs were recruited at 3 to 12 weeks of age after obtaining baseline for two days. All cases divided randomly to kangaroo care and conventional care group. For analyzing the data we used 2-sample t test, X² test and fisher exact test. In the begining of study, the kangaroo care group had 3.5hr/d crying and after the intervention, it decreased to 1.7hr/d, the difference were significant (P<0.05). But there were no difference in feeding duration between 2 groups (P=0.2). Awake and content (normal behavior) behaviors were significantly increased in the kangaroo care group (P=0.001). Sleeping duration was significantly increased in the kangaroo care group (P=0.02). Kangaroo care may use as a simple and safe method for colicky infants treatment.

Sepsis is the most common cause of neonatal mortality. As per National Neonatal-Perinatal Database (NNPD), 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live births. Signs and symptoms of sepsis are nonspecific; therefore empirical antimicrobial therapy is promptly initiated after obtaining appropriate cultures. The early manifestations of neonatal sepsis are vague and ill-defined. Novel approaches in the diagnosis of neonatal sepsis include heart rate analysis on ECG, and colorimetric analysis of skin color. Although blood culture is the gold standard for the diagnosis of sepsis, culture reports are available only after 48-72 hours. In this era of multidrug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat non-infected infants. Thus, rapid diagnostic test(s) that include Interleukien-6 (IL-6), neutrophil CD64 index, procalcitonin and nucleated RBC count– and differentiate the infected infants from the non-infected, particularly in the early neonatal period– have the potential to make a significant impact on neonatal care. The aim of this review is to specify the diagnostic criteria, treatment guidelines, and a summary of recent diagnostic tests of sepsis, along with the preventive measures.

methylmalonic acidemia (MMA) is a metabolic disorder and especial nutritional support has an important role in improvement of growth and development in these patients. A 3-month old female infant with known MMA was admitted to emergency department of Dr Sheikh Children Hospital with primary diagnosis of pneumonia and sepsis. This patient was a full term baby; MMA was diagnosed at 3th day of her life after several episodes of tachypnea, lethargia, poor feeding and irritability. After patient was stabilized, she was referred to nutritional support team for specialized MMA medical nutritional therapy. The patient’s growth and development improved significantly after 2 months of follow up.

One of the few conditions associated with skin ulceration in the neonatal period is aplasia cutis congenita (ACC). ACC or congenital absence of the skin is considered an uncommon anomaly. This malformation commonly appears on the scalp as a solitary lesion, though it can be seen in other surfaces of the body such as the trunk, limbs and face. ACC can be associated with other physical anomalies such as defects of the heart, gastrointestinal system, genitor-urinary system, central nervous system, and also in association with umbilical hernia. There are very few reports of ACC and seizure as a prominent clinical manifestation. In this study, we present a premature neonate with ACC lesions on the right side of the nose, on the right hand and the foot, together with frequent seizures with onset within the initial hours of the birth. Laboratory testing and brain MRI of the patient revealed no significant results. This case may present a new group of ACC classification, or a new neurocutaneous syndrome.