Iranian Journal of Neonatology
Volume:4 Issue: 3, Autumn 2013

pulmonary air-leakage especially pneumothorax (ptx), is a severe complication in neonates. The aim of this study was to assess the predisposing factors and frequency of ptx among the low birth weight (LBW) premature infants, under mechanical ventilation. This cross sectional study was performed in 121 LBW intubated premature infants at neonatal intensive care unit of a children hospital in Rasht, Iran during 18 months. Birth weight, gestational age(GA), sex, mode of delivery, initial diagnosis, respirator settings, history of surfactant therapy or ptx, 5th minute apgar score were recorded in neonates with or without ptx. Univariate and multivariate regression analysis were done. A total of 42 (34.7%) of infants developed ptx. Mean GA of neonates with ptx (case group) was 30±2.42 W and in neonates without ptx (control group) was 30.17±2.95 W. Mean birth weight in case and control groups were 1330 ± 386gr and 1482 ± 507gr respectively. In case group 69% and in control group 50% were delivered by cesarean section. 54.8% of cases and 53.2% of control group were male. No mentioned items reached statistical significance. Respiratory distress syndrome was the most common lung pathology in both groups. The rate of ptx was higher in cases with low apgar score at 5th minute (P=0.006). Surfactant therapy decreased the incidence of ptx (P=0.023). After multivariate logistic regression analysis only low apgar score at 5th minute significantly increased the risk of ptx. The incidence of ptx in this study was slightly higher than other reports and this may be due to assessment of only LBW premature intubated neonates. After multivariate logistic regression analysis only low apgar score at 5th minute increased the risk of ptx significantly.

Using of natural and synthetic surfactant is a rescue treatment for respiratory distress syndrome. In Iran, Survanta and Curosurf are the most frequent used natural surfactant preparations. We compared the clinical response and safety of two surfactants poractant alpha (Curosurf) and beractant (Survanta) for treatment of respiratory distress syndrome (RDS) in preterm infants. This study was a clinical trial study that performed during a 2-year period in Ghaem Center''s neonatal care unit.Sample size was calculated with 95% confidence and power 80. 104 premature infants were treated with surfactant, 74 in survanta group and 30 in Curosurf group,. The differences between the two groups were assessed by ANOVA or the calculation of relative risks. There were no statistically significant differences between infants treated with S and C in mean gestational age (30.58 vs. 29.00 weeks) and birth weight (1388 vs.1330 g). Also there was no significant difference between groups, incidence at 28th day of Bronchopulmunary dysplasia (%40.5 vs. %40), Intra ventricular hemorrhage III/IV (%13/5 vs. % 13/3), pneumothorax (%20 vs. % 20), Patent ductus arteriosis (%28/3 vs. % 20), and death (%28 vs. % 26/6). This study concluded that Survanta and Curosurf are similar in treatment of neonatal respiratory distress syndrome.

Hyperbilirubinemiais a common problem in newborn infants. It can progress to kernicterus in severe forms, unless an intervention is initiated. The objective of this study was to compare the efficacy of Clofibrate with Phenobarbital in full-term neonates with nonhemolytic jaundice. this double blind clinical trial study was performed on 60 neonate who were divided randomly in two groups of full-term jaundiced neonates: the clofibrate-treated group (n = 30) and the Phenobarbital group (n = 30). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate while the neonates in the Phenobarbital group received a single oral dose of 5 mg/kg Phenobarbital; both groups received phototherapy. Total serum and direct bilirubin levels were measured at the beginning, 12 and 24 hours after the initiation of treatment. The mean ± SD total serum bilirubin level of the Phenobarbital group and clofibrate groups at enrollment was 17.84 ± 1.017 and 18.04 ±0.852 mg/dL, respectively. The mean ± SD total serum bilirubin in Phenobarbital group and clofibrate groups after 24 hours was 11.11 ± 1.273 and 12.55 ± 1.008 mg/dL, respectively (P = 0.000). After 72 hours of intervention, 25 (83%) neonates of the Phenobarbital group and 23 (76%) of the clofibrate group were discharged with a total serum bilirubin of P = 0.000). No side-effect was observed on serial examination during hospitalization, and on the first and seventh day after discharge. Phenobarbital in the compared with clofibrate results in a faster decline in total serum bilirubin, shorter duration of hospitalization and had no side effects in jaundiced full-term neonates.

Lipoprotein lipase activity can be increased by clofibrate. Clofibrate is used to reduce serum triglyceride level in adults. The aim of this study was to determine the effect of clofibrate on serum triglyceride and cholesterol level after administration of intravenous lipid in very low birth weight neonates. In a randomized double blind placebo – controlled study, 60 very low birth weight neonates were elected. They received intravenous lipid for parental nutrition. Study participants (case) received one dose clofibrate 100 mg/kg orally. Control group received sterile water for placebo as volume as clofibrate. Serum triglyceride and cholesterol levels were measured in first and fifth days after starting of intravenous lipid (one day after intervention). Two groups were the same in sex, birth weight, gestational age and mode of delivery. There were no significant difference between the clofibrate and control groups in mean total serum triglyceride and cholesterol levels at before and after drugs administration (P=0.20 and 0.40 respectively). This study showed although clofibrate has been reduced serum triglyceride levels in adults but it has not effect on serum triglyceride and cholesterol levels in very low birth weight neonates who use intravenous lipid.

Preterm labor is at risk for respiratory distress syndrome (RDS) and sometimes requires to mechanical ventilation (MV) and surfactant therapy. Continuous positive airway pressure (CPAP) and Nasal Continuous positive airway pressure (NCPAP) are the methods of respiratory support especially for using in RDS of neonates. In other method surfactant is administered to babies via tracheal instillation. The aim of study was comparing nasal continuous positive airway pressure (NCPAP) with and without prophylactic surfactant therapy in preterm neonates’ RDS. Patients and This is a randomized clinical trial study that performed on eighty newborns (28-34 weeks) who were born in Ali-Ebne-Abitaleb Hospital of Zahedan University of Medical Sciences from October 2008 to September 2010. Subjects were randomly classified in two groups whom received nasal CPAP alone or with surfactant (40 patients in each group).The Including criteria for entrance to research were approved suggested RDS, gestational age less than 34 weeks and neonates 72 hours after delivery. The data collected through direct observation and questionnaire contained fourteen items. Groups received either surfactant (Curosurf, Parma, Italy) with NCPAP or NCPAP alone. The data analyzed were conducted through SPSS 17.00 version and followed by Crosstab (Pearson Chi-square). Results revealed that six neonates who received only NCPAP and four patients who received NCAPA plus surfactant required to MACHANICAL VENTILATION (MV) therapy. After a week, 33 neonates who received only NCPAP and 36 patients who received CPAP plus prophylactic surfactant remained alive. There was no significant difference between the groups regarding adverse outcomes (P=0.518). According to the results of this study, NCPAP is affordable as a safe protocol for RDS in preterm neonates. Further research especially with control or placebo groups is required to clarify and validate our findings.

some studies have suggested correlation between MPV index and inflammatory diseases such as rheumatoid arthritis in adults. Though bronchopulmonary dysplasia is also an inflammatory disease which develops in preterm neonates with Respiratory distress syndrome, we decided to study the possible correlation between the mean platelet volume (MPV) and the occurrence of bronchopulmonary dysplasia (BPD) Subject & We reviewed the medical records of 280 infant with the diagnosis of RDS admitted to the neonatal intensive care unit of the Mahdieh obstetrics and gynecology Hospital of Tehran and Amir general Hospital of semnan from April 2008 to April 2012. Infants who have been expired before first month of life were excluded. Enrolled infants were divided into BPD and no-BPD groups (30 with and 250 without BPD). MPV was determined during first three days of life in all cases. MPV measured during first three days of life was significantly(p=0.017) higher in the BPD than in the no-BPD group (10.8-0.96 versus 9.65-0.91 fL)but Platelet count at the same time were similar in the BPD and no-BPD groups, and MPV increment was associated with BPD development risk((OR=1.6, 95%CI: 2.38-1.08, p=0.019). We concluded that higher MPV in the first three days of life is a probable risk factor for the development of BPD in preterm infants with RDS. This might be attributed to the fact that high MPV could prone the neonate to inflammatory and oxidative lung damage.

Resistance to thyroid hormone is an uncommon condition. We report the clinical and laboratory findings of a case with both resistance to thyroid hormone and, a reduced capacity to produce and respond to thyroid hormone. RTH is a disorder characterized by elevated circulating thyroid hormones, state of non-suppressed pituitary TSH secretion and refractoriness to hormone action in peripheral tissues. Resistance to thyroid hormone might be an important additional diagnosis to consider in cases where thyrotropin remains persistently elevated. In this article we described an infant with RTH; her situation was diagnosed incidentally at birth with impaired hypothyroidism screening tests.

Resistance to thyroid hormone is an uncommon condition. We report the clinical and laboratory findings of a case with both resistance to thyroid hormone and, a reduced capacity to produce and respond to thyroid hormone. RTH is a disorder characterized by elevated circulating thyroid hormones, state of non-suppressed pituitary TSH secretion and refractoriness to hormone action in peripheral tissues. Resistance to thyroid hormone might be an important additional diagnosis to consider in cases where thyrotropin remains persistently elevated. In this article we described an infant with RTH; her situation was diagnosed incidentally at birth with impaired hypothyroidism screening tests.