Iranian Journal of Neonatology
Volume:5 Issue: 3, Autumn 2014

Asphyxia is a perinatal incident of high mortality rate. Therapeutic hypothermia in both the head and the whole body has been proposed as an effective method in this regard. In this study, we compared these methods in neonates with asphyxia. In this study, 16 neonates with asphyxia in two hospitals including Alzahra Hospital (head hypothermia) and Taleghani Hospital (whole body hypothermia) underwent therapeutic hypothermia for 72 hours. Temperature was maintained precisely controlled by several sensors. Moreover, body cooling was performed on the trunk and limbs of the neonates. The temperature and vital signs were controlled every hour while biochemistry and coagulation tests were performed regularly. Furthermore, the early and late complications of the patients, including developmental disorders, were closely evaluated. The two groups were compared using Chi-square and Mann Whitney U Test via SPSS software V.16 and the P value of less than 0.05 was considered significant. In total, 16 cases with the gestational age of 38±2 weeks were enrolled in this study. Of the 9 cases of head cooling, one expired and 2 others experienced mild developmental disorders. Of the 7 neonates of whole body cooling trail, 3 expired, one experienced minor developmental disorders and one case showed major signs of developmental disorders. No significant differences were found in terms of the feeding time (head group 5±2, body group 8±5 days) and the discharge time (head group 15±8, body group 14±5 days) of the studied neonates. The head hypothermia method seems to be associated with a lower mortality compared to the whole body method. However, the difference was not statistically significant in the sample size above. Therefore, performing such procedures on larger samples could confirm the findings of this study.

Macrosomia is a term used to describe newborns with a birth weight of 4,000 g or above. Fetal macrosomia increases the risk of perinatal mortality and morbidity. Clavicular fracture, brachial plexus injuries, and hypoglycemia are the important side‐effects of this condition. Infant sex and maternal factors including age, body mass index (BMI), height, weight gain during pregnancy, prior history of diabetes, macrocosmic delivery, gestational age, and parity are among factors associated with macrosomia. The purpose of this cross sectional study was to evaluate the prevalence of macrosomia and the associated risk factors in Asalian Hospital of Khorramabad during July‐ September 2010. Data were collected using a questionnaire containing 10 variables as the risk factors for macrosomia. The gathered data were analyzed, using SPSS version 16. Overall, 59 cases of macrosomia were reported among 500 live births. Frequency of macrosomia was estimated at 11.8%. As the results indicated, 69.5% of the neonates were male and 30.5% were female. The maternal risk factors affecting the prevalence of macrosomia included maternal age at pregnancy, obesity (BMI≥30), weight gain more than 18 kg during pregnancy, prior history of diabetes mellitus, history of macrosomic birth, prolonged gestation, and multiparity (parity≥5). However, there was no significant relationship between mother's occupation and macrosomia. As the results indicated, the prevalence of macrosomia was high in Khorramabad city (11.8%). Therefore, in order to prevent macrosomia, it is recommended that mothers over 35 years of age avoid pregnancy via contraceptive methods. In addition, maternal obesity should be prevented before pregnancy by suitable diets, and blood glucose monitoring should be performed during pregnancy via insulin therapy.

According to the Ethology Theory, the immediate separation of the mother from the infant upon birth could directly interfere with the infant’s innate behavior regarding the initiation of breastfeeding. This study aimed to determine the effects of an interventional program based on the Theory of Ethology on infants’ breastfeeding competence. One hundred and fourteen primiparous, Iranian, healthy, full-term mothers between 18-35 years were involved in this study. All of them had normal vaginal delivery and intended to breastfeed their infants. They were put through skin-to-skin contact with their infants immediately after birth for as long as two hours. Afterwards, the rate of the infants’ breastfeeding competence was compared with that of a control group receiving routine hospital care. The rate of the infants’ breastfeeding competence was higher in the skin-to-skin contact group compared to the routine care group (P=0.0001). Early skin-to-skin contact between the mother and the newborn greatly contributes to the promotion of the infant’s natural feeding behavior and thus, results in a higher rate of infant breastfeeding competence. The findings in our study confirm the Theory of Ethology.

Neonatal septicemia is a major cause of mortality and morbidity in newborns. This study aimed to evaluate the clinical manifestation and laboratory findings of positive blood culture in neonatal septicemia. In this retrospective study, we investigated 100 positive blood culture records of neonates suffering from septicemia. A questionnaire was completed for each patient regarding their age at admission, gender, birth weight, admission time, type of delivery, pre-term or post-term delivery and the clinical symptoms. Types of organism causing sepsis and their resistance to antibiotics were evaluated and empirical treatment was the method of choice. Respiratory distress, cyanosis and lethargy were more prevalent among the patients. The antibiogram was indicative of Ampicillin resistance in 86% and Gentamicin resistance in 66% of the studied records. Moreover, it was observed that 36% of the positive blood culture cases had gram-negative and 64% had gram-positive bacteria. The most frequent bacteria in blood cultures were coagulase-negative Staphylococcus (35%), Staphylococcus Aureus (24%) and Klebsiella (18%), respectively. Other prevalent bacteria were Enterobacter, E. coli and Enterococcus (5%), Acinetobacter (3%), Pseudomonas aeruginosa and gram-negative Bacilli (2%) and Serratia (1%). According to the antibiogram, the most effective antibiotics against bacterial growth were Vancomycin, Cephalosporin, Amikacin, Co-trimoxazole and Gentamicin. Since the most frequent bacteria in neonatal septicemia cases were coagulase-negative Staphylococcus, Staphylococcus Aureus and Klebsiella, pediatricians need to select regiments able to cover the gram-negative bacteria for empirical antibiotic treatment.

Educational models are used to study the behavior and plan for changing and determining the factors that affect the individuals’ decision making for conducting a behavior. This study aimed to compare the effects of the educational program based on BASNEF model and acupressure at GB21 point on the infants’ physical growth indicators. This clinical trial was conducted on 150 (50 per group) pregnant women in 2011-2012. The interventions included educational program based on the BASNEF model and application of acupressure at GB21 point. The infants’ physical indicators were compared to the control group one and three months after birth. The study data were analyzed using repeated measurement test, paired sample T-Test, one-way ANOVA, and Tukey’s test. The results showed a significant difference between the intervention and the control group regarding the infants’ weight and height one and three months after birth (P<0.05). However, no significant difference was found between the training and the acupressure group in this regard (P>0.05). Also, no significant difference was observed among the three groups concerning the infants’ head and arm circumferences (P>0.05). BASNEF model improved the infants’ height and weight. Application of acupressure also improved the infants’ height, weight, and head and arm circumferences compared to the control group. Hence, learning and application of techniques and models by the medical team are highly essential.

Acute Respiratory Infections (ARI) are the main cause for Antibiotic (AB) use in all age groups, specially during the first two years of life. The local information about the pattern of AB prescription in ARI is a necessary part of any program which aims for logical use of AB. The current study was designed to find the frequency and types of AB administration for ARI in young children (<2years) in Mashhad, Iran. This is an observational cohort study which started in November 2005 and ended in May 2006. The study group was composed of 1000 infants between 6 month and 20 months old. The children were followed monthly via telephone calls (for up to six month after the first interview) and were surveyed on the signs and symptoms of Acute Respiratory Infection and systemic Antibiotic use during each month. The average monthly incidence of ARI was 34.5% in the study population; 66.3 % (mean) of the children with ARI were visited by a doctor, which resulted in AB prescription in 32.7 % (mean) of times. The frequency of injectable antibiotics was almost twice for oral ABs, and benzatin penicillin was the most prminent prescribed AB (54% of all ABs). The rate of AB administration for infants with ARI is not very high in Mashad city. However, the frequency of AB injections is unacceptable.

NEC is inflammatory necrosis of the intestine, with the most common sites in preterm babies being the terminal ileum and the ascending colon (1). The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth; i.e. the earlier a baby is born, the longer the time of risk for NEC in premature babies. The incidence of NEC is inversely proportional to the gestational age and birth weight (2). The baby may have initial symptoms that include feeding intolerance, increased gastric residuals, abdominal distension, and bloody stools (3). The laboratory triad includes metabolic acidosis, hyponatremia, and thrombocytopenia. Pneumatosis intestinalis is the pathognomonic radiological finding in the NEC. Modified Bell’s staging is used to stage the NEC. Treatment involves Nil per Oral, supportive care, antibiotics, surgery in advanced stages, and parenteral nutrition (4, 5). Complication of NEC includes mortality, prolonged NICU stay, intestinal strictures, enterocutaneous fistula, intra-abdominal abscess, cholestasis, and short-bowel syndrome, and neurodevelopmental, motor, sensory, and cognitive problems (6-9).

Holoprosencephaly is a rare congenital brain malformation resulting from failure of diverticulation and cleavage of primitive prosencephalon which occurs at 4 - 8th week of gestation and is usually associated with multiple midline facial anomalies. It is the most common forebrain developmental anomaly in humans with prevalence of 1/16,000 in live borns, an incidence as high as 1:250 in conceptuses, and a worldwide distribution. The etiology of HPE is very heterogeneous. First, this pathology can be caused by environmental or metabolic factors. The only formally recognized environmental factors are insulin-dependent diabetes mellitus (1% risk of HPE) and maternal alcoholism with a risk that cumulates with smoking. Clinical expression is variable, extending in unbroken sequence from a small brain with a single cerebral ventricle and cyclopia to clinically unaffected carriers in familial holoprosencephaly. We report a Holoprosencephalic newborn with antenatal ultrasonographic diagnosis of; microcephaly, hypotelorism, flat nose, a single nostril; midline cleft lip and palate.