Iranian Journal of Neonatology
Volume:6 Issue: 1, Winter 2015

Neonatal deaths mostly occur within the first one week and first 24 hours of life from a variety of conditions. To examine the role of significant hypothermia and hypoglycaemia, in addition to some other factors, in neonatal mortality occurring within the first 24 hours of admission. A prospective study of newborn infants hospitalized within the first 24 hours of life in a Nigerian Special Care Baby Unit. The axillary temperature and serum glucose at the point of admission were recorded for consecutive admissions. Significant hypothermia (axillary temperature < 36C) and hypoglycaemia (random blood glucose < 40mg/dl) were related to the risk of death within the first 24 hours of admission using bivariate and multivariate analysis. Out of 277 infants, 24.2% and 27.3% had significant hypothermia and hypoglycaemia respectively. The overall mortality rate was 21.6% (49/227); 38.8% (19/49) of the infants died within the first 24 hours of admission. The Case Fatality Rate (CFR) among infants with co-existing significant hypothermia and hypoglycaemia was 41.2% compared to 0.9% among infants with neither significant hypothermia nor hypoglycaemia. Death within the first 24 hours of admission was significantly associated with hypoglycaemia, significant hypothermia, asphyxia and apnea using both bivariate and multivariate analysis. Deaths within the first 24 hours of admission, among infants admitted within the first 24 hours of life constituted close to 40% of all neonatal deaths in the present study with significant hypothermia and hypoglycaemia as major independent contributors.

TORCH infections causing via Toxoplasma gondii, other microorganisms (e.g., Treponema pallidum), Rubella virus, Cytomegalovirus (CMV) and the Herpes Simplex Virus (HSV) types 1 and 2 during the first trimester of pregnancy can lead to severe fetal anomalies or even fetal loss. The current study determined the serological data of TORCH infections in women who were in their first trimesters of pregnancy.This descriptive study was carried out on 80 pregnant women in their first trimester in Kashan, Iran. To detect specific IgM antibodies and specific IgG antibodies against the TORCH infections via ELISA, Sera were collected from the pregnant women. The specific IgG antibodies were found to be positive in 30(37.5%) cases for toxoplasmosis, in 74 (92.5%) cases for the Rubella virus, in 79(98.8%) cases for CMV and in 73 samples (91.3%) for the HSV types 1 and 2 infection. 3.8% of cases were found to be seropositive for Toxoplasma IgM antibody (95% CI, 0.38-7.9), 5% were positive for CMV IgM antibody (95% CI, 0.23-9.77) and 7.5% were positive for the HSV IgM antibody (95% CI, 1.8-13.2). 63.8% of pregnant women were at risk for at least to one of the TORCH agents. This study showed a high prevalence of infections caused by TORCH agents among pregnant women. Therefore, national screening programmed is necessary to screen the TORCH infections routinely and to prevent and treat congenital TORCH infection.

Considering the rarity of umbilical cord prolapse (UCP) and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS) due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition. Patients & Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients'' records and analyzed by SPSS version 18. Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00), engagement 8 times (14% vs 2% -P<0.001), transverse presentation 8 times (6% vs 2%-P<0.002), grand multiparity 3.9 times (4% vs 0-P<0.001), oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001). UCP was more prevalent in post-term deliveries (P<0.043). One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00). Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group. A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.

Phenylketonuria is an autosomal recessive disease. Early diagnosis is a important public health intervention to prevent neurological impairment. This study was designed to describe characteristics of phenylketonouria patients in Khorasan, Northeast of Iran. We included all  patients suffering from PKU in khorasan until September 2013. We gathered the variables like diagnosis age, sib of parents, cause of asking physician and screening based diagnosis or clinical based diagnosis. We use descriptive statistics for analysis. The mean age of diagnosis was 19 months. 80% pku patients had a positive history of consanguineous marriage in their parents. Incidence of new cases that identified by screening in 2012-2013 was 57 per 1000000 live birth. 10% patients identified with screening in first week of birth. Nearly all of our patients (90%) had been diagnosed without screening in the first days of their life only due to clinical manifestations in the first year of their life. According to efficacy of early diagnosis and dietary treatment, enforcement of public health policy for screening is a critical public health preventive intervention.

Infantile colic is a common complaint in the first few weeks of life. On the other hand, because of its unknown etiology, there is not a specific therapy for this complaint, but various therapeutic options for reducing pain and restlessness of these infants are recommended. Skin to skin contact by Kangaroo Mother Care (KMC) increases in pain threshold and it seems to be a suitable method for the care of these infants. This study was designed to evaluate the effect of KMC on infantile colic. This case- control study was performed between March 2012 and March 2013. Subjects were 55 infants with exclusive breast fed infant, aged 15-60 days with excessive fuss and crying, referred to Infant and Child Clinic in Ayatollah Rohani Hospital in Babol, north of Iran. Babies whose weights were less than 2500 Grams and with inheritance and clinical diseases excluded from the study. Infants were subjected to KMC at least 2 hours a day. Standard questionnaire and Barr Scale were filled by interview. Data was analyzed by SPSS v.11.5 and T-test, a P- value less than 0.05 considered being significant.The fuss and crying time before the KMC was 2.21±1.54 hours per day and decreased to 1.16±1.3 hours per day after the implementation of KMC. (p=0.001)Kangaroo mother care at home can be used as a simple and safe method for decreasing of cry and fussiness in colicky infants.

Head circumference (HC) measurement is one of the important parameter for diagnosis of neurological, developmental disorders and dysmorphic syndromes. Recognition of different disorders requires an understanding of normal variation for HC size, in particular, in infancy period with most rapid growth of the brain. Because of international and interracial standard chart differences about anthropometric indices, some differences from local to local, generation to generation and changes in ethnic mix of population and socioeconomic factors, periodic revolution of HC size is suggested. The aims of our study were presenting local HC standard for an Iranian infant population and comparison with the American national center of health statistics (NCHS) charts accepted by WHO. 1003 subjects aged from birth to 24 months apparently healthy normal children enrolled randomly in this cross sectional study. HC size were measured and recorded. Tables and graphs were depicted by Excel Microsoft Office 2007. We use two tailed t-student test for statistical analysis. The mean of HC size in boys was larger than girls. The curves were followed a similar pattern to NCHS based on a visual comparison. Overall our subjects in both sexes at birth time had smaller HC size than NCHS. In other ages our children had larger HC size than those of NCHS. Because of international and interracial difference of HC size. We recommend in each area of the world, local anthropometric indices are constructed and used clinically. In addition more extensive and longitudinally design comprehensive studies is suggested.

Premature infants may be more vulnerable to fungal infections because of their immature immune system, poorly developed epithelial skin and mucosal barriers, and the high rate of invasive procedures, such as central venous catheters and intubation, which compromise host defenses (eg, skin integrity).Voriconazole is a newer systemic antifungal agent effective against Candida and Aspergillus. There are few reports of its safe use in newborns. We report the first case report - a 29 gestational age-900 gram baby girl of safe Voriconazole use in a critically ill with profound pancytopenia –huge hepatosplenomegaly due to fungal infection resistant to amphotericin B.With beginning oral Voriconazole all liver functions tests what were severely abnormal returned normal with normalizing of the size of liver and spleen. It was noted to be safe and well tolerated by the newborn. Because of oral administration of it, voriconazole is a very good choice for fungal infections in neonates.

Meningitis, pneumonia, and sepsis in newborns and young infants (age < 60 days) are the main causes of childhood mortality in developing countries. Even though streptococcus pneumonia is the most commonly detected microorganism in pediatric bacterial meningitis, it is rare in newborn infants. The following article reports a case of pneumococcal meningitis that was detected early in a newborn infant in 2013. A female baby was born by vaginal delivery with a birth weight of 2900 grams. She was symptomatic (poor feeding) from her first day of life, but she was admitted with a toxic status (dehydrated, lethargic, cyanotic, hypo tone, hypo reflex) to our referral center on her third day life. Her blood culture showed no growth of any organism and her urine culture was also negative, but the Cerebrospinal fluid (CSF) culture showed growth of streptococcus pneumonia. The maternal sepsis workup was normal. Despite all therapeutic management, unfortunately, the patient died on her fourth day after admission.