Iranian Journal of Neonatology
Volume:6 Issue: 2, Spring 2015

Cadmium is an extremely toxic metal with ubiquitous environmental distribution. Cadmium is a potent reproductive and developmental toxic agent, and intensive environmental exposure to this substance has been reported among the residents of Tehran. In this study, we investigated the correlation between amniotic fluid cadmium levels and the risk of preeclampsia, prematurity and low birth weight. This study was conducted on 341 hospitalized pregnant women. Amniotic fluid samples were obtained during childbirth, prepared by acid digestion, and cadmium concentration was determined using atomic absorption spectrophotometer equipped with a graphite furnace. In this study, the mean amniotic fluid cadmium concentration in non-smokers was significantly lower (780± 0.231 µg/l) compared to smokers (13.4±0.91 µg/l). Increased amniotic fluid cadmium levels were associated with the reduction of birth weight, and birth weight was below 2500 g in all the cases with amniotic fluid cadmium levels of >15µg/l. Moreover, preeclampsia was more prevalent among smoking mothers compared to non-smokers. The total incidence rate of preeclampsia (12.6%) was significantly higher in this study compared to similar studies. In addition, no correlation was found between amniotic fluid cadmium levels and the rate of prematurity. According to the results of this study, cadmium levels of amniotic fluid could be used as sensitive and reliable biomarkers to monitor the reproductive and developmental toxicity of cadmium.

Metabolic bone diseases (MBD), including rickets and osteopenia, are important neonatal complications among preterm infants. This study aimed to determine the prevalence and risk factors of MBD in neonates with very low birth weight (VLBW). This prospective study was conducted on VLBW infants from January 2012 to July 2013. Inclusion criteria were birth weight of ≤1500 g and age of ≤7 days, and the exclusion criteria were cholestatic disorders, skeletal anomalies and genetic syndromes. Serum calcium, phosphorus and alkaline phosphatase (ALP) concentrations were measured regularly until the 12th week of birth. In addition, wrist and chest radiographs were obtained from the neonates at 8-12 weeks of age. In total, 58 neonates with the mean gestational age of 30.6±2.65 weeks, weight of 1265±262 g and height of 38.06±2.49 cm were enrolled in this study. The correlation between biochemical parameters in multiple analysis and radiological findings of rickets was examined, and a significant association was observed between serum phosphorus level at the first week of age and the incidence of rickets. Moreover, 14 infants had only one radiologic sign of rickets (e.g. fraying, cupping, widening or lack of provisional zone of calcification (PZC), and 8 subjects (13.7%) showed at least two radiologic signs. The prevalence of osteopenia and rickets among infants with birth weight of <1200 g was 32.7% and 81.8%, respectively. In addition, 72.2% of the neonates with birth weight of >1200 g had normal X-rays (P=0.036). Despite the remarkable advances in the management of VLBW infants, MBD is still a prevalent complication during the neonatal period. According to the results of this study, birth weight and gestational age are the most significant risk factors for MBD.

Motherhood is a transformative and pleasing experience in a woman’s life. However, given the physical and psychological changes, it can induce a degree of stress and anxiety in mothers. The aim of the present study was to evaluate the effects of cognitive-behavioral stress management (CBSM) on maternal anxiety and depression during pregnancy and newborns’ Apgar scores. This semi-experimental study was performed by applying a pretest-posttest control-group design. Overall, 30 primiparous mothers were selected among women referring to health clinics of Kerman, Iran, using convenience sampling. Subjects were randomly allocated to experimental and control groups. Data were collected, using Pregnancy-Related Anxiety Questionnaire and Edinburgh Postnatal Depression Questionnaire. After completing the pretest, the experimental group was subjected to 12 sessions of CBSM training; posttest data were collected after the intervention. Multivariate analysis of covariance was performed, using SPSS version 16. P-value < 0.05 was considered statistically significant. The obtained results revealed a significant decrement in the average posttest scores of anxiety and depression in the experimental group, compared to pretest scores and the control group. Moreover, differences in 1- and 5-minute Apgar scores between the two groups were statistically significant. These findings indicated the effectiveness of CBSM during pregnancy in reducing maternal anxiety and depression. Pregnant women can benefit from psychological interventions such as CBSM in medical and health care centers.

The Baby-Friendly Hospital Initiative was launched in 1989 by World Health Organization and the United Nations Children''s Fund for the promotion of breastfeeding. This program was implemented in many departments of gynecology and obstetrics and resulted in reduced malnutrition, infection, morbidity and mortality in children. This program has introduced 10 specific steps to support successful breastfeeding. For instance, in the fourth step, skin-to-skin contact and breastfeeding are promoted since the time of birth, and in the fifth step, mothers are instructed on how to breastfeed or persist in breastfeeding. In these ten steps, mothers are trained in various fields. In this cross-sectional study, a standardized questionnaire was used to collect data at baby-friendly hospitals. To assess the difference between multiple nominal variables, variance analysis was performed, using SPSS version 17. Based on the analysis, mothers'' awareness of the benefits of breast milk and breastfeeding was 83% in a baby-friendly hospital. Also, their awareness of proper breastfeeding was estimated at 78.5%. In addition, mothers'' knowledge about the frequency of breastfeeding was 70%. Given the role of Baby-Friendly Hospital Initiative in training mothers on the importance of breastfeeding and its persistence in future, careful monitoring of these hospitals, breastfeeding support services and breastfeeding training by midwives at healthcare centers are of great importance.

The aim of this prospective study was to evaluate the characteristics of patients, treated by acute peritoneal dialysis (PD). We also assessed the indications for PD, PD-associated complications and neonatal outcomes in our patients. During five years, 30 term newborns underwent temporary cycling PD. The procedure was performed by applying the manual technique. A straight and relatively rigid peritocat catheter (Germany) was percutaneously inserted in neonates. Statistical analysis was performed, using Chi-square and student''s t-test. All subjects were term newborns, including 16 females (52%) and 14 males (48%). In total, 16 cases (52%) were born via cesarean section. The average age and weight of neonates at catheter insertion were 15 days (range of 5-26 days) and 2800 g (range of 2300-4060 g), respectively. The mean PD duration was two days. There was no significant difference between gender, weight, mode of delivery and associated complications. In total, 74% of patients needed assisted ventilation. No case of death was reported due to catheter insertion; however, 12 patients (40%) died during PD. PD-related complications were reported in 70% of patients, and the most common complication was catheter outflow failure (14 cases, 46%). The underlying causes included inborn errors of metabolism (16 cases, 52%) and acute renal failure (14 cases, 48%). Urea cycle enzyme defect, along with hyperammonemia, was the most common etiologic disease (9 cases). PD is an effective treatment for seriously ill newborns with life-threatening conditions such as acute renal failure or certain inborn errors of metabolism. However, mortality rate remains high due to the severity of underlying diseases and comorbidities.

Premature infants are among high-risk groups in community who need to be hospitalized at intensive care units for survival and receiving basic or special care. Hospitalization at neonatal intensive care units (NICUs) unsettles the family and leads to the separation of parents from their infants. This study aimed to determine the effects of maternal attachment behaviors on the behavioral responses of premature infants, hospitalized at NICUs. In this randomized clinical trial, 64 premature infants, who were hospitalized at NICUs and were eligible for the study, were randomly allocated to study and control groups. Attachment behaviors including touching, massage and kangaroo care were applied for the study group, while the conventional attachment method was adopted for the control group. Behavioral responses were evaluated two hours before and two hours after training attachment behaviors. Data were analyzed, using Chi-square and student’s t-test. The mean difference in the duration of deep sleep and consciousness was more significant in the study group, compared to the control group. Furthermore, the duration of drowsiness was significantly less in the study group, compared to the control group. The implementation of attachment training at NICUs decreased the time of drowsiness and improved behavioral responses, deep sleep time and consciousness.

Injury is a leading cause of morbidity and mortality in children. There is insufficient data on the epidemiology or incidence of injuries in the first two years of life, especially in Iran. The main objective of this study was to describe the incidence and causes of injuries in a sample group of infants and toddlers in Mashhad, Iran. This prospective, observational study, was conducted on 1000 infants (6-24 months old), admitted to 46 healthcare centers of Mashhad. The infants were observed in terms of the occurrence of injuries and the outcomes over six months. At the beginning of the study, the mean age of the infants was 13.8±7.8 months. During six months of observation, 382 episodes of injuries were detected. The injuries were burning (134 episodes), falling (132 episodes), cuts and lacerations (63 episodes), choking due to foreign body aspiration (40 episodes), poisoning (9 episodes), traffic accidents and electrical injuries (2 episodes each) and drowning (no case), respectively. During the study period, 42 injury-related outpatient visits (by a physician) were recorded, which were caused by burning (28 visits), falling (13 visits) and traffic accidents (one visit), respectively. Twenty-one cases of hospital admission were reported, although only two of them were caused by accidents (a case of falling and a case of burning). During the cold months, burns and falls were the main causes of injury in children, aged 6-24 months in Mashhad. However, injury was not a major cause of hospital admission in this group.

A common, early postpartum concern of the breastfeeding mother is nipple pain. Because of a lack of effective treatment and opposing results about lanolin, we decided to compare the effect of lanolin ointment and aloe Vera gel on nipple soreness treatment. This clinical blind trial was performed in Mashhad, Iran, from February 2008 to May 2009. Sampling was nonrandom and purposive, and then samples were divided randomly into two groups. After first applying the preparation on their arms to check for allergy symptoms, mothers were instructed to then rub the preparation on their nipples three times a day for seven consecutive days, each application performed after feeding the baby. Mothers were to let the preparation dry and not to wash it before the next feeding. Researcher pretreatment at the third and seventh day filled out the Storr scale with interviews and examinations. There were no complications in mothers and infants because of the drug’s usage The data was then analyzed with Spss 11.5 and Mann-Whitney, Student’s t-test, and t-paired tests. A total of 100 samples enrolled with 50 samples in the lanolin group and 50 samples in the aloe vera group. In aloe Vera group Nipple soreness scoring decreased significantly at the third day versus pretreatment (p=0.00) and also at the seventh day versus pretreatment and the third day (p=0.000). Nipple soreness scoring decreased significantly at the third day versus pretreatment (p=0.00) and also at the seventh day versus pretreatment and the third day (p=0.000, p=0.001). The two groups were homogenous at the pretreatment day (p=0.711), but there was a significant difference between the two groups at the third and seventh day (p=0.048, p=0.003). Aloe Vera is more effective than lanolin on nipple soreness healing.

Giant chorioangioma is a placental tumor associated with gestational complications such as preeclampsia, polyhydramnios and hemorrhage. In addition, this tumor might lead to the incidence of non-immune fetal hydrops, heart failure, anemia, thrombocytopenia, weight loss and death among neonates. In this case report, the clinical image of a term newborn (weighing 2800 g) with one-minute Apgar score of 7 was suggestive of sepsis on the second day of birth. Moreover, epistaxis, petechia, anemia, thrombocytopenia, hypothermia, cardiomegaly and hepatosplenomegaly were detected in the neonate, which required blood transfusion and antibiotic therapy. However, in case of chorioangioma in the gestational history, it was possible to detect the motive for a clinical sepsis-like disease. According to the pathophysiological explanation, this tumor functions as a «dead space», increasing the rate of blood ejection with subsequent fetal heart failure, anemia through intratumoral hemorrhage or fetal-maternal transfusion, and consumption or intratumoral sequestration resulting in disseminated intravascular coagulation. After blood transfusion, all treatment procedures, including antibiotic therapy, were suspended due to the recovery of the newborn.

Onychomycosis refers to nail infections, caused by fungi including yeasts and non-dermatophyte moulds. One or several toenails or fingernails (seldom all) may be involved in this condition. Many cases of fingernail onychomycosis are due to yeasts. Fungal infection has emerged as an important cause of neonatal infection, associated with significant morbidity and mortality, especially in very low birth weight (< 1500 g) and extremely low birth weight (< 1000 g) infants. Herein, we report a case of a 24-day-old male infant, who presented with onychomycosis on the left ring fingernail, associated with fungal urinary tract infection (UTI). The evaluation of nails helped us detect fungal UTI. To date, there have been no reports suggesting onychomycosis as a presentation of fungal UTI. We could not find the association between onychomycosis and neonatal fungal UTI. Hence, retrospectively, it can be said that onychomycosis was a presentation of fungal UTI. Further studies are required to evaluate the etiology and treatment of neonatal onychomycosis. Moreover, dermatologists should pay particular attention to this rare event.