Tehran University Medical Journal

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Ito cell (Fat Storing Cell=FSC) is one of the cells which forms the liver sinusoidal wall it also forms the connective tissue of the liver. The cell was first identified in 1963 by a scientist named Ito. It will get damaged due to the plasma fat increase which is resulted from a diet of corn oil 10% and fish oil 10% the damage wil be in form of fat storing cell. The FSC morphology may represent the damage to the liver tissue. The biopsy of an infant's liver reveals that, Ito cell has a very small cell body which contains a core in the middle occupying 2/3 of the area of cytoplasm its basal cytoplasm is hollow and very clear. This study indicated that not only the ultrastructure of Ito cell is circular and three dimensional, but also its presence may show the damage to the liver tissue.

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Some of the endocrinologic diseases, especially Acromegaly, Cushing and Pheochromocytoma have multiple effects on blood glucose metabolism and regulation in non-diabetic patients. In this retrospective survey, records of patients of Tehran Medical Sciences University hospitals have been reviewd. Of 124 Acromegals, GTT was performed for 51 patients, being impaired in 18%. To evaluate diabetes, FBS and BS of 90 patients were checked, overt diabetes was detected in 27%. Among 90 Cushing patients, blood glucose was checked in 60 cases, 47% of these patients had levels above the normal range, and 39% had glucosuria. Among 80 Pheochromocytoma patients, 16 cases (26.5%) had overt diabetes. In comparison with other studied, we have obtained a little different results concerning diabetes and impaired GTT prevalence

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Background: Mental health of prisoners, as a high risk group, is of considerable importance. Unfortunately limited data is currently available about psychiatric morbidity of this group in Iran. This study was designed to determine the prevalence of axis I disorders in prisoners and their correlation with the type of offense.

Methods: Using stratified random sampling 351 prisoners from five offense categories (54 from financial, 71 from violent, 74 from nonviolent, 72 from drug related and 80 from immoral acts subgroup) were recruited into the study, and examined by Structured Clinical Interview for DSM-IV.

Results: Eighty- eight percent of the prisoners had experienced at least one axis I disorder throughout their lives, and 46.9% met the criteria for current disorders. Substance related (78%) and mood disorders (48.7%) were the most prevalent of lifetime disorders. However, mood (30.7%) and adjustment (12.6%) disorders had the highest amounts in current diagnoses. The total number of disorders was lowest in the financial subgroup. The drug related subgroup had lower rate of anxiety and higher rate of substance related disorders.

Conclusion: Compared to western studies, the prevalence of axis I disorders in this study is among the highest. The fact that about half of all prisoners at the time of study suffered from at least one axis I disorder shows the emergent need of this group for more mental health care and services.

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Background: Over the past two decades we have seen a marked increase in the survival of very low birth weight infants. This increase in survival has been attributed to increased use of corticosteroids, regionalization of perinatal care, improved methods of mechanical ventilation, availability of exogenous surfactant, and improved nutritional therapy. However, the reduction in mortality has not been accompanied by a reduction in neonatal morbidity or long-term handicaps. Preterm labor is a major issue in Iran. Besides various etiologies, preterm labor may be due to a biochemical alteration, such as magnesium. It is known that magnesium plasma levels fall during pregnancy. Since magnesium has an inhibitory role on myometrial contractions attention has been paid to the role of magnesium deficiency in preterm labor. Hypomagnesemia leads to neuromuscular hyperexcitability resulting in muscle cramps and uterine hyperactivity. The aim of this study was to determine the relationship between serum magnesium levels and preterm delivery in order to circumvent the high morbidity of preterm delivery by early diagnosis of this deficiency.
Methods: Serum magnesium was measured in 42 cases of preterm labor of idiopathic etiology (28-37 weeks) and 42 normal pregnancies at the same gestational age.
Results: Hypomagnesemia was variable in preterm labor cases, with only slightly low values in normal pregnant women.
Conclusion: Our study indicates that serum magnesium levels during pregnancy can be a valuable predictive tool for preterm labor. Hypomagnesemia must be considered in all pregnant women with preterm labor and supplementation must be provided effectively.

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Background: Kawasaki disease (KD) is an acute vasculitis in children. Eosinophilia, a reflection of the host's immune response that can cause tissue damage, has been associated with KD, with eosinophils preferentially accumulating in the microvasculature. In early-stage Kawasaki disease (KD), lesions (perivasculitis and vasculitis) first form in the microvessels, which can then extend to the larger vessels and result in coronary artery aneurysms, possibly leading to myocardial infarction even in young children. Overall, the prevalence of coronary artery aneurysms in children with Kawasaki disease is about 10-18%, which is much higher among those not treated early in the course of the illness.  We performed this study to gain a better understanding of the initial pathogenesis of KD and to assess the relationship between eosinophilia and coronary artery disease.

Methods:  The data from forty-eight patients at Vali-asr Hospital of the Tehran University of Medical Sciences (1996-2006) were included in this cross-sectional descriptive analysis. The presence and degree of coronary artery disease was assessed by echocardiography. Data was analyzed via Fisher's exact test and student's t-test using SPSS software, v. 11.5.

Results: Eosinophilia was seen in 10 cases (22%) and cardiac lesions were observed in 19 cases (41%). The frequency of microvessel lesions was significantly lower in patients with eosinophilia (10% with eosinophilia versus 50% without eosinophilia, p<0.03). The frequency of microvessel lesions was lower in males than in females (35 vs. 44%, respectively), although this was not significant. We found no correlation between the frequency of microvessel lesions and age.

Conclusions: In spite of the controversies regarding eosinophilia and microvessel lesions, in this study the number of circulating eosinophils was associated with fewer cardiac lesions. Comparative studies are needed to determine the exact relationship.

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Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT) to treat female stress urinary incontinence.

Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder), uroflowmetry and post-voiding residual volume assessment.

Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months) and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion) was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment.

Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.

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Background: Over the last 35 years, quinacrine has been used to sterilize more than 150,000 women in 40 countries, first in the form of slurry and now in the form of cylindrical pellets. Some studies confirmed the tubal occlusion by hysterosalpyngo-graphy, but this method increases the chance of failure. Only a few studies on tubal occlusion have used transvaginal sonography for confirmation, and there were some doubts about the effect of quinacrine on the endometrium. We performed this study to evaluate the tubal scar and endometrial pattern by ultrasound and to determine the feasibility, acceptance, and side effects of quinacrine sterilization (QS) in Iranian women
Methods: This prospective clinical trial was done at the Vali-e-Asr Reproductive Health Research Center of the Tehran University of Medical Sciences between April 2005 and July 2006. One hundred sexually active women ranging from 30 to 47 years of age, who had at least two children above two years old, requesting sterilization, were sterilized by this method. By the end of menstrual bleeding, seven pellets, each containing 36mg quinacrine, were inserted in the uterine fundal area via the cervical canal. The procedure was repeated one month later. Three cycles after the first step, transvaginal sonography was performed to visualize the tubal scar and determine the endometrial pattern. Patients were followed at one and three years after initiation of the procedure.
Results: All women were satisfied with the procedure. There were no side effects. No pregnancies had occurred, nor were there endometrial thickness abnormalities. Scar formation was visible in the tubes. Conclusion: Quinacrine sterilization is a useful method for women and can be recommended to family planning services as an ambulatory procedure due to its efficacy, simplicity, acceptance and cost effectiveness.

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Background: Preeclampsia is a disorder of pregnancy with increased maternal and perinatal morbidity and mortality. An imbalance between free radical induced lipid peroxidation and antioxidant system has been suggested as possible pathogenesis of preeclapsia. It has been shown correlation of some serum antioxidant agents (for example ceruloplasmin) with preeclampsia and its severity. The purpose of this study was to evaluate of this correlation.

Methods: In a analytic case-control study, in clinic and delivery unit of Mirza Koochak Khan university hospital, Tehran, we evaluated 90 pregnant women of 19-38 years old with gestational age higher than 20 weeks in two groups, case (preeclampsia) and control (healty mother). Case group was devided into two groups mild preeclampsia (n=30) and severe preeclampsia (n=30). Patients with preeclampsia (n=60) had either early (n=41) or late preeclampsia (n=19). Control group included 30 normotensive pregnant women. Serum Ceruroplasmin level was measured. Then relationship between this factor and preeclampsia was studied.

Results: The mean level of serum ceruloplasmin in women with severe preeclampsia (390.83mg/dl) and mild preeclampsia (319.43mg/dl) was higher than control group (212.7mg/dl). Likewise it was significantly higher in severe preeclampsia than mild (P<0.001) and higher in early (373.28mg/dl) than late preeclampsi (298.34mg/dl) (P<0.01).

Conclusions: Our data suggest that serum ceruroplasmin level may predict preeclampsia occurrance and its severity. Likewise antioxidant theryapy before the onset of preeclampsia in an attempt to decrease its frequency should be considered.

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Background: Axillary block is used for inducing anesthesia in outpatient hand and forearm surgeries. Few researches have studied hemodynamic and blockade effects of low doses of Epinephrine. The aim of the present study was to compare the duration of analgesia and hemodynamic changes following the injection of high/low epinephrine doses in such surgeries.

Methods: The present randomized clinical trial study was conducted on healthy individuals (ASA I-II) who were candidates for hand and forearm surgeries. The patients were randomly divided into three groups. The first two groups were allocated to receive lidocaine with low (0.6µg/cc) and high (5µg/cc) doses of epinephrine whereas lidocaine plus normal saline was injected in the third group. The hemodynamic changes (Mean arterial blood pressure and heart rate) and the occurance of any side-effects along with the duration of analgesia and motor block were recorded.

Results: From among the total of 75 patients, 15 cases were excluded due to incomplete blockade or failure needing general anesthesia. The duration of analgesia and the motor block were longer in the high dose epinephrine group, the difference, however, was not statistically significant. Heart rate changes within the groups was significant in the 4^th-7^th and 10^th minutes. Mean arterial blood pressure changes was only significant in the 4^th minute, within the groups.

Conclusions: Administering low doses of epinephrine plus lidocaine as a local anesthetic not only provides acceptable analgesia compared to higher doses of the medication, but also is associated with fewer side effects.

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Background: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication) makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births.

Methods: A cohort study was conducted on 303 primiparous women who had delivered vaginaly and 315 primiparous delivered by elective cesarean section in seven private hospitals in Tehran, employing data of demographic characteristics like age, education, BMI, obstetric history (weight gain in pregnancy, history of pelvic pain and vaginal discharge), stress incontinence history (prepregnancy and during pregnancy) and effect of delivery on sexual satisfaction in several follow-ups until 12 months after delivery.

Results: Sexual satisfaction after delivery in vaginal group was significantly more than cesarean group. (76% vs 60%, p<0.0001). There was no relation between pelvic pain & delivery type (in several follow- up).

Conclusions: Instead of social conception of have more sexual satisfaction after cesarean delivery, outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. Therefore Request of cesarean section by mother for having more sexual satisfaction after childbirth is not logic.

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Background: The transfer of multiple embryos during ART procedures (IVF/ICSI) in order to maximize the chance of pregnancy, has resulted in increasing rates of multiple pregnancies with a 20- fold increased risk of twins and 400- fold increased risk of higher order pregnancies with significantly high maternal and perinatal morbidity and mortality in comparison with singleton. Since at present there is no limitation in number of embryos being transferred in ART cycles in infertility centers in Iran, in order to evaluate the relationship between number of embryos transferred, pregnancy rates and multiple pregnancy, this study was performed in a referral university center.

Methods: In a cross sectional descriptive analytical study a total of 536 ART cycles in infertile patients treated at the Infertility Department of Vali-e-Asr Hospital & Vali-e-Asr Reproductive Health Research Center from October 1999- March 2003 were evaluated using a questionnaire dealing with the parameters affecting ART outcome.
Results: There was a total pregnancy rate of 21% with a multiple pregnancy rate of 12%. Increased age had a negative effect on pregnancy rate with a significant difference over 40 years (p<0.05). Pregnancy rate was higher with increased number of transferred embryos but it was only statistically significant when three versus two embryos were transferred (p<0.008). When more than three embryos transferred, although there was an increase in pregnancy rate, the difference was not statistically significant, but there was a significant increase in multiple pregnancy rate.
Conclusions: The maximum number of transferred embryos in ART cycles should not precede three embryos especially in age groups less than 40 and also when good quality embryos are available.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: The abdominal sacrocolpopexy is the gold standard method of vaginal prolapse correction and posterior intra- vaginal slingplasty (posterior IVS) is a newer procedure with minimal invasion. This study is going to compare the effectiveness and complications of these two surgical methods.
Methods: In this study, 51 patients with prolapse admitted to vali-e-asr Hospital of Tehran University of medical science were evaluated during years 2001-2004. 26 patients were operated by posterior IVS method (the first group) and 25 of them had undertaken sacrocolpo-pexy (the second group). Data were primarily gathered from patients' folder and further complimentary information were achieved by two years follow-up and inviting patients to interview or exam.
Results: Eighty percent of women with abdominal sacrocolpopexy were cured compared to 96.2 percent with posterior IVS. Surgery complications was reported in one patient (4%) of second group while none of patients in first group experience this and the difference was not statistically meaningful. Short-term post surgical complications (hemorrhage-perforation fever and abdominal distention) were also negative in first group (posterior intra vaginal slingplasty) but these problems such as fever and abdominal distention were positive in 36% of second group (abdominal sacrocolpopexy) which was evidently statistically meaningful (p=0.001). Long- term post surgical complication (tape and mesh disfunction) were seen in 7.7% of first group while none of second group patients showed these complications.
Conclusion: According to shorter operating time, lower complications and efficient response to therapy in posterior IVS method, it can be an alternative in prolapse surgery it is preferred in elderly patients with medical problems.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Low-birth-weight (LBW) children are at higher risk for failure to thrive. The aim of the study was to establish the trend of physical growth in Until now their growth was evaluated with normal birth weight baby's chart.
Methods: In this cohort study we investigated demographic characteristics and growth trend during the first of life 406 newborn divided into three groups: LBW (Low Birth Weight) n=103, VlBW (Very Low Birth Weight) n=20 and NBW (Normal Birth Weight) n=303. Body weight, length and head circumference were measured at the time of birth and several follow ups until 12 months of chronological age.
Results: NBW growth trend adopts the standard chart. Significant differences in terms of physical growth (weight- height- head circumference) were seen between the two groups of preterm (LBW & VLBW) and NBW children. Although it was demonstrated that growth velocity of preterm & NBW children were the same. Significant differences for weight was seen between VLBW and LBW group only until 6 months after birth. This difference was seen for height and Head circumference until the end of the first year of life.
Conclusions: VLBW and LBW babies need special growth charts. But the adjustment method of anthropometric traits to gestational age may be useful to evaluate LBW baby's growth.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Zinc is one of the elements necessary for growth and health in human. Some evidences indicate that zinc deficiency is one of real difficulties for the public health in both developed and developing countries. Since the pregnant women are more at risk of zinc deficiency, the objective of this study was to determine the rate of zinc deficiency in pregnant women in the 3 trimesters and to compare these data with that of the healthy controls.
Methods:  This research was an analytic- descriptive study which was done on 677 pregnant women in 3 Trimesters and 140 non pregnant groups who referred to clinic of Tehran University. Blood sample were taken And serum zinc was assessed By Enzymatic technique.
Results:  The prevalence of zinc deficiency is 16% in pregnancy and 0% in non pregnant women with a significant difference between two groups (p<0.001). Zinc deficiency had no relation to mother's age, gestational age, Iron supplementation, Parity and mothers BMI. Hemoglobin level showed a direct relation to zinc deficiency and was grossly found to be more prevalent in Hb levels less than 12 (CI: 1/36-4/26, OR=2/4).
Conclusion: Acording to the finding of presented study, zinc deficiency is more prevalent in Hb<12 inspite of iron supplementation. Iron and zinc supplements in pregnancy period seem to be more effective for Hb repair in each case.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Increased total plasma homocysteine (Hcy) is an accepted risk factor of cardiovascular disease (CVD), stroke, preclampsia, recurrent abortion and diabetes type I and II. The aim of the current study was to assess serum homocysteine and its relation with serum folat, vitamine B12 and lipid profile in gestational diabetes mellitus and to compare these with those of pregnant women.
Methods: In a prospective controlled survey 80 pregnant women (24-28 weeks) with uncomplicated pregnancies were evaluated. They were assigned to one of two groups according to the results of 100g-OGTT. In the case group there were pregnant women with gestational diabetes mellitus according to the OGTT and in the control group women who had normal OGTT results were put. Levels of fasting glucose, homocysteine, vit B12, and folic acid, uric acid, total cholesterol, triglyceride, Low Density Lipoprotein cholesterol (LDL) and High Density Lipoprotein cholesterol (HDL) were measured in both groups.
Results:  The mean level of homocysteine in GDM group was significantly higher than control group (p=0.000). The mean level of folic acid and vit B12 was significantly lower than the level in control group (p=0.001, p=0.004 respectively). Body mass index (BMI) in GDM group was higher (p=0.000) and HDL level was lower (p=0.006) than control group. There were no significant differences among the groups with respect to levels of total cholesterol and triglyceride.
Conclusion: We found that patients with gestational diabetes have higher homocysteine level than normal pregnant women. This increased level seems to be related to an abnormal OGTT. Further investigations are needed to follow up these patients in the postpartum period and later on.

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Background : Septic Arthritis is an acute infection of intra-arthicular space. Delay in diagnosis and in appropriate treatment may lead to prolongation of treatment duration and poor outcome. We decided to evaluate clinical aspects of this disease in our department pediatric department, Imam Khomeini Hospital complex, Tehran, Iran during a 10 years period.

Methods : In a retrospective cross-sectional study, 60 patients with age from 1 month to 14 year-old during 1996-2005 were evaluated. The demographics characteristics, clinical observations (signs & symptoms) and paraclinic values were gathered from medical records and analyzed with statistical tests.

Results : Pain and Swelling was seen in all, joint limited motion in 80% ( 50 cases) claudicating in 64% ( 38 cases), fever in 80% ( 48 cases), monoarticular disease in 80% ( 48 cases) and polyarticular one in 20% ( 12 cases) of them. Hip was most Common involved joint 62% ( 37 cases), elevated ESR was seen in all patients. CRP was positive in 85% ( 51 cases). Leuckocytosis was found in 65/8% ( 17 cases) of cases. In infectious cases, Staphylococcus aurous was responsible organism in 65.6% ( 16 cases), klebsiella in 12.4% ( 3 cases), Streptococcus pneumonia in 12.3% ( 3 cases), group b streptococcus in 4.1% ( 1 case), Hemophilus Influenza type b in 4.1% ( 1 case) of study patients. With therapy ESR was normalized in 64% ( 39 cases) and CRP was normalized in all patients.

Conclusions: In general, all children with complaint of fever, pain, and limited joint motion or claudicating should be suspected for septic arthritis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stress urinary incontinence is a major confounding factor which impairs health quality in women. Some procedures cannot resolve it&aposs impact on life quality. This study aims to assess a less common and newly method use of transobturator tension- free vaginal tapes (TOT) in regard to short- term and long-term morbidity and impact on patient&aposs quality of life (QOL).

Methods: Fifty four patients diagnosed with urinary stress incontinence, underwent a transobturator tension free vaginal tape procedure with or whitout prolapse surgery. Pre and post operative quality of life assessed with Incontinence- specific Quality of Life questionnaire (I-QOL), and objective and subjective cure rate according to patients signs and symptoms before operation, early and late surgical complications like hemorrhage, Injury and/ or perforation of bladder, intestine, urethra and infection were mentioned.

Results: The overall intraoperative and early post-operative complication rates were 5.5% and 3.7%, respectively. No case of hematoma, bladder or bowel injury was seen.   I-QOL scores were significantly higher after surgery. The mean I-QOL score were 23.6 and 64 before and after surgery respectively (p<0.0001). This improvement was independent of the concomitant pelvic floor repair surgery, menopause, underlying diseases, number of parity, body mass index (BMI) and age. The global rate of objective cure was 94.4% (p<0.0001). The majority of women were satisfied with the outcome. (subjective cure was 90.7%- p<0.001).

Conclusions: This study demonstrates that the TOT approach in the treatment of stress urinary incontinence is a safe and effective procedure which promotes health quality of life.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: American pediatric Association proposes to screen all neonates with Oto-Acoustic Emission (OAE). In developing countries, because of several limitations, health policy makers recommend to screen only in high risk patients. This study is performed with the aim to screen hearing loss in 950 high risk newborns hospitalized in hospitals affiliated to Tehran University using the OAE test.
Methods: A total of 950 neonates hospitalized in the Neonatal and NICU wards of Vali-e-Asr, Shariati, Medical Center and Bahrami Hospitals during the years 2004-2006 who showed at least one risk factor using TEOAE hearing test were enrolled into this cross-sectional descriptive analytical study and were diagnosed with mild deafness and total deafness. Blood exchange due to hyperbillirubinemia, septicemia, congenital heart disease, the fifth minute apgar scores below six, PROM more than six hours, epilepsia, need to NICU more than five hours, pneumonia and Oto-Toxic drugs were considered as risk factors. Data was past medical history, current disease, admission cause, sign & symptoms and complications of disease.
Results: Multivariate logistic regression and paired t-test showed that blood exchange, low birth weight and low first minute Apgar scores had the highest independent risk for hearing loss among newborn.
Conclusion: Despite of the low prevalence of neonatal hearing loss, screening of hearing loss at early stages is important.

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Background: Soft tissue chondroma is a rare slow-growing benign cartilage forming tumor. Tumors of this kind arise from the relative mesenchymal tissue and have tendency to occur in the fingers and toes. Due to its rarity, this tumor is likely to go undiagnosed. Histopathological examination usually reveals the correct diagnosis. Case presentation: Hereby, we report a case of soft tissue chondroma in a 27 year-old woman presented with a slow-growing mass in the volar aspect of her right hand. The tumor had developed over a 7-month period. The skeletal system was unremarkable on X-ray evaluation. The lesion was excised and the histopathological findings revealed a well-delineated cartilaginous neoplasm with lobular pattern. The tumor was composed of mature chondrocytes without atypia and the findings were compatible with chondroma. Conclusion: There are various hypotheses about the etiology of soft tissue chondromas and their microscopic findings are variable. They have a good prognosis. Recurrence is rare and malignant transformation has not been reported yet.

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Background: Neonatal jaundice, especially breast feeding jaundice is one of the most common causes of neonatal readmission during the first month of life. Breast feeding jaundice may be due to decreased milk intake with dehydration and/or reduced caloric intake.  The aim of this Study was to determine maternal risk factors of breast feeding jaundice in order to prevent it than before.
Methods: This case- control study was performed at Bahrami University Hospital, Tehran, Iran and involved 75 term exclusively breast fed newborns admitted for hyperbilirubinemia, with a weight loss greater than 7%, with one positive lab data as: serum Na&ge 150meq/lit, urine specific gravity> 1012, serum urea&ge 40mgr/dl, without assigned cause for hyperbilirubinemia. They were compared with 75 matched controls with weight loss less than 7%, without dehydration and a known cause of hyperbilirubinemia.
Results: In comparison with control group, in neonates with breast feeding jaundice, inappropriate feeding practice (P<0.033), delayed onset of lactation (P<0.0001), inverted nipple (P<0.001) were significantly higher. In our study, there was no significant difference between two groups in education level of mother, learning breast feeding practice before and after delivery, method of delivery (cesarean or vaginal delivery), primiparity or multiparity and use of supplements (water or glucose water).
Conclusion: This study shows need for special attention and follows up of mothers and neonates at risk for breast feeding jaundice, especially those with inverted nipples or undergraduate for successful breast feeding. On the other hand this study shows encouraging mothers for early lactation especially in the first hour of life decreases the risk for this kind of jaundice.