Tehran University Medical Journal

Background: Jaundice is the common cause of hospitalization of infants in the first month after birth. Therefore, detection of risk factors associated with jaundice can effect on its process and complications. This study aimed to determine the prevalence and characteristics of diabetic mother's infants and comparing with infants with unknown jaundice.
Methods: In this cross-sectional study, among 2,800 infants with jaundice in Ghaem hospital in Mashhad during the 2007 to 2014, features of 59 infants of diabetic mother's (case group) and 78 infants with unknown jaundice (control group) were analyzed. After confirming of jaundice (Bilirubin ≥ 17 mg/dl) in newborns based on examination of pediatrician and laboratory results, a researcher made questionnaire containing maternal demographic data, (maternal age, parity, maternal problems during pregnancy, route of delivery). Also neonatal characteristics including age, sex, birth weight, current weight, duration of hospitalization, current age, age of recovery and laboratory data (Bilirubin, direct bilirubin, hematocrit, platelet, sodium, potassium, blood urea nitrogen, Cr, TSH, T4) were assessed. After data collection and recording information in SPSS software, version 19.5 (IBM SPSS, Armonk, NY, USA), by using tables, charts and statistical indices, the study was evaluated. Data were analyzed using statistical tests such as Mann-Whitney, Chi-square tests after normality control. Comparison of the two groups in normal distribution with t-test and for non-standard data with Mann-Whitney test. Also for definitive variables Chi-square test was used. P-value less than 0.50 was the significant level minimum.

Background: The length of maternal hospitalization in uncomplicated delivery has declined and it has become common event around the world. With the expansion of early maternal discharge from hospital in recent years, the identification, follow-up and proper treatment of neonatal problems such as jaundice have been confronted with challenges. Hyperbilirubinemia is the most common disease among neonates especially preterm neonates during the first week of life. This study was performed aiming to investigate maternal hospitalization duration after delivery and its effect on neonatal jaundice level.
Methods: In this descriptive-analytical study, 1347 newborns with the jaundice hospitalized in neonatal clinic or emergency unit or neonatal intensive units of Ghaem Hospital, Mashhad, during May 2011 to November 2017 were investigated. The data collection tool was a researcher-made questionnaire containing three parts. First part was maternal demographic information (age, long hospitalization, and mode of delivery), Second part was neonatal information (serum bilirubin, hematocrit and platelet) and third part was laboratory information (serum bilirubin, hematocrit, and platelet). The relationship between the severity of jaundice in hospitalized infants and maternal hospitalization duration were evaluated. Values were expressed as mean±SD. Student t-test, chi-square and Pearson coefficient tests were used as appropriate. P-value less than 0.05 was considered significant.
Results: 752 (fifty six percent) of mothers are discharged from the hospital at the end of first day. The mean maternal hospitalization duration was 1.31±0.57 days in normal delivery and 1.73±0.65 days in cesarean delivery (P=0.000). Pearson correlation test showed that increasing the duration of maternal hospitalization, some issues were observed including as decreasing serum bilirubin level (P=0.000) in newborns, increasing the admission age in hospital (P=0.045), decreasing daily weight loss rate (P=0.012) and decreasing the percentage of daily weight loss (P=0.002).
Conclusion: By increasing the hospitalization duration of the mother in hospital, serum bilirubin level, rate and percentage of daily weight loss in the newborns would be decreased.

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.

Background: dehydration fever is a common problem during the first week of life. This study aimed to compare the characteristics of neonates with fever due to dehydration and healthy infants.
Methods: This cross-sectional study was performed on 324 neonates including 120 neonates with normal body temperature and 204 neonates with fever due to dehydration (hyperthermia) referred to Ghaem Hospital in Mashhad, Iran from 2017 to 2019, using a convenience sampling method and a researcher-made questionnaire. Infants presenting with elevated body temperature and having an axillary temperature above or equal to the rectal temperature and with no clinical or laboratory evidence of infection were considered as fever due to dehydration (case group). Infants who were referred for a routine examination or had jaundice but did not require treatment were considered as controls. Infant characteristic (neonatal age, sex, Apgar score, defecation frequency, the first defecation, breastfeeding frequency, urinary frequency, duration of feeding, birth weight, daily weight loss, daily weight loss percentage, lethargy, irritability, mucosal dryness, status fontanelles, hyperthermia, convulsion, apnea, decreased consciousness and  infant hospitalization) and maternal information (age, weight, parity, hospital stay, breast problems, mode of delivery, breastfeeding position, delayed breastfeeding, and pregnancy problems. The data were analyzed using Student’s t-test, Chi-square and SPSS software, version 20 (IBM SPSS, Armonk, NY, USA).
Results: In dehydration fever of newborn, admission weight, frequency and duration of feeding, defecation frequency, maternal age were low, but time to first feeding were high (P<0.05). In fever of dehydration: restlessness, mucosal dryness, fontanel status, seizure, apnea, decreased consciousness, breastfeeding with traditional remedies, inappropriate breastfeeding position, lack of let-down reflex, delayed onset of lactation, breast problems and jaundice were more frequent.
Conclusion: Infants with fever of dehydration were more likely to weight loss, delayed in first feeding, shorter feeding times and lower duration of feeding, higher sodium, urea, creatinine, and blood glucose levels. According to the results of this study, breast problems, inappropriate breastfeeding position, absence of reflux, delayed lactation, less frequent breastfeeding, consumption of breast milk with dextrose, manna, and clay tap were risk factors for dehydration fever.
 

Background: The gender of the baby is one of the risk factors for neonatal jaundice, but the difference in the severity of jaundice and its prognosis between the two sexes is not clear. Therefore, in this study, we investigated the severity, duration and prognosis of jaundice in both sexes.
Methods: The present study is a cross-sectional study that was performed on 2847 icteric neonates over 35 weeks admitted to Ghaem Hospital in Mashhad from May 2014 to May 2021. This study is done by available sampling. After confirmation of jaundice in infants, data were recorded using a researcher-made checklist including maternal demographic information (maternal age, mode of delivery), complete infant characteristics (age, birth weight, age at onset of jaundice, jaundice recovery age) and laboratory findings (Bilirubin, Indirect Coombs, direct Coombs, G6PD), and neonatal development up to two years of age was performed based on the Denver 2 test. Then data analysis was performed by SPSS software using Chi-square test and Student’s t-test.

Results: 1642 infants (57.7%) were boys and 1205 infants (42.3%) were girls. Mean and standard deviation of bilirubin in values less than 20 mg/dl in boys was 17.20±2.48 mg/dl and in girls was 16.54±2.80 mg/dl (P=0.000), birth weight was 3.16±0.49 (kg) for boys and 3.07±0.45 for girls (P=0.000). In two groups of male and female infants, age (P=0.004), direct bilirubin (P=0.001), direct and indirect Coombs (P=0.000), and G6PD enzyme deficiency (P=0.000) had a significant difference. Acute kernicterus was reported in 25 (2.03%) boys and 4 (0.46%) girls (P<0.001). In the two-year follow-up, 23 boys (1.9%) and 11 girls (1.28%) had developmental delay (P<0.05). Conclusion: The incidence of jaundice in male infants was higher than female infants, which is probably due to a higher prevalence of G6PD deficiency in boys. The severity of jaundice was higher in boys less than 20 mg/dl. Jaundice has a worse prognosis in male infants.

Background: Neonatal sepsis is a severe systemic bacterial infection that affects on premature neonates prognosis. Therefore, the aim of this study was to evaluate the short-term prognosis of neonate's infection.
Methods: The present study is a cross-sectional study that was performed on 729 neonates suspected of infection, in neonatal ward in Ghaem Hospital of Mashhad since May 2015 to May 2022 by available sampling. The data collection tool was a researcher-made checklist containing neonatal characteristics (gestational age, birth weight, first and fifth minute Apgar score, and neonatal status at discharge) and laboratory information (White Blood Cell, Platelet (PLT), C-reactive Protein, Blood culture, Cerebrospinal fluid culture). Infants with congenital infection, congenital anomaly and positive blood cultures without clinical and laboratory symptoms were excluded from the study. Neonatal prognosis was compared in terms of death or discharge among neonates with and without definitive infection. First, we described the results using statistical tables and graphs, and then, data were analyzed by Kolmogorov-Smirnov, T test and SPSS software, version 26 (IBM SPSS, Armonk, NY, USA). P<0.05 considered as significant.

Results: According to the results of this study, low birth weight and lower gestational age and lower Apgar score increase the risk of neonatal death. About one-fifth of infants died of definitive infection. The cases of death due to infection in the group of deceased infants were about 4 times higher than in the group of discharged infants. About one third of the babies with sepsis and half of the babies with meningitis died. Forty-four percent of infants with early sepsis and 40% of infants with late sepsis died. In cases of neonatal death due to sepsis, the most common gram-negative infectious agent was Acinetobacter and the most common gram-positive infectious agent was Enterococcus. Conclusion: Neonatal definitive infection worsens their prognosis. So, the risk of neonatal death increases by 5 times. The probability of death in meningitis is more than sepsis and in early sepsis is more than late sepsis and in sepsis due to gram-negative is more than gram-positive.

Background: Maternal diseases such as diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy in pregnancy are associated with fetal and neonatal complications. The aim of this study was to compare the prognosis of neonates in maternal diseases.
Methods: This study was a cross-sectional study. The present study was performed on 600 preterm infants with mothers with diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy. This study was done in Ghaem Hospital of Mashhad from March 2015 to April 2021 with available sampling. The data collection tool was a researcher-made checklist including infant (gestational age, Apgar score of the first minute, Apgar score of the fifth minute) and maternal (mode of delivery, prenatal care, premature rupture of the membranes) characteristics. Neonatal prognosis was compared at birth. All clinical and diagnostic examinations of newborns were performed by a neonatologist. Neonatal and maternal data in the group of newborns with normal mothers and newborns with maternal diseases were analyzed by Kolmogorov-Smirnov and Chi-square tests. The significance level was considered p≤0.05 in all cases.

Results: The results show that 161 newborns (28.90%) had normal mothers, 89 newborns (15.98%) had diabetic mothers, 117 newborns (21.01%) had hypertensive mothers, and 50 newborns (8.98%) had hypothyroid mothers. One hundred tweny newborns (21.72%) had mothers with preeclampsia, 19 newborns (3.41%) had mothers with epilepsy. Newborns with mothers with epilepsy had the lowest Apgar score of the first minute and the lowest gestational age and newborns with mothers with diabetes had the lowest Apgar score of the fifth minute. Mothers with hypothyroidism had the highest rate of premature rupture of the membranes and mothers with hypertension and preeclampsia had the highest incidence of cesarean section. Conclusion: Maternal diseases including diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy affect the prognosis of neonates in terms of the severity of prematurity, premature rupture of the membranes, type of delivery, Apgar scores of the first and fifth minutes. Therefore, proper control and treatment of these diseases may improve neonatal prognosis.