Showing 21 results for Neonatal
F Nili,
Volume 59, Issue 6 (11-2001)
Abstract
Neonatal septic arthritis and osteomyelitis is not prevalent in first month of the life in new borne children. According to anatomic specifications of bones in this period, the manifestation of disease is different from other periods of life and the disability induced, will be serious and permanent. In this investigation, 31 infants with the diagnosis of septic arthritis and osteomyelitis were studied during 10 years. Hyperbilirubinemia (58.1 percent), emergency cesarean (25.8 percent), umbilical vessel catheterization (26.6 percent), permaturity (12.9 percent), perinatal asphyxia (9.7 percent), scalp laceration (6.5 percent), omphalitis & previous bone fracture (6.5 percent) were the most common findings among predisposing factors. Previous hospital admission was detected in 19 patients (67.3 percent) and multiple bone involvements demonstrated in 12 (38.7 percent). From those who had risk factors, 42.3 percent had multiple bone lesions. Only 5 patients (16.12 percent) had no predisposing factors. The mean age for diagnosis and seeking admission were 23 and 30 days respectively and the mean age of diagnosis at surgery was over 72 hours in 15 (48.38 percent) cases. All with delaying in requesting admission had destructive changes in their joints. Knee and hip were most involved (77.3 percent). The most common microorganisms found in this study were staphylococcus aureus and klebsiella. Of all, 47 percent were gram negative & 53 percent gram positive microorganisms. Existence of risk factors and previous hospital admission in the majority of cases accompanied by microorganisms such as methiciline resistant S.aureus and klebsiella as a causative agents who were also resistant to empirical antibiotics demonstrated the role of nosocomial infections as an important cause of infection.
Torkaman M, Afsharpeyman Sh, Khalili Matinzadeh Z, Amirsalary S, Kavehmanesh Z, Hashemi S.a,
Volume 64, Issue 10 (10-2006)
Abstract
Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.
Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.
Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.
Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.
Hantoushzadeh S, Shariat M, Azamati F, Abdolmotallebi F,
Volume 65, Issue 7 (10-2007)
Abstract
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.
Eslamian L, Shahsavari H,
Volume 65, Issue 12 (3-2008)
Abstract
Background: There is dearth of reports from Iran regarding the prevalence of postterm pregnancy and its complications. The present study was conducted to evaluate the prevalence, management and outcome of prolonged pregnancies.
Methods: This cross-sectional study included data from the hospital records of all women referred to Shariati Hospital, Tehran, from 2001 to 2002 with pregnancies of more than 40 weeks in duration. Pregnancies ≥40-42 weeks were considered postdate and those more than 42 weeks postterm pregnancy. The data compiled from the hospital records were subjected to t, χ2 and Mann-Whitney U tests.
Results: Of the 1500 deliveries in this hospital, 98 patients were included in this study, 66.3% of whom were nullipara and 33.7% multipara. The prevalence of postterm pregnancy was estimated to be 3.3%. Cervix dilation of 2 cm or less on admission occurred in 65 women (73.3%). The mean Bishop score was 4.31. Of the 62 fetuses that underwent assessment tests, 54 (87.1%) were normal. The median time between the last test and induction of labor was 2.1 days, and 2.6 days for cesarean deliveries, which was not a significant difference (P=0.6). Cervical ripening with misoprostrol was performed in 36 cases (36.7%) and was successful in 18 cases. In this group, the median time for cervical ripening in multiparas was significantly less than nulliparas (4 vs. 7 hrs, P=0.004). Women not subjected to cervical ripening had a higher cesarean rate than those who did undergo cervical ripening (74.7% vs. 66.1%), although this difference was not significant (P=0.9). Vaginal and cesarean delivery rates showed no significant difference between cases that underwent induction with oxytocin and those subjected to cervical ripening with misoprostol (P=0.9). The mean Apgar score was 9.5, with all scores above 6. There were no cases of neonatal hypoglycemia, hypocalcemia, NICU admission or prenatal death. The mean nursery stay was 1.84 days with a range of 1-8 days.
Conclusions: The prevalence of postterm pregnancies was 3.3% in this study, due in part to erroneous estimation of gestational age. Sonography exam in the first half of pregnancy can provide a better estimation of gestational age and thereby reduce the rate of postterm pregnancy. Cervical ripening and induction of labor shorten the duration of pregnancy however, whether it has any beneficial effect on neonatal outcome remains controversial.
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Volume 66, Issue 4 (7-2008)
Abstract
Background: Much has changed in neonatal care for extremely low birth weight (ELBW birth weight <1000g) infants over the recent years in Iran, resulting in an increase in their survival rate. We determined neonatal survival and short-term morbidity rates among ELBW infants, and the correlation of these factors with mortality risk.
Methods: All single live-born ELBW babies delivered at Vali-e-Asr Hospital over a four-year period were identified. Data that were prospectively collected included: maternal age, prenatal and perinatal complications, antenatal steroid use, birth weight, gestational age, route of delivery, sex, need for resuscitation, APGAR score, need for mechanical ventilation, and complications including respiratory distress syndrome (RDS), sepsis, jaundice, intraventricular hemorrhage (IVH), necrotizing entrocolitis (NEC) metabolic and hematologic and cardiac disorders. Information was statistically analyzed and a probability value of <0.05 was considered significant.
Results: A total of 93 neonates were included in the study. The survival rate in the delivery room was 36.6%. The lowest birth weight was 400g, with a mean birth weight of 850.43(±136.48)g, and the lowest gestational age was 22 weeks. The mean gestational period was 28.31(±2.77) weeks. The most frequent complication after birth was RDS(69.89%) and the least frequent was NEC (6.4%). Short and normal gestation was observed in 44.08% and 48.4% of the neonates, respectively. There was a significant relationship between neonatal mortality and the need for resuscitation after birth, RDS and need for a respirator (p<0.05).
Furthermore, there was significant increase in mortality among neonates with gestational age <30 weeks, birth weight under 750g and lack of steroids before birth (p<0.05).
Conclusions: To enhance perinatal and neonatal care and decrease the rate of preterm labor, improved standard resuscitation and increased administration of antenatal steroids and respirators are required.
Keshavarz M, Babaee Gh R, Dieter J,
Volume 67, Issue 5 (8-2009)
Abstract
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Background: Many
studies have demonstrated that pre-term neonates gained more weight over the 10 days
stimulation period. This research has been conducted to determine the effects
of five days Tactile- Kinesthetic stimulation (TKS) on weight gaining of pre-term
infants hospitalized in Fatemiye neonatal intensive care unit.
Methods: Fifty one babies who graduated from the NICU to the
intermediate care nursery were randomly allocated into test and control groups
(24
and 27
neonate respectively). TKS was provided for three 20 minute periods per day for five
consecutive days to the test group, with the massages consisting of moderate
pressure strokes in left and right lateral position and kinesthetic exercises
consisting of flexion and extension of the limbs. They were observed for
changes in physiologic parameters and weight gaining during five days
stimulation in hospital.
Results: Over the five days TKS an increase in weight was seen in the test group (p=0.018, 43.1 vs 5.4). Infants in
both the test and control groups were matched for mean weight before study and days
in which they received antibiotics and photo therapy. Mean temperature and O² saturation had
no meaningful difference, but an increase in respiratory rate (p=0.047, 32.9 vs 32.5) and heart
rate (p<0.001, 148 vs 145.7) (within physiologic range) was seen in the test
group during stimulation, so that no one excluded from study.
Conclusion: Tactile- Kinesthetic stimulation has no adverse
effects on physiologic parameters, meanwhile has a beneficial effect on weight
gaining in pre-term neonates, So touch and massage therapy which are both beneficial
and cost effective could be placed in policy of care programs in nurseries in
Iran.
Ali Zamani, Alireza Karimi, Mohsen Naseri, Elaheh Amini, Mohammad Milani, Amir Arvin Sazgar, Seyed Mousa Sadr Hosseini, Mohammad Sadeghi Hassan Abadi, Fatemeh Nayeri, Firouzeh Nili, Mamak Shariat, Mostafa Vasigh, Fariba Nasaj, Fatemeh Zamani, Narges Zamani,
Volume 68, Issue 1 (4-2010)
Abstract
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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.
Akbarzadeh Baghban A, Jambarsang S, Pezeshk H, Nayeri F,
Volume 70, Issue 5 (8-2012)
Abstract
Background: Hypothermia is an important determinant of survival in newborns, especially among
low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine
the factors affecting transition from hypothermic state in neonates.
Methods: The study consisted
of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonates' rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multi-state Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model.
Results: Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute,
respectively. Weight had a significant effect on transition from hypothermia to normal condition (95% CI: 0.1364-0.4165, P<0.001). Environmental
temperature significantly affected the transition from hypothermia to normal stage (95% CI: 0.0439-0.4963, P<0.001).
Conclusion: The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28 °C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental
temperature in an optimum level could help neonates to pass through the hypothermiastages faster.
Rashidi-Nezhad A, Fakhri L, Hantoush Zadeh S, Amini E, Sajjadian N, Hossein Zadeh P, Niknam Oskouei F, Akrami Sm,
Volume 70, Issue 10 (1-2013)
Abstract
Background: Neonatal deaths stand for almost two-thirds of all deaths occurring in infants under one year of age. Congenital anomalies are responsible for 24.5% of these cases forming a highly important issue for health policy-makers.
Methods: We studied the pre-, peri- and post-natal conditions of 77 patients with multiple congenital anomalies (MCA) through genetic counseling at Several university Hospitals, in Tehran, Iran. The collected data were subsequently analyzed using SPSS software.
Results: The patients did not have a good prognosis, demonstrating the need for the diagnosis of such diseases early in pregnancy to be of utmost importance. We screened for trisomy and nuchal translucency, which the first showed a low risk and the second showed normal results in most cases.
Conclusion: Establishment of standards for prenatal diagnosis of congenital anomalies and monitoring their implementation seem to be necessary for the reduction of deaths due to congenital anomalies and infant mortality rate (IMR).
Khosravi N, Noorbakhsh S, Tabatabaei A, Ghavami Y,
Volume 70, Issue 11 (2-2013)
Abstract
Background: Infection with group B streptococcus (GBS) can present with respiratory distress, Pneumonia, meningitis and Osteomyelitis in neonates. The aim of this study was to determine the prevalence of GBS colonization in trachea of intubated neonates.
Methods: This observational analytic study was performed upon 33 intubated neonates due to respiratory distress in neonatal intensive care unit (NICU) Rasoul Hospital in Tehran, Iran during 2010-2012. Tracheal secretions cultured upon TODD-HEWITT BROTH and sheep blood agar 5%., chi-square test was used for compare the qualitative variables. P<0.05 was considered meaningful.
Results: Three cases had positive streptococcal culture (9.1%) and four cases had posi-tive culture for non-streptococcal organisms. no meaningful relation observed between positive GBS culture and neonatal gender, kind of delivery, PROM.
Conclusion: Prevalence of GBS positive results (9%) in present study is very close to GBS colonization in pregnant women although the higher colonization rate of pregnant women are expected.
Sajjadian N, Shajari H, Mofid R, Jahadi R, Alizadeh Taheri P,
Volume 70, Issue 12 (3-2013)
Abstract
Background: The relationship between season of birth and human diseases is well known and such a relationship could be mediated by seasonal and environmental effects on early events of extrauterine life Empirical neonatological experience suggests that prevalence and degree of neonatal jaundice might be dependent on seasonal variation, mainly due to the sunshine duration. However, evidence based data on this issue are scarce. Thus, we have analyzed the seasonal effect on the rise of serum bilirubin level during the neonatal period.
Methods: A prospective cohort study was done on a sample of 629 term and healthy infants born consecutively in Shariati Hospital, Tehran, Iran, during the years 2008-2009. The cord bilirubin level and then the serum bilirubin level near to 48 hour of age were measured. Seasonal differences in rise of serum bilirubin were studied.
Results: Rise of serum bilirubin in spring was 3.951.4 mg/dl, in summer 3.761.69 mg/dl, in fall 3.511.60 mg/dl and in winter 4.791.99 mg/dl. Serum bilirubin level in cord blood did not appear to be correlated with season of birth. After correction for the possible effect of these variables the relation between season of birth and rise of serum bilirubin remained significant. The rise of serum bilirubin in winter was significantly higher than other season (P<0.0001).
Conclusion: Season acts as an independent etiological factor of neonatal hyperbilirubinemia. Mean rise of serum bilirubin in winter is higher than other season. This provided information to improve education for nurses in identifying risk factors and the prevention of hyperbilirubinemia readmissions.
Abootaleb Beigi , Nima Taheri , Hamid Reza Norouzi ,
Volume 71, Issue 3 (6-2013)
Abstract
Background: Very preterm birth (26-32 weeks) has an important effect on infant morta-lity and disability of infancy. The aim of this study was to investigate the prevalence of very preterm delivery and early neonatal morbidity (the first 28 days after birth).
Methods: In this cross-sectional retrospective study, among 4393 delivery in Arash Women's Hospital in Tehran, 59 deliveries were very preterm that resulted in 79 very preterm neonate births. We assessed maternal risk factors and neonatal complications in women who were admitted for delivery from March 2009 to March 2010.
Results: Among 59 pregnant women, 17 (12/27%) had multiple pregnancies and 17 (12/27%) had premature rupture of fetal membranes. Caesarean section method was more common than normal vaginal delivery (46 cases- 97/77%). Women aged 18 to 35 had the highest rate of preterm delivery (45/86%). Among 79 very preterm neonates about half of them were very low birth weight, 74 neonates (93/67%) suffered from respiratory distress syndrome and 13 deaths were reported.
Conclusion: Premature birth is a multi-factorial phenomenon. Identifying maternal risk factors and increasing knowledge about it can decrease the rate of preterm labor. The prevention of premature labor is better than cure. Further prospective studies with large number of patients and long-term follow-up are recommended for better understanding of the phenomenon.
Samileh Noorbakhsh , Majid Kalani , Ali Mohamad Aliakbari , Azardokht Tabatabaei , Fahimeh Ehsanipour , Reza Taghipour , Mohamad Reza Shokrolahi ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma.Gondii infection and describe the clinical presentation from birth and follow up them.
Methods: We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies (IGG, IGM) evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease.
Results: Gestational age of newborns was between 28-41 weeks. Positive T.Gondii -IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%), and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases.
Conclusion: One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.
Amir Kamal Hardani , Firouzeh Nili , Mamak Shariat , Fatemeh Nayeri , Hosein Dalili ,
Volume 72, Issue 10 (1-2015)
Abstract
Background: Respecting gestational age and medical intervention at birth, Combined Apgar score, a new method proposed by American Academy of Pediatrics (AAP) may better evaluate neonatal condition at birth compared with conventional Apgar score. The combined Apgar consists of the Specified and the Expanded Apgar describe a more detailed condition at birth. In Expanded Apgar, administered intervention and in Specified Apgar, infant`s condition regardelless of gestational age and intervention are emphesised. To evaluate combined Apgar score in perinatal asphyxia, we compared conventional versus Combined Apgar scores to anticipated neonatal asphyxial complications.
Methods: In a prospective cohort study, we assessed 464 neonates admitted in, Vali-e-Asr University Hospital, during one year from September 2012 to September 2013. We assessed neonates by Conventional and Combined Apgar scoring at 1, 5 and 10 minutes after birth. Asphyxia was recognized based on newborn`s records. Diagnostic criteria for asphyxia include, occurrence of metabolic or mixed acidosis, apgar score less than three in 5th minute, occurrence of neurological complications like seizure, hypotonia, coma and multiple organ failure. Then we used SPSS V16 for data analysis and compare sensitivity between two methods of Apgar scoring.
Results: From 2200 delivered neonates, we assessed 464 neonates. 9.3% of studied neonates had Asphyxia, which equals 2% of live births. The Apgar score was lower in asphyxiated neonates by both methods (6±1 vs. 9±1 according to conventional method and 9±1 vs. 16±1 scored in combined method). Combined method was more sensitive than the Conventional Apgar scoring (99% vs. 88%).
Conclusion: In asphyxiated neonates sensitivity and specificity of combined apgar were more than conventional apgar. With respect to this study, better assessment could be achieved by combined apgar score method instead of conventional Apgar.
Narges Sadat Taherzadeh , Farideh Zaini , Roshanak Daie Ghazvini , Sasan Rezaie , Mahmoud Mahmoudi , Maliheh Kadivar , Fatemeh Sadat Nayeri , Mahin Safara , Parivash Kordbacheh ,
Volume 73, Issue 11 (2-2016)
Abstract
Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.
Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.
Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).
Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.
Farin Soleimani , Farahnaz Mohammadi Shahboulaghi , Fatemeh Nayeri, Hosein Dalili, Mamak Shariat ,
Volume 74, Issue 3 (6-2016)
Abstract
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Background: In fact, there is no doubt that medical education should be to prepare students for those clinical problems that they may encounter in their future performance. But according to the findings of previous studies in this area, one of the important priority and basic needs in education is training health workers, including physicians.
Methods: In this qualitative study focuses on the content analysis of typical (conventional content analysis) was performed. The aim of this study was to determine the needs and skills required to train neonatal subspecialists in the ability to manage vulnerable neonates problems and their families specialized in the field of comprehensive health care have driven. Based on purposive sampling, the research participants, staff and alumni of the second year and above the five-year sub-specialty in neonatology, formed by the association of neonatal diseases were chosen. Saturation as a termination criterion was applied to the collected data. Method of data collection was semi-structured interviews and focus group discussions. Reliability means the adequacy and accuracy that was measured by four methodological criteria: credibility, confirmability, transferability and dependability. All phases of study were recorded elaborately and the researchers reported all findings in the same speech research participants.
Results: Respondents consider themselves some week points in neonatal medicine education; they expressed their opinions in three categories with four subcategories as follow: "competent person knowledgeable", "weakness of the curriculum", "educational challenges", "need to review the curriculum", "the need to reform medical education system in the country", and "effective strategies for teaching".
Conclusion: Editing curriculum to teach coherent and comprehensive clinical skills in one hand, social support and health care for vulnerable children and families in other hand will improve care for vulnerable neonates.
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Nastaran Khosravi , Samileh Noorbakhsh , Shima Javadinia , Sarvenaz Ashouri ,
Volume 74, Issue 11 (2-2017)
Abstract
Background: Bacterial sepsis is a main cause of mortality and morbidity especially in preterm newborns. The aim of this study was to search the bacterial etiologies of neonatal sepsis in NICU admitted preterm neonates.
Methods: A descriptive cross-sectional study had done in NICU of Ali Asghar Hospital, Tehran, Iran from March 2007 to March 2009. Seventy septicemic preterm newborns (<37 weeks) were studied. At admission day, for blood culture, 1-2 ml of venous blood was drawn after swabbing the venipuncture site with alcohol. After centrifugation of blood samples, deposits were cultured on sheep blood agar and incubated in a candle jar at 37 °C for 48 h and followed by subcultured. Isolates were identified using standard techniques (Nima pouyesh, Iran). Type of isolated bacterial organisms determined. Its correlation with gestational age, birth weight, premature rupture of membranes (PROM) and other variables determined we used the nonparametric two independent sample test, Mann-Whitney U test. Chi-square values (CI 95%, P< 0.05) were calculated for all categorical variables. P-value less than 0.05 considered statistically significant.
Results: Of 70 studied septicemic preterm cases, 17 (10.6%) cases had positive blood culture. Overall gram-negative organisms were more frequent than gram-positive organisms, Klebsiella (K.) pneumoniae, Escherichia (E.) coli and Staphylococcus (S.) aureus organisms were the 3 common causes of bacterial sepsis in studied cases. Early onset sepsis produced by K. pneumonia (40%), E. coli (20%) and S. aureus (20%). K. pneumonia, E. coli, S. aureus had equal incidence in late onset sepsis (26.8%). K. pneumonia was more frequent in early onset sepsis (P= 0.05), and in low birth weight (< 1500 g) neonates (P= 0.005, and PROM (P= 0.05).
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Conclusion: Three causes for sepsis in premature newborns were determined: K. pneumonia, E. coli and S. aureus, it is so important for initial antibiotic treatment in admission day. Low birth weight, prematurity, and, PROM were the common risk factors for sepsis in cases. By preventing of low birth weight, low gestational age, and PROM the risk of sepsis could be decreased. We recommend empiric antibiotic in septic preterm newborns which can cover: K. pneumonia, E. coli and S. aureus in our center.
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Parvaneh Sadeghi-Moghaddam , Elham Farasat, Hosein Heydari , Zahra Movahedi, Mohammad Aghaali,
Volume 77, Issue 2 (5-2019)
Abstract
Background: With the increase in the number of premature neonates, there are concerns about the complications of this group. One of the common complications of preterm neonates is fungal sepsis. Therefore, this study was conducted to evaluate the efficacy of intravenous fluconazole on fungal sepsis and other complications related to premature newborns under 1200 g in a neonatal intensive care unit.
Methods: The study was conducted by field trial. The intervention included intravenous injection of fluconazole (3 mg/kg, twice per week for 6 weeks) in neonates weighing less than 1200 gr in the Izadi Hospital in Qom, Iran. The intervention was conducted on September 2016 in entire population of the study. The control group was retrospective and from neonates admitted to Izadi Hospital, which were hospitalized before intervention. The outcomes (such as the need for amphotericin injection, death, fungal sepsis, time taken to reach enteral feeding and length of stay) were compared between the two groups.
Results: There was no significant difference between the two groups regarding their sex ratio (P=0.139), gestational age (P=0.834), type of delivery (P=0.841) and birth weight (P=0.458). After the intervention, fungal sepsis (from 65% to 48.3%) and the need for amphotericin injection (from 27.1% to 5%) were significantly reduced, and the mortality rate decreased from 40% to 28.3%, but this decline was not statistically significant (P=0.178). After the intervention, the length of stay in hospital (P=0.142) and neonatal intensive care unit (P=0.422), time to reach the weight of 1500 gr (P=0.717), and time taken to reach enteral feeding (P=0.289) did not change significantly. Proportion of pneumothorax, apnea, necrotizing enterocolitis, retinopathy of prematurity and need for respiratory support did not change significantly.
Conclusion: The present study showed that administration of venous fluconazole could reduce fungal sepsis in neonates weighing less than 1200 grams in the intensive care unit. However, this study failed to demonstrate the effect of fluconazole on death, pneumothorax, apnea and need for respiratory support.
Amir Hosein Movahedian , Mohammad Jahangiri , Mona Nabovati, Mohammad Reza Sharif , Raheleh Moradi , Ziba Mosayebi ,
Volume 77, Issue 9 (12-2019)
Abstract
Background: Congenital heart diseases are the second group of congenital anomalies in infants. These disorders are a major cause of death in the first year of a child's life. Early detection helps to treat these diseases better. In this study cardiology consultations of hospitalized infants in the neonatal intensive care unit were evaluated.
Methods: In this cross-sectional study, two hundred and fifty pediatric cardiology consultations conducted in Shahid Beheshti Hospital in the year 2012 were reviewed. Information such as the cause of consulting, delivery type, age of parents, relative couples, family history of congenital heart disease, maternal medications, maternal background diseases, the final diagnosis, and prognosis follow-up of the patients were recorded in a designed questionnaire. Finally, the data were entered into the SPSS software, version 16 (IBM SPSS, Armonk, NY, USA) and analyzed using descriptive statistics and chi-square test. P-value of less than 0.05 was considered significant.
Results: The mean age of the consulted neonates was 4.845±5.14 days with a gestational age of 33.933±3.65 weeks. Male sex and cesarean section were the most frequent. Fifty-six percent of consulted infants were male. The present study revealed that prematurity (76%), murmurs (30.8%), respiratory distress syndrome (14.4%) and cyanosis (13.2%) were the most common causes of the cardiac consultation seeking among infants. Seventy-six percent of infants were consulted due to prematurity. Eighty-four percent of infants had a normal conditions. Septal defects (ventricular or atrial septal defect) and patent ductus arteriosus were the most common disease diagnosed with the prevalence of 27.5 and 17.5%, respectively. There was a significant relationship between preterm labor and congenital heart disease (P<0.001). Additionally, prematurity associated with respiratory distress syndrome and using assisted reproductive techniques.
Conclusion: The higher prevalence of congenital heart disease in the present study, compared with other studies, reflects the fact that cardiology consultation based on clinical suspicion leads to the more identification of congenital heart disease that means the right referral of newborns for consultation was accompanied with a higher incidence of heart failure.
Razieh Sangsari, Maryam Saeedi, Malihe Kadivar, Mahsa Niknam,
Volume 78, Issue 5 (8-2020)
Abstract
Background: The effects of magnesium physiology are contradictory to the neurotoxic effect of bilirubin, but the relationship between magnesium level and hyperbilirubinemia in neonates has not been well studied. In this study, we investigated the relationship between serum magnesium level and hyperbilirubinemia and hyperbilirubinemia complications at the Children’s Medical Center.
Methods: In this cross-sectional and prospective study, 100 neonates who were admitted to the Children's Medical Center from October 2018 to 2019 due to neonatal jaundice were enrolled. Neonates were divided into two groups: serum bilirubin levels 16-20 mg/dl were included in the moderate hyperbilirubinemia group and bilirubin >20 mg/dl into severe hyperbilirubinemia group. Serum magnesium levels and clinical complications of hyperbilirubinemia including fever, seizure, apnea, bradycardia, and abnormal neurological examinations were recorded in these infants.
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Results: In this study, 100 neonates were evaluated. The mean serum magnesium level in these patients was 2.32 mg/dl. This rate was significantly higher in neonates with seizure (P=0.038), hyperbilirubinemia fever (P=0.048), and neonates with chronic encephalopathy (P=0.003). The mean serum magnesium level was significantly higher in severe hyperbilirubinemia (P<0.001). Serum Magnesium in complications of chronic encephalopathy (P=0.007), Fisting (P=0.001), retrocoli (P=0.001), hypertonia (P=0.004), hypotonia (P=0.001) and seizures (P=0.030) were significantly different. The serum magnesium levels were positively correlated with total bilirubin (r=0.443, P<0.001). The magnesium levels correlated with the chronic encephalopathy (OR: 4.15, P=0.040) and it was observed that magnesium levels above 2.15 could predict chronic encephalopathy with a sensitivity of 100%, the specificity of 47.82%, a negative predictive value of 100% and a positive predictive value of 14.28%.
Conclusion: The results of this study showed that serum magnesium levels significantly correlated with serum total bilirubin and magnesium cutting points above 2.15 mg/dl in patients with jaundice could predict chronic encephalopathy.
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