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Showing 21 results for Premature
Comparison of incidence of intraventricular hemorrhage in vaginal and cesarian section deliveries
A Arab Mohammadhosseini ,
Volume 56, Issue 5 (7-1998)
Abstract
Intraventricular hemorrhage (IVH) is one of the major cause of neonatal mortality and morbidity in premature babies. The etiology of intraventricular hemorrhage is multifactorial. The role of normal vaginal delivery as a cause is controversial in literature. During recent years the incidence of cesarian section has been increasing in Iran and many other countries. In a prospective study we compared the incidence of IVH in premature babies who were born by cesarian section (C.S.) or vaginal delivery. In this study we investigated 84 premature babies at or before 34 weeks gestation who were admitted during 2 years period in NICU of Ali Asghar children hospital for IVH. 10 out of 31 neonates who were born by vaginal delivery had IVH (33%) and 18 out of 53 newborns were born by C.S. had IVH (34%). There was no statistically significant difference between 2 groups. Our study showed delivery by C.S. is no associate with lower incidence of IVH and should not be a reason for doing delivery by C.S.
Frequency of different types of precocious puberty, determining the predisposing factor and need to treatment in children - Emam Hospital (1993-2000)
Moayeri H, Rabbani A,
Volume 60, Issue 2 (5-2002)
Abstract

Background: This study was performed in order to detect the frequency of different types of precocious puberty, predisposing factors and to show which group of patients need to treatment.

Materials and Methods: In this study, 74 patients who referred to pediatric endocrine clinic of Imam Khomeini Hospital and private office from 1993-2000 were assessed. A complete history was taken and physical examination was done in all patients by pediatrics endocrinologist. Bone age was done in all patients and specific hormonal tests were measured in some of them.

Results: Among 74 patients, 50 cases (67.6 percent) were female and 24 cases (32.4 percent) were male. The age of the patients was between 0.8-10 years old with mean 5.37 year. 75 percent of male patients had central (complete) precocious puberty and 25 percent had peripheral (incomplete) precocious puberty. 40 percent of female patients had central precocious puberty, 46 percent had premature telarche, 8 percent had premature pubarche, 2 percent had premature menarche and 4 percent had other kinds of precocious puberty (one case with hypothyroidism and one case with Mccune-Albright syndrome). 10 percent of female patients with central precocious puberty had predisposing factor and 90 percent of them were idiopathic. 38.8 percent of male patients with central precocious puberty had predisposing factor and 61.2 percent of them were idiopathic. 100 percent of male patients with peripheral precocious puberty had congenital Adrenal Hyperplasia. 38 percent of female patients and 100 percent of male patients needed to treatment.

Conclusion: According to this study and references, precocious puberty in female usually benign but in male patients it should be evaluated thoroughly because they usually have a serious disorder which needs treatment.


Prevalence of Coronary Artery Disease and related risk factors in first degree relatives of patients with premature CAD Tehran Heart Center
Salarifar M, Kazemeini S.m, Haji Zeinali A.m,
Volume 65, Issue 1 (3-2008)
Abstract
Background: Premature coronary artery disease (CAD) has a familial predisposition and occurrence. We determined the prevalence of CAD and related risk factors in individuals with a history of premature CAD in their first-degree relatives.
Methods: This study included 700 healthy individuals with a history of premature CAD in their parents or siblings in Tehran Heart Center in 2003-2004. History of smoking, diabetes mellitus (DM) or hypertension was taken. Fasting levels of blood sugar (FBS), triglycerides (TG), cholesterol, LDL and HDL were measured. Noninvasive studies for CAD were performed with resting echocardiography (ECG) and ECG with exercise tolerance test (ETT). Patients with positive findings for ischemia in these tests underwent a myocardial perfusion scan and if positive proceeded to coronary angiography.
Results: The mean age of our subjects was 35.2 (15-65) years. DM was found in 5.3%, smoking in 14.7%, hypertension in 20.6%, cholesterol above 200 mg/dl in 39.9%, TG above 150 mg/dl in 58.6%, LDL above 130 mg/dl in 38% and HDL below 40 mg/dl in 32.6%. In addition, 6.4% had ECG changes and 3% echocardiographic abnormalities in favor of ischemia. ETT was positive in 7.3% and myocardial perfusion scan in 2.1%. Coronary angiography showed 50-70% stenosis in eight patients (1.1%) and >70% in four patients (0.6%).
Conclusion: High cholesterol, TG and LDL and low HDL were found among our subjects. Risk factor determination in these individuals may prove to be beneficial. Noninvasive tests for CAD yield low true-positive results and are not recommended in the population as a whole. In certain subgroups, including those with persons older than 40 years and diabetic patients, these tests may be useful.
A 36 years old woman with Hutchinson-Gilford Progeria Syndrome: a case report
Akrami S M, Yousefzadeh G R,
Volume 65, Issue 9 (12-2007)
Abstract

Background: Hutchinson-Gilford Progeria Syndrome (HGPS) is a very rare genetic disorder with a frequency of 1 in 8 million live births. It is characterised by premature aging phenotype. The median age at death is 13.4 years. It is an autosomal dominat disease due to a de novo point mutation in the Lamin A gene exon 11 in the majority of cases. More than 100 cases have been reported world wide.
Case report: We describe here an exceptionally long-lived patient with HGPS, who is alive at age 36. She was referred by a cardiologist to our endocrinology clinic to be worked up for presence of a metabolic or genetic disorder before a heart surgery.
Results: Having more attention of clinicians about very rare diseases and referring the patients to geneticist are the main goals of this case report as well as describing the disease.


Hydrocephaly and Intraventricular hemorrhage in premature neonates in Yazd University Hospitals
Reza Nafisi Moghaddam, Ahmad Shajari, Pegah Roozbeh,
Volume 68, Issue 1 (4-2010)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cerebrovascular accidents are the most common complications in premature neonates (gestational age <37 weeks). Intraventricular hemorrhage (IVH) and hydrocephaly are the most common presentations of these accidents. Premature neonates less than 28 week age or 1000 gr have maximum risk of cerebrovascular accidents with prevalence of 30 percent. Early screening in high risk pregnancies with real-time ultrasonography can detect these lesions and affect on final prognosis. The purpose of this study is evaluation of brain ultrasonongraphic findings of 60 premature neonates born in Yazd University Hospitals, Yazd, Iran and relationship between these findings and delivery types.
Methods: In this descriptive cross sectional study 60 cases of premature neonates (less than 37 week) who were born from January to July 2007 in Yazd hospitals were evaluated ultrasonographically to detect cerebrovascular accidents.
Results: Among 60 premature neonates, 52(86.67%) were low birth weight and 8(13.33%) neonates weighted more than 2500gr. IVH was seen in five (9.6%) LBW neonates and hydrocephaly was seen in five (9.6%) LBW neonates. One LBW neonate (1.9%) had haloprocencephaly. Eight normal weight neonates had no abnormal ultrasonographic findings.
Conclusion: All factors that induce preterm delivery and high risk pregnancies can increase cerebrovascular accidents in premature infants. Neonatal weight had most powerful relationship with neonatal ultrasonograohic findings.


The relationship between salivary bacterial flora and adverse pregnancy outcomes
Sadeghi R, Rabiee M, Saderi H, Jafari M,
Volume 69, Issue 1 (4-2011)
Abstract
Background: Many studies have shown that periodontal pathogens are emerging as a risk factor for preterm delivery and low birth weight, but there are few studies about the relationship between other oral bacteria and pregnancy outcomes. The aim of the present study was to determine the relationship between salivary bacteria and pregnancy outcomes. Methods: This cohort study was performed on 300 pregnant women who were recruited from the prenatal clinic of Zeynab Hospital in Tehran during 2009-2010. The patients’ demographic and pregnancy data were recorded. Using samplers, saliva samples were collected about one hour after breakfast. Microbial evaluation was performed by counting the bacteria based on their shape and the Gram reaction. The studied bacteria were composed of gram-positive and negative cocci, gram-positive and negative bacilli, spirilla, spirochetes, yeasts, fusiform bacteria and actinomycetes. Results: The data on the bacteriological profile and pregnancy outcome of 243 out of the 300 eligible participants of the study were completed. Five cases (2%) had intra uterine fetal death (IUFD) while 238 (98%) delivered live infants. There was a significant statistical relationship between the mean of gram-negative cocci and IUFD (P=0.04). 10 cases (4.1%) of 243, experienced adverse delivery outcomes and 233 cases (95%) had normal delivery. The adverse pregnancy outcomes had a significant relationship with the presence of spirochetes in saliva (P<0.05) but this relationship was not true for the other bacteria. Conclusion: Some oral bacteria may pose a risk for premature deliveries and low birth weights.
Different doses of ibuprofen in the treatment of patent ductus arteriosus: a randomized clinical trial
Jafari Fesharaki H, Nayeri Fs, Akbari Asbaq P, Amini E, Sedaqat M,
Volume 70, Issue 8 (11-2012)
Abstract

Background: Patent ductus arteriosus (PDA) is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited hence, we compared the effects of two different doses of ibuprofen in this interventional study.
Methods: In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups.
Results: Thirty (100%) patients in 15-mg/kg group and 23 (76.7%) patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011) and the highest response to treatment was seen within the first 24 hours of treatment.
Conclusion: We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg) would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.


The effect of massage therapy on weight gain and calories intake in premature neonates: a brief report
Elaheh Amini , Bita Ebrahim , Paideh Dehghan , Mohadeseh Fallahi , Samaneh Sedghi , Fereshteh Amini , Mamak Shariat ,
Volume 71, Issue 10 (1-2014)
Abstract
Background: Improvement of growth, nutrition and calories intake in neonates is derived by massage. Methods: This study is a randomized clinical trials settled in Vali-e-Asr Hospital Neonatal Intensive Care Unit (NICU) ward in 2012. The control group consisted of 19 infants who were not massaged on them. 15 infants in the intervention group received massage therapy for 10 days, three times a day by trained massage theurapist. Massage last 15 minutes and was done one hour after feeding. Massages were done in 2-7 days neonates. Weight gain, intake calories and oral feeding were compared between studied groups. Data was registered in SPSS v.18 and was analyzed via compatible statistics tests. Results: There were no significant different anthropometric measures at birth (weight-head circumferences and height) and gestational ages of delivery between two groups. Massages had no side effects on cases. Caloric intake at the end of 10 days (end of intervention) showed significant differences between the two groups (P=0.04). But no differences was shown for weight gain. Cases who received massage reached sooner to oral feeding but this difference was significant at 90% significance level (P=0.08). Conclusion: After 10 days, massage therapy increases oral nutritional intake but to find more accurate details requires further studies to be planned.
Correlation between retinopathy of prematurity and clinical risk index for babies score
Mousa Ahmadpour-Kacho, Yadollah Zahed Pasha, Seyed Ahmad Rasoulinejad, Mahmoud Hajiahmadi, Parisa Pourdad ,
Volume 72, Issue 6 (9-2014)
Abstract
Background: Several risk factors like prematurity, hyperoxia, hyperglycemia, duration of mechanical ventilation and supplemental oxygen use have been attributed to the occurrence of retinopathy of prematurity (ROP) in low birth weight infants. Clinical Risk Index for Babies (CRIB) score have been used to assess the severity of the newborn's disease and neonatal mortality. The relation between the CRIB score and the incidence of retinopathy of prematurity is less assessed. This study was carried out to determine the relation between the CRIB score and retinopathy of prematurity in preterm infants. Methods: In a cross-sectional study all preterm infants admitted to NICU from March 2009 to November 2012, with a birth weight less than 1500 grams and gestational age less than 28 weeks and other premature infants with birth weight 1500 to 2000 grams and gestational age 29 to 34 weeks with an unstable clinical condition, were included. The CRIB score was recorded in firs 12 hours of admission to the NICU. Ophthalmologic examination was done by a retinologist unaware of CRIB score. ROP classification was done according to the international classification of ROP. The CRIB score compared with presence or non-presence of ROP and its stage, progression or regression of disease. A P-value less than 0.05 are considered significant. Results: One hundred and eighty (70%) neonates out of 256 neonates developed ROP. In 124 (68.88%) neonates it resolved spontaneously on serial ophthalmologic examination, but fifty-six (31.11%) neonates were required treatment for ROP which 42 (75%) received Avastin and 14 (25%) neonates treated with Laser. The Mean±SD for CRIB score in ROP group was 4.79±2.74 and in a group without ROP it was 3.78±2.00 (P=0.004). No correlation was found between the severity of ROP and CRIB score (P=0.152). Conclusion: The CRIB score can predict the occurrence of ROP, but can't predict its severity and progression or regression.
Preterm delivery in women with low PAPP-A at first trimester screening
Razieh Mohamad Jafari, Mehrnaz Taghvai Maasomi , Mahin Najafian , Najmie Saadati ,
Volume 72, Issue 7 (10-2014)
Abstract
Background: Previous investigations have shown that pregnancy-associated plasma protein-A (PAPP-A) levels are associated with adverse pregnancy outcomes including intrauterine growth restriction (IUGR) fetuses as well as preterm delivery. The aim of this study was to determine the rate of preterm delivery in women with low PAPP-A and at intermediate risk for chromosomal abnormalities in the first trimester screening. Methods: A total of 137 women who underwent Down syndrome screening between 11 to 14 weeks of gestation were studied from September 2011 to September 2013 at Perinatal Care Clinic, Imam Khomeini Hospital, Ahvaz, Iran. From those, 52 patients had low PAPP-A. Inclusion criteria were singleton pregnancies, at 11 to 14 weeks of gestation, at intermediate risk for Down syndrome (risk in 1:101 to 1:1000). The intermediate risk was estimated based on maternal parameters, maternal serum markers (PAPP-A and β-hcG), and nuchal translucency (NT) using fetal medicine foundation (FMF), UK) software. The power of the study was 90%. The sample size was estimated based on prevalence of preterm delivery in pregnancies with low PAPP-A in the first trimester screening. Patients were followed-up until delivery to observe pregnancy outcomes. We evaluated the variables such as level of PAPP-A, outcomes of delivery, age, β-hCG, and gestational age. Results: Among 137 normotensive pregnant women at intermediate risk for Down syndrome, 52 cases (38%) had low PAPP-A (<0.4 MoM). Of 52, 14 cases (27%) had preterm delivery. None of our patients had pregnancy related or non related diabetes, preeclampsia, or chromosomal anomalies. 45 cases (86%) from 52 patients were equal or less than 35 years, while 7 patients were more than 35 years. Among 52 followed-up patients, 48 patients (92.4%) were at low-intermediate risk (risk in 1:251 to 1:1000), and 4 cases (7.6%) were at high-intermediate risk (risk in 1:101 to 1:250). Conclusion: We found high frequency of preterm delivery in pregnant women with low PAPP-A level at the first trimester screening. Hence, this group of patients needs special and early preventive management. Furthermore, we suggest that future researches to be conducted with larger sample size and also cervix length measurement to be included.
Nourodevelopmental follow-up in high-risk infants: review article
Farin Soleimani , Nasibe Sharifi , Fereshteh Rasti Borujeni , Mina Amiri , Somayeh Khazaiyan , Azita Fathnezhad Kazemi ,
Volume 72, Issue 11 (2-2015)
Abstract
Growing and developing are influenced by genetic, social and environmental factors and it's most important and initial phase step is formed of the early life of the fetus and infant. According to the world health organization, the incidence of preterm birth and low birth weight are increasing in most countries that most of it related to developing countries. Low birth weight (LBW) and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems that can affect growing and developing so that it can threaten public health. Advances in medical technology in recent decades at intensive care unit, increased survival of premature infants and high-risk specialist care is needed, but failed, to reduce the complications of premature birth but it couldn’t reduce complications of preterm birth. There is also an increased recognition of the potential disconnect between perinatal outcomes and long-term outcomes. The administration of oxygen and postnatal steroids are prime examples of interventions that may have immediate positive effects but negative long-term effects. Many premature babies will be encounter with mobility problems, cognitive, neurosensory impairments, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances in the future. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Without a doubt, one of the tragedies of the world is people with physical or mental damage caused by premature birth, many of these disorders are not early diagnosed and the prediction of long term complications of infants discharged from the NICU is difficult. Although nourodevelopmental follow-up of these babies is a necessary part of the neonatal assessment but there is no standard process for it. The present review article aims to introduce the care process and tools that is used for following-up these babies, also introduces the application of screening tools for neuro-developmental care.
The effect of body status on gastroesophageal reflux after feeding among hospitalized premature infants: a randomized crossover clinical trial
Leila Valizadeh , Golnar Ghahremani , Manizheh Mostafa Gharehbaghi , Mohammad Asghari Jafarabadi Asghari Jafarabadi ,
Volume 75, Issue 8 (11-2017)
Abstract
Background: Gastroesophageal reflux is a common condition among premature infants, which causes problems such as reduced weight gain and prolonged length of hospital stay. Body status is an appropriate way to reduce this condition. However, there have been few studies conducted in this regard. The objective of this study was therefore to investigate the effect of body status on gastroesophageal reflux in premature infants.
Methods: The present research was a crossover study conducted on premature infants with a gestational age of 33-36 weeks in Al-Zahra Hospital in Tabriz, Iran, from January to March 2015. In this clinical trial, thirty-two premature infants hospitalized in this center were selected as the sample. The initial selection of the participants was based on the simple random sampling. Then the participants were allocated to groups using randomized block procedure. Each infant was under study for 4 days. After each feeding and about two hours before the beginning of next feeding, the infants were randomly and not repeatedly put in one of the following four status for 12 hours (8 am -8 pm) every day: facilitated fetal tucking posture in lateral position, free body posture in lateral position, facilitated fetal tucking posture in supine position, and free body posture in supine position. Then, the incidence of gastroesophageal reflux was measured in each of these statuses. SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) was used to analyze the data at significant level of P<0.05.
Results: The results showed that there was a significant difference between facilitated fetal tucking posture in lateral position and other status (P<0.001). The incidence of gastroesophageal reflux in facilitated fetal tucking posture was lower than free body posture, but there was no statistically significant difference in this regard. Moreover, the incidence of reflux in lateral position was significantly less than those in supine position (P=0.04).
Conclusion: The findings of this study revealed that facilitated fetal tucking posture and lateral positioning reduced the incidence of gastroesophageal reflux in hospitalized premature infants.
 

Duration of kangaroo mother care and weight gain in very low birth weight preterm infant
Mohsen Haghshenas Mojaveri , Zahra Akbarian Rad , Zeynab Shafipour , Somayeh Alizadeh Rokni , Fatemeh Valizadeh ,
Volume 75, Issue 11 (2-2018)
Abstract
Background: One of the important effects of kangaroo mother care (KMC) in preterm baby is improvement in weight gain and so shortening in hospitalization, but it is not clear that how long of kangaroo mother care is effective in weight gain. The aim of this study was to determine the least effective duration of kangaroo mother care in weight gain in very low birth weights.
Methods: Preterm babies with birth weight less than 1500 gr, without chronic cardiopulmonary disease, congenital anomaly and other medical problem when receiving to 140 ml/kg/d enteral feeding enrolled the study. KMC was started when the baby has been stabled, on the mother’s appetency and ability at bedside. The mean daily weight gain in KMC period was compared with expected that (15 mg/kg/d) for the same baby. The babies with KMC≥ 7 days were divided in three groups on the basis of mean daily KMC duration (< 30 min, 30-60 min and> 60). Statistical study performed by using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and P values of less than 0.05 were considered to be significant.
Results: In this study, 103 preterm baby (47 boys, 56 girls) less than 1500 gr were enrolled, with mean birth weight 1107.85±190.87 gr. Mean weight gain of boys in KMC period and expected that were 324.78±162.66 gr Vs. 127.46±54.66 gr (P< 0.001). In eighty-seven babies who received KMC (7-40 days) mean daily weight gain was 26.69±15.55 gr (P< 0.001). Mean weight gain in KMC period for group with< 30 min (n=19), 402.63±126.29 gr Vs. 167.21±74.20 (P< 0.001), group with 30-60 min (n=54) were 338.79±182.60 gr Vs. 220.36±66.98 (P< 0.001) and group with 60< (n=14) 352.14±236.02 gr Vs. 259.96±112.23 (P= 0.09).
Conclusion: On the basis of this study KMC less than 1 hour per day is effective in weight gain of very low birth weight preterm babies.

Intraveneous fluconazole in prevention of infection in neonates under 1200 grams admitted to NICU
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.

Efficacy and complications of oral ibuprofen and intravenous acetaminophen in closure of patent ductus arteriosus of preterm neonates
Semira Mehralizadeh, Majid Mirmohammmadkhani, Aylin Kalantarzade ,
Volume 77, Issue 8 (11-2019)
Abstract
Background: Previous studies have considered patent ductus arteriosus (PDA) a common finding in premature infants, leading to complications such as intracranial hemorrhage, necrotizing enterocolitis and pulmonary dysplasia. The aim of this study was to assess and compare the efficacy of oral ibuprofen and intravenous acetaminophen in the closure of arterial duct in premature newborns. We also evaluated the complications of each drug.
Methods: A cross-sectional and analytical study was conducted at Amiralmomenin Hospital, Semnan City in Iran from April 2012 to December 2017. Subjects were selected through convenient sampling and consisted of all premature infants with patent arterial duct. All of the infants with the diagnosis of PDA were treated with either intravenous acetaminophen or oral ibuprofen. Cardiac echocardiographic findings were assessed in two study groups before and after each treatment course. The complications associated with the two treatment approaches were evaluated in two groups after treatment of each drug.
Results: In general, twenty-four neonates (62.5% females) with the average gestational age of 31.46±3.43 weeks were studied. There was no significant difference in the echocardiographic characteristics in the two treatment groups at the pre and post-treatment periods as well as the side effects of the medications. The average number of treatment cycles in newborns treated with oral ibuprofen (1.06±0.25) was not significantly different compared to those with intravenous acetaminophen (1.25±0.46) (P=0.190). There was no significant difference concerning closure status of the arterial duct in the two treatment groups at the end of the first period (P=0.112) as well as after the second period of treatment (P=0.386).
Conclusion: Our study indicated similar efficacy of oral ibuprofen and intravenous acetaminophen in the closure of the arterial duct. The incidence of complications was not significantly different between the two groups. The results of this study suggest the use of intravenous acetaminophen as a suitable drug for PDA closure, particularly in cases of ibuprofen contraindications.

Effect of multi-sensory stimulation on physiological parameters in preterm infants: randomized clinical trial
Fatemeh Nasimi , Hossein Zeraati , Javad Shahinfar , Mohammadreza Safdari , Ali Esmaeili , Maryam Ghorbanzadeh ,
Volume 78, Issue 2 (5-2020)
Abstract
Background: Premature infants undergo a lot of stressors during treatment procedures in the neonatal intensive care units which causes significant physiological changes in these neonates. Multi-sensory stimulation is a broad category of interventions designed to improve the evolutionary and physiological outcomes of premature infants hospitalized in the neonatal intensive care unit to minimize stress in this environment. So, the study aimed to evaluate the effect of multi-sensory stimulation on physiological parameters in preterm infants.
Methods: This double-blind clinical trial conducted in the neonatal intensive care unit of Shahid Motahari Hospital in Jahrom from April to December 2016. In this study, 80 preterm infants with a gestational age of 34 to 36 weeks were selected by non-probability sampling method and were randomly divided into two groups of multi-sensory stimulation and control. Neonates in the intervention group received a multi-sensory stimulation program for 60 minute. The multi-sensory stimulation program was included a combination of auditory, tactile, motor and visual stimulation. The preterm infants in the control group received only usual care. The data collecting tool was a questionnaire and checklist for physiological parameters of preterm infants.
Results: The results showed that the two groups were homogeneous in terms of fetal age, birth weight, the height of birth, first and fifth minute Apgar score of birth. The results showed that there was no significant difference between the mean of physiological indexes in the two groups before the intervention. Statistical tests showed that there was a decreasing trend in the average of all physiological indices during the intervention (first and second half during the intervention) (P<0.001), However, these changes were not significant in the control group (P<0.05). Also, analysis of variance (ANOVA) with repeated measures showed that there was a significant difference between changes in physiological variables between the two groups at different stages of evaluation (P<0.001).
Conclusion: Multi-sensory stimulation leads to a decrease in heart rate and respiratory rate and the stability of blood pressure in preterm infants.

Evaluation of predisposing factors for developmental delay of pre-term infants in the first year of life
Mitra Radfar, Narjes Jafari, Mona Karimi Khaledi , Naeeme Taslimi Taleghani , Reihaneh Askary Kachoosangy , Leila Yazdi,
Volume 78, Issue 12 (3-2021)
Abstract
Background: Developmental delay in preterm infants was estimated to be more common than term infants. Identifying the factors predisposing to developmental delay can help experts and health professionals in this field to prevent developmental delay of the infants, and leads to better management of the condition of them. This study aimed to evaluate and investigate the predisposing factors of developmental delay in preterm infants in the first year of their lives.
Methods: In this analytical cross-sectional study, 87 preterm infants were enrolled in the study by convenience sampling during the period of April 2016 to the end of March 2017 from two educational hospitals of Shahid Beheshti University of Medical Sciences (Imam Hussein hospital and Mahdiyeh hospital). Demographic and other initial data such as age, sex, gestational age, and the data about clinical problems observed at birth were collected through infants' medical records and were recorded in a special form for each infant. Also, the ASQ test was used to assess infants' developmental status at one year of age.
Results: Based on the findings, 23 infants (26.4%) had the abnormal developmental condition at the end of one year. There was a significant relationship between infants' developmental status and their age, birth height, one-year-old weight, one-year-old height, duration of ventilator use, Apgar scores at first and twentieth minutes, seizures, reflex reduction, pneumonia, breastfeeding status in the first year of life, Retinopathy of prematurity (ROP), receiving occupational therapy services, and electrocardiogram (ECG) findings at one year of age. Among these variables, only breastfeeding status in the first year of life was able to predict infants' developmental status at the end of one year (OR=0.18).
Conclusion: This study showed that the risk of developmental delay in preterm infants who are breastfed in the first year of life or fed the combination of breast milk and supplemental feeding is one-fifth lower than other preterm infants who were not breastfed.

Comparing outcomes of slow versus rapid feeding in premature neonates hospitalized in Al-Zahra hospital, Rasht
Seyedeh Zohreh Jalali, Sadroddin Mahdipour, Reza Sharafi, Fariborz Torkipour, Afagh Hassanzadeh Rad , Babak Moqtader, Marjaneh Zarkesh ,
Volume 79, Issue 10 (1-2022)
Abstract
Background: one of the leading clinical problems for premature neonates especially with very low birth weight is the type and amount of feeding. The authors aimed to compare outcomes of slow versus rapid feeding in premature neonates hospitalized in Al-Zahra hospital, Rasht.
Methods: This is a clinical trial that was conducted on 62 premature neonates aged less than 35 weeks of gestation who were referred to Al-Zahra Hospital from April 2015 to April 2016. They weighed 1000-2000 gr at birth. Samples were randomly assigned to intervention or control groups. The intervention included neonatal feeding with breast milk or formula with feeding advancement of 30 cc/kg/day which was compared with the routine method of slow feeding (20 cc/kg/day). Neonates were assessed until discharge or the occurrence of Necrotizing enterocolitis. Data were reported by descriptive statistics including mean, standard deviation, frequency, and percent, and analyzed by independent samples t-test and chi-square test in SPSS software, version 22 (IBM SPSS, Armonk, NY, USA).
Results: All 62 patients finished the study including 31 neonates weighing 1000-2000 gr at birth in the intervention group and 31 neonates weighing 1000-2000 gr at birth in the control group. Neonates in the intervention group reached to full milk feeding of 150 cc/kg/day sooner (6.06±1.34 versus 9.45±2.39), return to birth weight faster (9.89±3.57 versus 12.9±6.46), had a lower duration of needing parenteral fluids (5.10±1.61 versus 8.86±3.81), and had a lower duration of hospitalization (9.97±4.03 versus 16.87±9.13) compared to controls. Results showed that there was no necrotizing enterocolitis in the intervention and control groups.
Conclusion: The results of this study showed that initiating feeding by 30 cc/kg/day method shortened the duration of access to intravenous line and hospitalization and caused sooner discharge. Also, no adverse complication was noted. Therefore, it seems that further investigations assessing these methods can be help manage preterm neonates.

Short-term prognosis of definitive neonatal infection
Hassan Boskabadi, Maryam Zakerihamidi,
Volume 80, Issue 8 (11-2022)
Abstract
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.

Prognosis of neonates in maternal diseases
Hassan Boskabadi , Nafiseh Pourbadakhshan, Maryam Zakerihamidi,
Volume 80, Issue 10 (1-2023)
Abstract
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.

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