Iranian Journal of Neonatology
Year:2015 | Volume:6 | Issue:3|Papers Count:12

Background: TORCH Early discharge of newborns due to social, economic and medical reasons increases the rate of readmissions, especially for hyperbilirubinemia. Therefore, identification of high-risk neonates for subsequent hyperbilirubinemia is paramount. This study aimed to investigate the level of total serum bilirubin (TSB), which could be used to predict neonatal hyperbilirubinemia at the first day of birth.Methods: Venous blood samples were obtained from 300 newborns during the postpartum period (i.e.24±6 hours) to determine the blood group, direct Coombs test, TSB and direct bilirubin levels (DBL). Neonates were followed-up for 5 days, and TSB and DBL were recorded in 90 newborns presented with jaundice according to the Kramer’s scale within 120±6 hours of birth.Results: In total, 23.3% of the studied newborns (N=90) required phototherapy. The cut-off value of TSB to determine high-risk newborns for subsequent hyperbilirubinemia at the first day of birth was 6.50 mg/dl with positive and negative predictive values of 19.75% and 97.72%, respectively. At this point, the sensitivity and specificity were 76.19% and 76.70%, respectively.Conclusion: According to the results of this study, TSB cut-off point of 6.5 mg/dl at the first day of birth could predict the risk of subsequent hyperbilirubinemia in healthy, term infants with early discharge. Since TSB cut-off point is economic and available, use of this method is recommended in all healthcare centers.

Background: The present study aimed to evaluate different clinical parameters on admission for the prediction of hospital stay in neonates.Methods: This prospective observational study was conducted during one year (Jan-Dec 2010) in a tertiary referral hospital in North India. Out of 344 neonates admitted at the hospital, 41 were discharged against medical advice and excluded from the study. At the time of admission, initial vital signs and basic information of the neonates were recorded. Subjects were evaluated based on clinical parameters and followed-up until discharge/death. Final outcomes were recorded in terms of total length of hospital stay in surviving and non-surviving neonates. In the statistical analysis, odds ratio with 95% confidence interval were calculated for each parameter, and significant associations were investigated between the variables (P≤0.05).Results: Of 30 clinical variables, 18 were found to be significantly associated with prolonged hospitalization (>7 days) in surviving neonates. These parameters included abnormal heart rate (>160/min or<100/min), abnormal respiratory rate (>60/min or<30/min), abnormal SpO2 (<90%), prolonged capillary refill time (≥3 seconds), moderate hypothermia or hyperthermia, decreased consciousness, abnormal crying, reduced or lack of physical activity, presence of pallor, icterus involving soles, central cyanosis, dehydration, chest recessions, respiratory distress, abdominal distension, hypotonia, incomplete or absent Moro reflexes in term neonates, and absent or sluggish deep tendon reflexes. Additionally, three parameters were found to be significantly associated with the mortality of non-surviving neonates within 7 days of hospital stay, including abnormal respiratory rate (>60/min or<30/min), abnormal SpO2 (<90%) and prolonged capillary refill time (≥3 seconds).Conclusion: According to the results of this study, length of hospitalization in neonates could be predicted at the time of admission using simple, easily-assessed clinical parameters.

Background: Once an infant is hospitalized in the Neonatal Intensive Care Unit (NICU), the entire family dynamics is disrupted due to stressors such as interruption in maternal-infant bonding, abandonment of other siblings and financial burdens. Combination of multiple stressors often ends in divorce or other devastating results. In this study, a novel survey questionnaire has been developed to assess the level of parental stress in NICU and identify the warning signs, in order to provide assistance to young couples in need of help.Methods: Qualitative content analysis was performed to survey 13couplesrecruited from various teaching hospitals in Isfahan, Iran.Results: The initial part of the questionnaire was designed to assess parents’ stress level with an expected content validity index of 0.78 or above and to measure face validity of the questionnaire, all the items received a mean impact score of 1.5 or above, and the Cronbach’s alpha reliability of the 12-item questionnaire equaled to 0.904.Based on the factor analysis, the items with a correlation coefficient of less than 0.4 were excluded (one item was omitted).Conclusion: Most survey questionnaires found in the existing literature have investigated the types of stressors experienced by parents with an infant in NICU. In this study, researchers offer a novel 11-item questionnaire designed to assess the level of stress among parents with a hospitalized infant in NICU.

Background: Currently, the number of premature deliveries has been increasing, resulting in early postnatal discharge due to shortage of beds in the neonatal intensive care units (NICU).Methods: This descriptive-analytical study was conducted through investigating the premature infants’ files for gestational age (GA), birth weight (BW) and duration of the first hospitalization. Furthermore, the readmission rate during the first year of life and their causes were studied.Results: Overall, 495 infants were enrolled in this study. The range of GA and BW of infants who were admitted to NICU were 24-36 weeks and 470 - 2500 g, respectively. A total of 172 (34.74%) infants had a BW of less than 1500 g (VLBW), and 144 of them (29.09%) were severely premature (GA of between 24-31 weeks). The median (range) time of hospitalization in VLBW infants was 22 (1-75). Moreover, 76 (15.3%) infants were re-hospitalized during the first year of life, and 32 (6.4%) infants were readmitted during the first three months of life. The four most common causes of re-hospitalization during the first year of life were as follows: pneumonia (32.89%), icter (17.10%), treatment of retinopathy of prematurity (10.52%) and sepsis (9.20%).Conclusion: Hospital policies are changing due to the high rate of preterm births and lack of neonatal beds. The results of this study suggested that premature neonates, who are able to regulate body temperature at room temperature, and gain weight by oral feeding with no recent apnoea or bradycardia, could be discharged regardless of their gestational age and body weight.

Background: Jaundice is affecting over 60-80 percent of neonates in the first week of life. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an important cause of pathologic hyperbilirubinemia, can lead to hemolytic anemia, jaundice and kernicterus. The present study was performed to determine the prevalence of G6PD deficiency among icteric neonates in Shirvan, Iran.Methods: This descriptive, analytical study was performed by evaluating the medical records of neonates with jaundice, admitted to the neonatal ward of Imam Khomeini Hospital of Shirvan in 2012-2013. All neonates, who were evaluated in terms of G6PD, were included in this study. Data including the clinical signs and symptoms, laboratory test results and maternal history during pregnancy were recorded in the questionnaires. The patients were divided into two groups: with and without G6PD deficiency. The recorded data were compared between the two groups, using t-test and Chi-square test. P-value less than 0.05 was considered statistically significant.Results: Among 452 admitted neonates, 16 (3.5%) presented with G6PD deficiency. There was no significant difference between the two groups in terms of birth weight, weight on admission, Coombs’ test results, hematocrit level, length of hospital stay and total bilirubin level. However, there was a significant difference between the two groups regarding reticulocyte count.Conclusion: Based on the findings, establishment of an early G6PD screening program, which can prevent further complications in neonates, seems essential, particularly in countries such as Iran where G6PD deficiency is highly prevalent.

Background: This study aimed to investigate different methods used to provide necessary supplementations for pregnant women and obtain reliable data about the general status of health promotion during pregnancy.Methods: This descriptive, cross-sectional study was conducted on 401 pregnant women referring to different women’s hospitals of Tabriz, including Alzahra, Taleghani, 29-Bahman, Zakariya, Shafa, and Shams from March 2011 to September 2013. Subjects were selected using simple random sampling and had prior experience of childbirth.Results: In this study, prenatal care was provided for all the pregnant women at public (55.8%) and private sectors (44.2%). Iron supplementation used by the subjects included ferrous sulfate (150 mg) +folic acid (0.5 mg) (20.2%), regular-release ferrous sulfate (325 mg) (70.4%), folic acid (0.1 mg) +ferrous sulfate (200 mg) (6.5%), and vitamin B12 (15 mg) +ferrous fumarate (350 mg)+vitamin C (150 mg) +folic acid (1 mg) (1.6%). Supplementations were provided before (56.7%) or after (43.3%) the onset of pregnancy. In total, 40.9% of the subjects received family planning care, 44.7% of whom referred to medical centers, 34.6% referred to health houses, 12.3% consulted gynecologists, 2.8% consulted midwives and 5% received traditional care.Conclusion: According to the results of this study, general status of iron and folic acid supplementation, their provision and average use of these substances were suboptimal. However, status, provision and use of iron were significantly more efficient than folic acid.

Background: Mothers are highly vulnerable to depression within the first year after childbirth. Approximately 10-20% of mothers suffer from depression during this period, and half of these women with symptoms of prominent postpartum depression (PPD) remain undiagnosed. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely applied screening instrument for PPD evaluation. In this study, we evaluated EPDS scores (score ≥12) at discharge and 2, 28 and 42 days following delivery to determine the risk factors and prevalence of PPD in mothers of infants admitted to the Neonatal Intensive Care Unit (NICU).Methods: A sample of 682 women completed the EPDS scale upon admission and hospital discharge. PPD assessment was performed at days 28 and 42 following delivery via phone interviews.Results: Upon admission, the average EPDS score was 9.72 (SD=4.4) and 27.4% of women (n=187) had EPDS scores ≥ 12. At discharge and 28 and 42 days following delivery, the average scores were normal as follows: 9.34 (SD=3.8), 9.12 (SD=3.7) and 8.52 (SD=3.36), respectively. Within the mentioned intervals, 25.4% (n=173), 23.3% (n=141) and 15.3% (n=88) of women presented with PPD. A positive correlation was shown between EPDS scores on admission and D42 (P=0.001) that all PPD cases at D42 had EPDS score ≥ 12 on admission The analysis showed that multiple gestation (P=0.001) and advanced age (P=0.001) were significantly associated with PPD.Conclusion: As the results indicated, women with EPDS scores ≥ 12 should benefit from close follow-ups during the postpartum period and be provided with psychological support.

Background: Hyperbilirubinemia is a common cause of referral to neonatal care units. According to several studies, jaundice is among the primary symptoms of urinary tract infection (UTI) in neonates. This study aimed to determine the prevalence of UTI in asymptomatic term neonates diagnosed with indirect hyperbilirubinemia within the first two weeks of birth.Methods: This prospective study was conducted on 314 term neonates under 14 days of age, presented with unexplained indirect hyperbilirubinemia for UTI (total bilirubin level: 15 mg/dl). Subjects were referred to 17-Shahrivar Children’s Hospital in Rasht during 16 months, and neonates diagnosed with UTI were further investigated.Results: Out of 314 neonates, 12 patients (3.8%) were diagnosed with UTI, and E. coli was the most prevalent pathogen in these patients. No significant differences were observed between neonates with and without UTI in terms of gender, birth weight, age, bilirubin level on admission and mode of delivery (P>0.05). Additionally, pyuria and bacteriuria were significantly more prevalent among UTI patients compared to other neonates (P<0.0001).Conclusion: According to the results of this study, appropriate urine tests could rule out the possibility of coincidental UTI in icteric term neonates under two weeks, who are diagnosed with unexplained indirect hyperbilirubinemia.

Cystic lymphangioma is a rare benign tumour occurring during childhood. This tumour, caused by lymphatic system malformations, commonly occurs in head and neck regions. Herein, we report the case of a three-month-old male infant, diagnosed with a large cystic mass in the abdominal cavity and groin. The infant presented with low-grade fever and significant abdominal distension. Abdominal CT scan (with a contrast agent) revealed a large cystic mass in the abdominal cavity. During surgery, the mass was found to originate from the mesentery and was inferiorly connected to the sigmoid colon. Also, a small cystic mass was detected in the left scrotal region. The mass was removed along with a portion of the sigmoid colon and the cyst in the groin. Later on, histopathological examination of the mass confirmed the diagnosis of mesenteric cystic lymphangioma.

Background: Few cases of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) have been reported, so far. The main concern in the management of PHHI is to prevent severe hypoglycemia, which can lead to coma, brain damage and mental retardation. Total or subtotal pancreatectomy is normally required for the infants, despite the availability of medical therapies.Case report: In this report, we present the case of a three-day-old male infant with hypoglycemia and seizure, admitted to a hospital in Mashhad with the diagnosis of PHHI. Further evaluations revealed multiple congenital disorders including dextrocardia, posterior communicating aneurysm, atrial septal defect, ventricular septal defect, situs inversus and asplenia. Maximal doses of diazoxide, octreotide and intravenous glucose were prescribed for the infant. The patient was referred to our hospital and subtotal pancreatectomy was performed. In addition, due to frequent hypoglycemic episodes, a near-total pancreatectomy was conducted six days after the first surgery. The patient died eight months after total pancreatectomy at the age of nine months with no follow-ups.Conclusion: Infants with PHHI are at a high risk of severe neurological damage due to severe hypoglycemia, unless immediate and adequate medical interventions are carried out. Considering the co-occurrence of different congenital anomalies and PHHI in the present case, further assessment of concomitant congenital disorders is highly recommended in PHHI patients.

The human cytomegalovirus (CMV) is widely distributed among the human population as one of the most common causes of congenital infection with an incidence of about 0.15-2.0% in developed countries. In this case report we present a female neonate (with a maternal history of flu-like syndrome in 30 weeks of pregnancy) delivered via caesarian section with good reflexes and appropriate APGAR score, without any obvious anomalies. Its cerebrospinal fluid and unigrams were found to be normal. The CMV diagnosis was confirmed by neonate serology (IgM-positive). Additionally, positive results for CMV were obtained from the neonate’s urine polymerase chain reaction test. Therefore, the necessity for differential diagnosis (e.g. hemolysis, ABO RH mismatch, biliary duct obstruction) was eliminated. Treatment with ganciclovir and granulocyte-colony stimulating factor (Gancyclovir induced neutropenia) was provided, as a result of which a dramatic immediate and short-term response was observed. It is proposed that multisystem involvement in congenital CMV should be suspected and medical treatment should be administered especially in life threatening conditions.

Background: Stillbirth is a sensitive indicator for health care quality, living conditions and equity in a society. The aim of this study was to determine the rate and contributing factors of stillbirth at Babol hospitals.Methods: This cross-sectional, descriptive, analytical study was designed as an applied research, using census sampling in 2012-2013. A questionnaire was applied for data collection. The study samples included all fetal mortalities occurring between 22 weeks of gestation and birth. Data were analyzed using SPSS version 18 at the significance level of 0.05.Results: Stillbirth rate was estimated to be 11.7 per 1000 cases. The age of mothers of stillborn babies ranged between 15 and 35 years with a mean of 26.94±5.995 years. Gestational age ranged between 22 and 41 weeks with a mean of 28.9±5.941 weeks. The range of weight at birth was 250-5500 g, with a mean weight of 1331.553±1068.468 g. Stillbirth had a significant correlation with gender, the number of babies in multiple gestations, congenital abnormalities, underlying maternal diseases and maternal conditions during pregnancy.Conclusion: Stillbirth can be effectively prevented through screening high-risk women and referring them to appropriate care centers. Moreover, training and counseling these women and proper follow-up before, during and after pregnancy can aid with early detection and termination of high-risk pregnancies.