IRANIAN JOURNAL OF NEONATOLOGY
Year:2019 | Volume:10 | Issue:3|Papers Count:17

Background: Among the most common causes of death in preterm infants are neonatal infections, which remain high despite antibiotic therapy and preservative measures. The control of hospital infections is now a global priority, and many factors contribute to the spread of these infections. This study aimed to determine the frequency of bacterial infections in neonates and identify the common causes of infection in neonates admitted to the neonatal intensive care unit (NICU) of Alzahra Hospital in Isfahan, Iran. Methods: In this cross-sectional study, the population consisted of all neonates who were admitted to the NICU of Al-Zahra Hospital in Isfahan, Iran, from April 2017 to March 2018. Neonates who had a positive culture (blood, cerebrospinal fluid, urine, eye discharge, and tracheal tube secretions) were enrolled. The data were collected by a structured questionnaire, including maternal and neonatal information. Results: In this study, 56 newborns admitted to the NICU of Alzahra Hospital in Isfahan were studied. Their age range was within 5-28 days (18. 88± 8. 41). Thirty-two (57. 1%) neonates were male, and 24 (42. 9%) newborns were female. In total, 26 (46. 4%) neonates had prematurity that was the most common reason for hospitalization. The most isolated microorganisms were Staphylococcus epidermidis, Enterococcus, Klebsiella, Enterobacteriaceae, Candida spp., Acinetobacter, Streptococcus pneumoniae, E. coli, and Streptococcus viridans, respectively. Conclusion: According to the results of this study, the frequency of nosocomial infections in the NICU of Alzahra Hospital in Isfahan was 7. 4%. The indings of this study highlighted the importance of paying more attention to controlling and preventing hospital infections in NICUs.

Background: Necrotizing enterocolitis (NEC) is a disease with high mortality. It is more present in premature infants and can also happen in term and late preterm neonates. It may affect any segment of the small intestine or colon. However, most commonly influences the terminal ileum and proximal ascending colon. This disease might damage the entire bowel, which can be irreversible. Intestinal mucosal defects cause the migration of large numbers of inflammatory cells into the gut lumen. Extensive mucosal affection results in increased calprotectin levels. This study aimed to investigate the role of fecal calprotectin as a non-invasive marker in the diagnosis of NEC for the better management of infants with NEC. Methods: This case-control cross-sectional study was performed in two groups. Group 1 was the case group consisting of the neonates admitted at Suez Canal University Hospital, Neonatal Intensive Care Unit with a clinical diagnosis of NEC. All cases were evaluated by Bell's staging criteria. Group 2 included control subjects. All the studied subjects had complete medical history, full physical examination, and laboratory investigations, including complete blood count, stool analysis, and C-reactive protein. Radiological examination entailed chest X-ray and erect abdomen X-ray, abdominal ultrasonography, and the measurement of stool calprotectin. Results: Fecal calprotectin level showed a positive strong correlation with NEC stages and this was statistically significant. Regarding the sequels of NEC, our study showed a positive correlation between NEC stage and fecal calprotectin level with r of 0. 911 and P-value of < 0. 001. The mean level of calprotectin in stage Ι a was 226. 9 μ g/g with the maximum in patients affected with stage Ι Ι b (875 μ g/g). Conclusion: According to the findings of this study, fecal calprotectin can be used as a marker in the diagnosis of NEC and has a strong positive correlation with the severity of NEC.

Background: Premature neonates admitted to the neonatal intensive care unit (NICU) undergo sleep disorder due to various manipulations. The present study aimed to investigate the effect of clustered nursing care on sleep behaviors in premature neonates admitted to NICUs. Methods: This clinical trial study was conducted on 60 neonates selected through convenience sampling method out of the infants admitted to the NICU. First, in the control group, a constant nurse took care of the neonates in a complete shift. The nurse observed the neonates sleep behaviors every two min for 45 min and recorded them in the questionnaire. The intervention group was investigated one week after the control group. The neonates ‘ sleep behaviors were observed and recorded every two min by Prechtl instrument. All the data were analyzed by the Mann-Whitney U test using SPSS software version 16. Results: The mean sleep times in the control group were as follow: quiet sleep 5 min and 86 millisecond, active sleep 21 min and 50 milliseconds, quiet wake 4 min and 6 milliseconds, alertness9 min and 6 milliseconds, and cry1 min and 76 millisecond. On the other hand, in the neonates who received clustered care in the intervention group, the mean timings were as follow: quiet sleep time 19 min and 33 millisecond, active sleep 24 min and 66 millisecond, quiet wake 1 min and 76 millisecond, alertness2 min and 76 millisecond, and cry0. 13 min. According to the mentioned times, it could be concluded that the neonates in the test group had a quiet and active sleep (P <0. 05). Conclusion: Findings of this study demonstrate that cluster care can significantly increase the time of quiet and active sleep in the newborns. Based on the result, it is recommended that this kind of care be provided in the NICU program, as well as in the syllabus of students and nursing retraining.

Background: The present study aimed to investigate the prevalence of electrolyte imbalance in hypoxic-ischemic encephalopathy (HIE). Moreover, the correlation of this condition with Apgar score is evaluated. Methods: This prospective observational hospital-based study was conducted on 75 neonates affected by asphyxiation. Immediately (within ≤ 30 min of stabilization) after resuscitation, basic routine tests along with sodium (Na+), potassium (K+), and calcium (Ca++) were requested from laboratory to be quantitatively estimated. These neonates were clinically examined and classified into various stages of HIE according to recommended staging classification. The values of electrolytes were calculated and compared between various stages of HIE. Furthermore, the correlation between these electrolytes and Apgar score was assessed. Results: It was observed in our study that HIE is associated with low levels of sodium and calcium. On the other hand, it is correlated with high levels of potassium. As severity of HIE increases, sodium and calcium levels decrease, while potassium level augments. Apgar score was significantly correlated with sodium and potassium. However, the correlation of potassium and sodium with Apgar score was shown to be negative and positive, respectively. Calcium levels did not have a significant correlation with Apgar score. Conclusion: Electrolyte imbalances, such as hyponatremia, hyperkalemia, and hypocalcemia are common in HIE. Hyponatremia and hyperkalaemia are significantly correlated with Apgar score. Therefore, Apgar score can be used as a determinant to start electrolyte therapy in HIE.

Background: Many newborns are hospitalized in neonatal intensive care units (NICU) and undergo invasive procedures. Intravenous (IV) insertion is one of the most common painful invasive procedures performed on newborns. Thus, it is important to carry out this procedure according to the standards. The present study aimed to determine the effect of video feedback on nurses’ adherence to neonatal IV insertion standards in selected hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Methods: This study was conducted as a clinical trial on 60 nurses in selected hospitals affiliated to Isfahan University of Medical Sciences in 2018. In the control group, after filling out the pre-test checklist and recording the IV insertion processes, the procedures were implemented according to the NICU routines. After a month, the post-test checklist was filled out. In the intervention group, feedbacks were given to the nurses about the correct insertion of IV and their performance after filling out the pre-test checklist and recording the processes. After a month, the post-test checklist was filled out, and the data were analyzed by the independent t-tests, Fisher’ s exact test, Chi-square test, covariance analysis, and paired sample t-test using SPSS software (version 22). Results: According to the findings, the mean score of adherence to neonatal IV insertion standards in the intervention group was about 59 before the intervention, but it increased to 78. 7 after the intervention. The statistical test also indicated a significant difference in this practice before and after the intervention (P<0. 001). Moreover, the results of the independent t-test showed that the mean score of adherence to neonatal IV insertion standards had improved significantly in the intervention group after the intervention, compared to that in the control group (P<0. 001). Conclusion: Use of feedback method can be effective in nurses’ adherence to standards.

Background: Preterm birth is a major contributor to neonatal and under-five mortality, and births at lower gestational ages (GA) contribute more to these statistics. Most developed countries have succeeded in improving survival at extremes of GA, while most developing countries like Nigeria still lag behind. The objective of this retrospective study was to document the survival rates among extremely preterm neonates and factors associated with mortality in a tertiary center in Nigeria. Methods: The labor ward delivery and neonatal unit admission records were reviewed from January 2010 to December 2017. The GA, gender, mode of delivery, birth weight, duration of admission, and outcomes for babies delivered at 24 to 27 weeks + 6 days of gestation were recorded. The survival rates and factors associated with mortality were analyzed. Results: During this period, there were 11, 607 live births with 1, 685 (14. 5%) preterm deliveries. There were 4, 523 admissions to the neonatal unit; overall, 736 (16. 3%) cases were preterm neonates out of which 152 (3. 4%) subjects were extremely preterm. The overall survival rate was 24. 3%, and the survival rate increased with increasing GA and birth weight (BW). Most deaths occurred in the first week of life. The means of BW and GA were significantly lower in babies that died, compared to those who survived. The median duration of admission was also lower for those that died, compared to those that survived. The most common causes of death were respiratory distress, sepsis, and intracranial hemorrhage. Conclusion: The survival rate of extremely preterm neonates is low in this study. Facilities to improve care, especially for respiratory support should be put in place to reduce mortality.

Background: The beneficial effect of breastfeeding for the health of mothers and infants are well recognized. Breast milk is a novel source of the stem cells forming during pregnancy and lactation. In the present study, the colony forming efficiency (CFE) of breast milk-derived stem/progenitor cells in the breast milk of mothers with preterm delivery (gestational age of fewer than 37 weeks) was compared with that of mothers with full-term delivery (gestational age of more than 37 weeks). Methods: Fresh-pumped breast milk of 30 healthy mothers with full-term delivery and 30 mothers with preterm delivery who had no underlying illness and drug intake were collected on days 5 and 15 after delivery, and then immediately assessed. For the purpose of the study, 10 ml fresh breast milk was gently mixed with equal amount of phosphate buffer saline, centrifuged at 1, 380 rpm for 20 min, cultivated in 1 ml MethoCult H4435 medium (Stem Cell Technologies), and incubated at 37° C with 5% CO2 and 80% humidity for 14 days. Results: The CFE is significantly lower in the 25 to 35-year-old mothers on day 15 after delivery than in 35 to 45-year-old mothers (P=0. 01). In both groups of mothers, the CFE was higher on day 5 than on day 15. Moreover, a significant correlation was observed between the CFE of breast milk stem/progenitor cells obtained on days 5 and 15 with the infants weighing 3, 000-4, 000 g (130± 62, P=0. 03 and 105± 26, P=0. 021), respectively. Furthermore, CFE increased in the breast milk of mothers aged 35 > years in comparison to that of younger mothers. Conclusion: According to our analysis, breast milk stem/progenitor cells CFE was higher in mothers with preterm delivery than in mothers with full-term delivery. These observations may uncover the compensatory mechanisms illustrated in the mothers' breast milk to improve the preterm infants' tissues development and organ formation in which various factors were involved, such as mothers' age and infants' weight.

Background: Jaundice is one of the most common health problems among neonates, involving almost 60% of full-term newborns, therefore requiring consequent phototherapy. Since phototherapy has several complications, considering alternative treatments has long been of pivotal importance. Therefore, the present study aimed at comparing the effectiveness of bath and massage in bilirubin levels in neonates. Methods: This was a randomized clinical trial conducted on neonates who were born in Zeyaei Hospital in Ardakan, Iran, in 2018. A total of 90 neonates were selected using the convenience sampling method and then assigned into two intervention groups (i. e., bath group and massage group) and a control group through random allocation method. In the bath group, the neonates were bathed immediately after birth. In the massage group, the neonates received field massage twice a day each lasting 15 min for 5 consecutive days. The neonates belonging to the control group were served with routine care. The jaundice meter China 800 (jk) device was used to measure the skin bilirubin levels of the neonates in the three groups in a scheduled manner (i. e., days 1, 3, 5, and 7) at 9 a. m. The data were analyzed using the ANOVA, Chi-square test, Tukey's post hoc test, and repeated measures ANOVA in SPSS software (version 18). Results: There was no significant difference between the mean bilirubin scores of the three groups over the first, third, and fifth days. A significant difference was found between the mean bilirubin scores of the bath and massage groups compared with that of the control group on the seventh day (P=0. 001). Also, no significant difference was seen between the mean bilirubin levels of the bath and massage groups on the seventh day. Conclusion: The findings revealed that there was no difference between the bath and massage techniques in reducing neonatal jaundice. Therefore, both techniques can be utilized in this regard.

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in the management of respiratory distress in preterm neonates. However, it is not known whether it takes precedence over the gold standard nasal continuous positive airway pressure (NCPAP) in this age group as a primary mode of non-invasive ventilation (NIV). There is limited evidence addressing this issue in the literature. Therefore, this study aimed to focus on the effect of HHHFNC on preterm neonates with respiratory distress, compared to NCPAP as a primary mode of respiratory support. Methods: A prospective observational study conducted in tertiary level III NICU. The preterm neonates 28-36 weeks with respiratory distress syndrome (onset of distress within ≤ 4 hours of life with FiO2 ≥ 0. 25 with compatible chest radiograph) were managed with either HHHFNC or nCPAP The need for invasive ventilation within 72 hours of initiation of non-invasive respiratory support was studied. FiO2 and Downe’ s scores were recorded every 4th hour for the first 48 hours. Results: In total, 84 neonates were enrolled in this study. Treatment failure for HHHFNC group was 34. 4%, whereas it was 32. 2% (P=0. 34) for NCPAP group which indicated no significant differences. In the late preterm strata, NCPAP group obtained longer duration for NIV (Median: 64 vs 43 hours, respectively; P<0. 001); however, there were no differences between the study groups regarding the use of supplemental oxygen. The estimation of the survival time was plotted using the Kaplan-Meier curve (P<0. 001). In addition, the two groups were compared through Gehan– Breslow– Wilcoxon test. Moreover, the results revealed differences between the two groups in terms of the hazards ratio for time to success regarding such items as the intervention group, gestational age, birth weight, surfactant therapy, and Downe’ s score (1. 17; CI: 95% [0. 7, 1. 8]). Conclusion: Early HHHFNC obtained similar results, compared to NCPAP as a primary mode of NIV for a preterm population with respiratory distress, and it may not be superior to NCPAP.

Background: Advances in neonatal intensive care have markedly improved survival in preterm infants. These babies need hospitalization due to the immaturity of the respiratory and digestive systems. The timing for the initiation of proper feeding in premature infants admitted to neonatal intensive care units (NICUs) is an important challenge for physicians, parents, and nurses. Therefore, this study aimed to investigate the effect of oral motor intervention (OMI) on the early onset of oral feeding in preterm infants. Methods: This clinical trial was carried out on 40 premature infants who were admitted to the NICU of Ali-ibn Abi Talib Hospital, Zahedan, Iran, in 2012 with the gestational age of 28-32 weeks. The subjects were randomly allocated to two equal groups of intervention and control. In the intervention group, 5-minute oral stimulations were performed based on premature infant OMI (PIOMI) by the researcher on a daily basis 15 minutes before gavage for seven days. On the other hand, the control group received routine care. Then, the groups were compared using the premature oral feeding readiness assessment scale in terms of timing, initiation of oral feeding, and hospitalization duration. Results: The intervention group achieved independent feeding significantly earlier than the control group (P=0. 034). In addition, the duration of hospitalization was shorter in the intervention group, compared to that of the control group (P=0. 027). Conclusion: The utilization of PIOMI method to stimulate oral movements is beneficial in the early onset of oral feeding and reduces the duration of hospitalization. Therefore, this method can be effective in treating premature infants and reducing treatment costs.

Background: Studies regarding cleansing the area with antiseptic solutions prior to catheterization in premature infants are limited. Therefore, the present study aimed to evaluate and compare the effects of chlorhexidine 2% and iodopovidone-alcohol solutions on bacterial colonization associated with the peripheral venous catheterization in premature infants. Methods: This quasi-experimental study was conducted in 2016-2017 at a neonatal intensive care unit in Qazvin, Iran. Premature infants (N=106) were assigned to the two groups of “ A” treated with chlorhexidine 2% or “ B” cleaned with iodopovidone-alcohol 10%. Quantitative culture of the catheters was performed 48 hours after insertion. Results: Our findings showed that the frequency of positive catheter tips culture was 6. 6% among all the samples (N=7). Out of the seven positive cultures, five (43. 9%) belonged to the iodopovidone-alcohol group and two (3. 7%) were from the chlorhexidine 2% group. Although a number of the positive cultures in the iodopovidone-alcohol group was higher than the chlorhexidine 2% group, this difference was not statistically significant (P=0. 21). Conclusion: Results of this study demonstrated that bacterial colony growth may be decreased when using preparatory chlorhexidine 2%, compared with iodopovidone-alcohol at no added risk to infants. We recommend further study in this regard.

Background: Neonatal mortality rate is an important health index. The present study was conducted to determine the mortality rate and its causes in neonatal intensive care units (NICUS) in Iran. Methods: Online search was done without time limit until June 2018 in several databases, such as PubMed, Web of Science (ISI), Scopus, Magiran, Barakat Knowledge Network System, SID, Iranian National Library, Regional Information Center for Science and Technology (RICST), Google Scholar search engine, and Iranian journals. The articles were qualitatively assessed after evaluating the inclusion and exclusion criteria. The Cochran's Q test and I2 index were used to determine the heterogeneity between studies. Meta-analysis was done based on a random effects model using Comprehensive Meta-Analysis Software (version 2). Results: Thirty-one eligible studies were analyzed. The mortality rate in 24, 995 neonates admitted to NICUs in Iran was estimated to be 11. 40% (95% CI: 9. 10-14. 20). The lowest mortality rate reported as 7. 70% (95% CI: 6. 01-9. 82) was related to the Center of Iran, and the highest mortality rate was reported as 19. 26% (95% CI: 15. 82-23. 24) in the west of Iran. In this regard, the difference was statistically significant (P<0. 001). The most common causes of mortality in NICUs in Iran were prematurity (44. 14% [95% CI: 31. 95-57. 08]), respiratory distress syndrome (RDS) (31. 93% [95% CI: 22. 83-42. 66]), congenital malformation (16. 09% [95% CI: 12. 85-19. 95]), septicemia (12. 66% [95% CI: 8. 87-17. 75]), and asphyxia (7. 58% [95% CI: 4. 63-12. 19]). Conclusion: The most common causes of mortality in Iranian neonates were prematurity, RDS, and congenital anomalies. We also found the mortality rate to be acceptable (11. 4%). To reduce the mortality rate, we recommend performing prenatal screening tests and genetic counseling. In addition, maternal care during pregnancy should be improved to reduce premature delivery.

Background: This study aimed to investigate the effect of development-based care programs by mother on low birth weight (LBW) infants after being discharged from hospital. The present research was based on the assumption that there is a difference between intervention and control groups regarding the mean neonatal growth indices on the 15th and 29th days. Methods: This quasi-experimental study was conducted on 60 infants with LBW (1, 500-2, 500 g) and gestational age of < 37 weeks in Beheshti Hospital, Isfahan, Iran. The study population was selected through convenience sampling method and then randomly divided into two groups of intervention (n=30) and control (n=30). In the intervention group, the mothers received developmental care training, and in the control group, the mothers received routine care. The data collection instrument were questionnaires, tape meter, stadiometer, and baby scale. The height, weight, and head circumference indices were measured and recorded on the 1st, 15th, and 29th days of birth. Results: The repeated measures ANOVA in within-group analysis revealed a significant difference in the mean weight and height indices of the infants between the intervention and control groups on the 1st, 15th, and 29th days of birth (P<0. 001). However, there was no significant difference between the two groups in terms of mean head circumference (P<0. 05). Also, the Bonferroni post-hoc test showed a significant difference between the intervention and control groups regarding the weight index on the 29th day (P<0. 05). Conclusion: The results showed that the intervention could significantly increase the weight index in the infants. Given that some developmental care techniques are low-cost and executable by mothers, and LWB infants are at risk for various disabilities in the future, health managers are advised to utilize this technique to improve the quality of life in these infants.

Background: Low birth weight is one of the most important health indicators for assessing the status of newborns in every country. It is, therefore, necessary to identify factors associated with this adverse pregnancy outcome. This study was conducted to determine predicting factors associated with low birth weight using path analysis. Methods: This prospective study was performed on 719 eligible pregnant women with a gestational age of 24-28 weeks who visited the health centers in Ilam, Iran. The participants were selected through stratified cluster sampling. The data were collected using relevant scales and analyzed using SPSS software (version 19. 0) and LISREL (version 8. 8). Results: The incidence rate of low birth weight was obtained at 7. 5%. The risk scores of low birth weight were 2. 7, 2. 5, 3. 3, 1. 8, and 2. 8 times higher in the participants with stress, anxiety, depression, domestic violence, and food insecurity, respectively, compared to those without the mentioned conditions. The goodness of fit index confirmed the favorable fit of the model. The most influential direct determinants of birth weight were the number of prenatal visits (β =0. 19) and mother’ s body mass index (β =0. 02). The most important direct determinant of birth weight was stress in this study (β =-58. 006). Conclusion: The etiology of low birth weight is complex and may involve demographic characteristics, as well as nutrition, reproductive, and socioeconomic factors. Given that prenatal care and psychological and nutritional factors are the major determinants, it is essential to take fundamental steps, including the improvement of living standards and nutritional status in pregnant women, more regular prenatal care visits, and pre-conception counseling.

Dear Editor-in-Chief: I read and enjoyed your stylish article, "Frequency of Congenital Cardiac Malformations in Neonates with Congenital Hypothyroidism", in relation to heart disease with hypothyroidism. As we know, one of the most commonly associated congenital hypothyroidism disorders is congenital heart disease, which has a significant effect on the recovery of patients suffering from these disorders. On the other hand, both of these cases are visible and consistent in patients with Down syndrome. Down syndrome is the most common chromosomal abnormality among live-born infants, which usually has certain characteristic signs, including a variety of dysmorphic features, such as flat facial features, small head and ears, short neck, and congenital malformations, the most important of which are congenital heart diseases and other health problems and medical conditions. In what follows, we will study the diagnosis and treatment of an infant with Down syndrome undergoing surgery due to congenital heart disease, whose late detection of hypothyroidism led to lack of proper response to heart failure correction.

Background: Pericardial effusion and cardiac tamponade are the rare complications of peripherally inserted central catheters (PICC insertion) in extreme low birth weight infants. In this regard, paying attention to these complications is of utmost importance, because they can result in infant death. Case report: The case of our infant is a sample of these complications. On the 39th day of the birth of the infant, the muffled sounds of heart and pathological murmurs in heart auscultation raised the doubt of a problem in infant’ s heart. Conclusion: In this regard, echocardiography was performed. The report was massive pericardial effusion impending tamponade. After pericardiocentesis for saving infant’ s life, diagnostic evaluations were performed, and PICC insertion was proved as the cause of these complications. Although these complications are usually diagnosed with symptoms like bradycardia, hypotension, and drop in saturation or cardiac arrest, the first step of diagnosis in our infant was abnormal heart examination. Therefore, it is essential that all neonatologists pay attention to heart examination of infants with PICC along with other symptoms such as bradycardia, hypotension, and drop in saturation or cardiac arrest to avoid occurring pericardial effusion and cardiac tamponade as rare complications of PICC insertion. They should consider pericardial effusion and cardiac tamponade as the fatal complications of PICC insertion in extremely low birth weight infants with PICC.

Background: This case report presents a very rare Dandy-Walker malformation (DWM) in association with a sporadic condition characterized by congenital melanocytic nevi and melanocytic thickening of the leptomeninges called Neurocutaneous melanosis (NCM). The DWM is a rare congenital disorder characterized by enlarged posterior fossa and a cystic enlargement of the fourth ventricle with cerebellar vermis dysgenesis. This association is a very rare complex, and this is another rare case to be reported in the literature. Case report: A full-term newborn was presented with tachypnea at birth whose hydrocephalous was reported prenatally. The magnetic resonance imaging and cerebrospinal fluid immunohistochemistry confirmed leptomeningeal melanosis. After documenting findings by skin biopsy, we decided to report this case. Diagnosis and treatment for such disease entity are discussed in this report. Conclusion: Even without malignant transformation, the prognosis is poor after symptomatic progression of the NCM resulting from either mass effect in the central nervous system or hydrocephalus. We reported this case in order to increase the knowledge of pediatric physicians to diagnose this combined situation.