فهرست مطالب

Neonatology - Volume:5 Issue: 4, Winter 2015

Iranian Journal of Neonatology
Volume:5 Issue: 4, Winter 2015

  • تاریخ انتشار: 1393/11/20
  • تعداد عناوین: 9
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  • Fatemeh Nayeri, Mamak Shariat, Majeed Firozi, Majeed Kalani, Bita Ebrahim Pages 1-5
    Background And Objective
    NAS is a combination of signs and symptoms that due to physical and mental dependency, develops in neonates born from drug addicted mothers. The onset of NAS varies in accordance with the type, amount, frequency and duration of substance used. Because of diverse and unclear pattern of substance abuse in Iranian addicted pregnant mothers in comparison with western countries, this multi-center study has been designed to evaluate NAS in neonates born from drug addicted mothers.
    Material And Method
    A cross sectional study was carried out on newborns of narcotic addicted mothers during the first six months of 2008. The newborn’s status and clinical signs were checked by physical examination and scored by the Finnegan scoring system.
    Results
    In this study 100 neonates born from narcotic addicted mothers were examined; the most used narcotic was crack (36%). 60% of neonates showed signs of NAS. The most prevalent signs of NAS were increased muscle tonicity (60%/7), irritability (59%/6) and increased moro reflex (51%/8). Neonates born from crack abusers, in comparison with other drugs, were significantly at risk of NAS (100% vs.87%, p).
    Keywords: NAS, addiction, Pregnancy
  • Ashraf Mohammadzadeh, Ahmad Shah Farhat, Abbas Alizadeh Kaseb, Fatemeh Khorakian, Mohammad Ramezani Pages 6-10
    Introduction
    One of the common problems in neonatal period is jaundice that occurs in the first week of birth in 60% of term and 80% of preterm neonates. In preterm newborn hyperbilirubinaemia is higher, persistent, longer, and more likely to be associated with neurological injury than term neonates. The purpose of this study was to determine Prophylactic effect of zinc sulphate on hyperbilirubinemia in premature very low birth weight neonates. Method and Material: Sixty Newborns who admitted in our NICU which had inclusion criteria were eligible in this trial. Included neonates were randomly placed in two groups (case and control) and before intervention the total serum bilirubin (TSB) was measured at second day. The participant received either 20 mg of zinc sulfate or placebo through NG-tube divided in two doses till day seven of age. Then total and indirect bilirubin was measured at 3ed, 5th and 7th day of life. If any of newborns in duration of hospitalization develop clinical jaundice, after assessment of bilirubin, need for phototherapy was evaluated based on phototherapy and exchange schedule as described by the American Academy of Pediatrics guidelines. The termination point of phototherapy was defined as a bilirubin level less than 50 percent of starting point. After gathering Data, they were analyzed using SPSS software (version 11.5) and T-test, Chi-square and repeated measurement tests.
    Results
    Seventy eight patients enrolled in this trial that 18 cases were excluded and the remaining cases divided into two equal groups (N=30 in each group). Demographic condition was similar in two groups. There were no different between two groups in decreasing total serum bilirubin and duration of phototherapy.
    Conclusion
    This study showed that zinc sulfate has no preventing effective in hyperbilirubinemia in preterm very low birth weight neonates. It has also no effect on duration of phototherapy.
    Keywords: Jaundice, premature, Zinc, Phototherapy
  • Narges Pishva, Alie Mirzaee, Zohre Karamizade, Shahnaz Pourarian, Fariba Hemmati, Mostajab Razvi, Forough Saki Pages 11-14
    Objective
    Although metabolic diseases individually are rare, but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases.
    Method
    using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients. Lethargy, poor feeding, persistent vomiting, cholestasis, intractable seizure, decreased level of consciousness, persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.
    Results
    Organic acidemia with 40 cases (42%) was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism (30%), 15 patient had classic galactosemia (GALT<5%). Methyl Malonic acidemia and propionic acidemia were the most common, they become symptomatic from three days to several months after birth. The most common symptoms in these patients were repeated vomiting, respiratory distress and lethargy. Most patient had repeated hospitalization even on special formula. Disorder of amino acid metabolism also is not uncommon (17%) in this high risk population, MSUD was the most common.
    Conclusion
    Metabolic diseases are not rare in Iranian populations. Consequently, sensitive methods for prompt diagnosis and treatment are required in our country.
    Keywords: metabolic disorders, Screening, Fars
  • Reza Saeidi, Vahid Sadeghi Pages 15-18
    Background
    Although many efforts made for the advancement of medical science, it is distributed inequitably despite of all existing financial and human resources facilities. Children as the most important and vulnerable groups of society are influenced by these inequities. The Objective of this study is comparison of children health indices in rich and poor rural zones in Mashhad/Iran.
    Methods
    This is a cross sectional study, We considered a poor (Andad) and a rich (Toos) zones to compared for some health indices. We compared some indices like: maternal mortality rate (MMR), neonatal mortality rate (NMR), children under 1 (IMR) and under 5 years mortality rate (U5MR), low birth weight prevalence (LBW), exclusive breast feeding (EBF) and fertility rate. Data collected with check list and analyzed by SPSS-11.5.
    Results
    in our study in two poor (Andad) and rich (Toos) zones we have: Neonatal mortality rate (zero versus 5.46) (P=0.00); breast feeding indices like exclusive breast feeding indices up to 6 month (54.4% versus 79%) (P=0.01); have significant differences between two zones. But fertility rate indices like total fertility rate (2.09 versus 1.95) (p=0.98) and Mean children mortality rates during 2011-2013 like children less than 5 years mortality (18.65 versus 12.13 per thousand live birth) (p=0.29) does not have statistically significant differences.
    Conclusion
    This study shows that health indices in rich and poor zones, have significant differences.
    Keywords: children mortality rate, neonatal mortality rate, equity in health
  • Ziba Mosayebi, Amir Hossein Movahedian, Bita Ebrahim Pages 19-23
    Background And Objective
    Neonatal sepsis is defined as presence of clinical signs accompanied by positive blood culture in newborns less than one month of age. Sepsis is a common cause of hospital admission in neonates, and it is known as one of the main causes of mortality among them, not only in developed countries but in developing ones. Delay in diagnosis and appropriate antibiotic therapy would result in death. The aim of this study is to find the main pathogens of sepsis and evaluate sensitivity changes of organisms to antibiotics in comparison with the past.
    Method
    In this descriptive study, 104 (files of) neonates, admitted to the neonatal ward of Shabih Khani Hospital, with positive blood culture over a 24-month period (2005-2007) were assessed. Data were extracted for analysis.
    Results
    Over this 24-month study on 104 neonates with sepsis, the most common organisms included flavobacterium 43.3%, pseudomonas 33.3%, coagulase negative staphylococcus 17.3%, coagulase positive staphylococcus 5.9% followed by enterobacter, E.coli, beta-haemolytic streptococcus, klebsiella, diphtheriod and lysteria.
    Conclusion
    In this study Flavobacterium is found to be the most common organism for early sepsis. Although infection with flavobacterium is rare, its rate of mortality is high and it is resistant to majority of common antibiotics. Therefore, early diagnosis and appropriate antibiotic prescription helps reduce its complications.
    Keywords: Early onset sepsis, Neonatal sepsis, Neonate
  • Mohammadreza Rafati, Maryam Nakhshab, Vagihe Ghaffari, Mohammadreza Mahdavi, Mustafa Sharifi Pages 24-29
    Background
    Extrauterine growth restriction remains a common and serious problem in newborns especially who are small, immature, and critically ill. Very low birth weight infants (VLBW) had 97% and 40% growth failure at 36 weeks and 18-22 months post-conceptual age respectively. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may cause significant growth delay or morbidity in VLBW infants. The purpose of this study was to evaluate current nutritional status in the neonatal intensive care unit in a teaching hospital.
    Methods
    During this prospective observational study, the nutritional status of 100 consecutive critically ill neonates were evaluated by anthropometric and biochemical parameters in a tertiary neonatal intensive care unit. Their demographic characteristics (weight, height and head circumference), energy source (dextrose and lipid) and protein were recorded in the first, 5th, 10th, 15th and 20th days of admission and blood samples were obtained to measure serum albumin and prealbumin. The amount of calorie and protein were calculated for all of preterm and term neonates and compared to standard means separately.
    Results
    The calorie and amino acids did not meet in the majority of the preterm and term neonates and mean daily parenteral calorie intake was 30% or lower than daily requirements based on neonates’ weight. Mortality rate was significantly higher in neonates with lower serum albumin and severity of malnutrition but not with serum prealbumin concentration.
    Conclusion
    Infants were studied did not receive their whole of daily calorie and protein requirements and it is recommended early and enough administration of calorie source (dextrose, lipids) and amino acids. Prealbumin was a more benefit biochemical parameter than albumin to evaluate short term nutrition especially in critically ill patients.
    Keywords: infants, NICU, Malnutrition, Albumin, Prealbumin
  • Bita Najafian, Aminsaburi Aminsaburi, Seyyed Hassan Fakhraei, Abolfazl Afjeh, Fatemeh Eghbal, Reza Noroozian Pages 30-34
    Background
    Respiratory Distress syndrome is the most common respiratory disease in premature neonate and the most important cause of death among them. We aimed to investigate factors to predict successful or failure of INSURE method as a therapeutic method of RDS.
    Methods
    In a cohort study,45 neonates with diagnosed RDS and birth weight lower than 1500g were included and they underwent INSURE followed by NCPAP(Nasal Continuous Positive Airway Pressure). The patients were divided into failure or successful groups and factors which can predict success of INSURE were investigated by logistic regression in SPSS 16th version.
    Results
    29 and16 neonates were observed in successful and failure groups, respectively. Birth weight was the only variable with significant difference between two groups (P=0.002). Finally logistic regression test showed that birth weight is only predicting factor for success (P: 0.001, EXP[β]: 0.009, CI [95%]: 1.003-0.014) and mortality (P: 0.029, EXP[β]: 0.993, CI [95%]: 0.987-0.999) of neonates treated with INSURE method.
    Conclusion
    Predicting factors which affect on success rate of INSURE can be useful for treating and reducing charge of neonate with RDS and the birth weight is one of the effective factor on INSURE Success in this study.
    Keywords: Respiratory Distress Syndrome (RDS), Intubation, Surfactant, Extubation (INSURE), Nasal Continuous Positive Airway Pressure (NCPAP), Surfactant
  • Deepak Kumar Sharma, Srinivas Murki, Tejo Pratap Pages 35-36
    A preterm female baby with birth weight of 1.5kg was referred to our hospital on day 6 for difficulty in breathing. Baby was admitted at birth for respiratory distress and feed intolerance to other hospital and in view of clinical deterioration baby was referred. Baby had thrombocytopenia with platelets counts of 11000/ mm3 and high CRP titer. Baby had petechial haemorrhagic spots all over the body with hepatosplenomegaly and sclerema (figure 1,2,3). Baby further platelets counts were 3000, 43000, 67000 and then normal. Baby was managed with antibiotics and platelets transfusion. Gradually baby counts improved and petechial spots disappeared. DiscussionNeonatal Sepsis is a common complication in the neonatal intensive care unit. It is most common in the smallest and most premature infants in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is the common manifestation of neonatal sepsis in sick babies(1). The manifestation can be seen in newborn as petechial spots over the body with predominance over chest and abdomen(2).Thrombocytopenia is seen in 18% to 35% of NICU patients, and in 73% of extremely low birth weight (ELBW) infants(3). Bacterial,fungal and viral infection causes thrombocytopenia. Infection causes damage to vascular endothelium which increases the destruction of platelets and there removal by reticuloendothelial system(4)
    Keywords: Petechial Hemorrhage, Neonatal Thrombocytopenia, Neonatal sepsis
  • Reza Saeidi, Shadi Nourizadeh* Pages 37-39
    Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT) or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.
    Keywords: Octreotide, Chylothorax, newborns