فهرست مطالب

Neonatology - Volume:8 Issue: 4, Autumn 2017

Iranian Journal of Neonatology
Volume:8 Issue: 4, Autumn 2017

  • تاریخ انتشار: 1396/10/10
  • تعداد عناوین: 17
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  • Sunita Arora*, Shifali Gupta, Pushpjeet Sheemar Pages 1-6
    Background
    This study was conducted to compare the cord blood lipid profile in term small for gestation (SGA) and appropriate for gestational age (AGA) babies as determination of cord blood lipid profile is useful screening tool for early detection of babies at higher risk as atherosclerosis has its genesis in childhood.
    Methods
    Study Design: Hospital based cross sectional study. Setting: neonatal unit of tertiary care hospital. Subjects: 200 full term babies born at SGRDIMSR during study period out of which 100 were AGA and 100 were SGA babies. Mean cord cholesterol, triglyceride, HDL, LDL, VLDL was measured in both the groups.
    Results
    Mean cord blood cholesterol was 72.29± 21.13 mg/dL, triglycerides 67.18± 20.36 mg/dL, HDL 28.51± 5.68 mg/dL, LDL 34.94± 16.45 mg/dL, VLDL 13.43± 04.10 mg/dl in 100 AGA babies. In 100 SGA babies, mean total cholesterol was 100.85± 26.82 mg/dl, triglycerides 82±22.58 mg/dL, HDL 27.70± 7.79 mg/dL, LDL 44.93± 7.663 mg/dL, VLDL 16.40± 4.479 mg/dL.
    Conclusion
    Lipid profile values except HDL were significantly higher in SGA compared to AGA neonates (p
    Keywords: AGA, Cholesterol, HDL, LDL, SGA, Triglycerides
  • Nayer Salmani, Zohre Karjoo *, Khadige Dehghani, Alireza Sadeghnia Pages 7-12
    Background
    There is a low threshold of pain in newborns, especially premature infants, who are extremely sensitive to pain and painful procedures by showing a strong response. This study aimed to determine the effect of facilitated tucking with simulated hands on physiological factors of pain during venipuncture in premature infants.
    Methods
    This experiment was conducted on preterm infants admitted to the neonatal intensive care unit of Amin and Shahid Beheshti hospitals in Isfahan, Iran in 2016. In total, 66 patients were selected through convenience sampling and were randomly assigned to the intervention (N=33) and control (N=33) groups. In the intervention group, venipuncture procedure was performed as infants were placed in the facilitated tucking position using simulated hands. Data were collected applying the new Iranian S1800 monitors for hemodynamic control. Data analysis was performed in SPSS version 18 using Kolmogorov-Smirnov, Chi-square, independent t-test and repeated measures ANOVA.
    Results
    In this research, a statistically significant difference was observed between the mean of arterial oxygen saturation and respiratory rate of the intervention and control groups (P
    Conclusion
    According to the results of the research, placing premature infants in the facilitated tucking position using simulated hands can reduce physiological changes during venipuncture process.
    Keywords: Facilitated tucking, Pain, Physiological response, Premature infant
  • Parisa Maziri, Golnaz Asaadi Tehrani *, Fereshteh Bahrami Hidagi, Masoumeh Nejatollahi, Sedigheh Asadi Pages 13-19
    Background
    Recurrent pregnancy loss (RPL) is a common problem among couples, and acquired thrombophilia is the well-known etiology of RPL. The aim of this study was to establish the association between inherited thrombophilic gene polymorphisms and RPL.
    Methods
    This case-control study was conducted on 50 women with unexplained RPL and 50 parous women with no history of miscarriage (age range: 17–48 years). The data were collected during 2013–2015 in Sarem Hospital, Tehran, Iran. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for glycoprotein IIIa (PLA1/PLA2), KDR (Q472H), and β-fibrinogen (-455G/A); tetra-primer amplification refractory mutation system (ARMS)-PCR for glycoprotein Ia (807c/t) and vascular endothelial growth factor (VEGF) (2578c/a), and ins/del PCR for angiotensin I-converting enzyme (ACE) (intron 16 I/D). The association between the frequency of the genotypes and RPL was determined by Chi-square and Fisher’s exact tests.
    Results
    The results of the present study revealed a significant relationship between glycoprotein Ia (807C/T), VEGF (2578C/A), and ACE (intron 16 I/D) polymorphisms and RPL (P=0.00, 0.02, and 0.00, respectively). In contrast, no relationship was observed between β-fibrinogen (-455G/A), KDR (Q472H), and glycoprotein IIIa (PLA1/PLA2) polymorphisms and increased risk of RPL (P>0.05).
    Conclusion
    This study demonstrated that glycoprotein Ia (807C/T), VEGF (2578C/A), and ACE (intron 16 I/D) polymorphisms may be a risk factor for the women with a history of RPL.
    Keywords: Polymorphism, Recurrent pregnancy loss, Thrombophilia
  • Mostajab Razavi Nejad, Mohammad Heidarzadeh, Parisa Mohagheghi, Forouzan Akrami, Amir Almasi-Hashiani, Zahra Eskandary * Pages 20-25
    Background
    Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU). This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers.
    Methods
    This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics.
    Results
    In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77.
    Conclusion
    According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions.
    Keywords: Developmental care, NICU, Physical environment, Preterm neonate, Tertiary care center
  • Hassan Boskabadi, Mohammad Hadi Sadeghian, Javad Sadeghinasab * Pages 26-32
    Background
    Early diagnosis is paramount to the treatment of neonatal infections. Nucleated red blood cells (NRBCs) are immature erythrocytes that increase in number due to stress and hypoxia. This study was conducted to determine NRBC count in the peripheral blood and examine its significance as a marker of neonatal infection.
    Methods
    This case-control study was conducted on 154 infants (78 infants with infection as the case group and 76 infants without infection as the control group) admitted to Ghaem and Emam Reza hospitals, Mashhad, Iran. After a complete physical examination, a series of tests, including blood culture, complete blood count, C-reactive protein test, and peripheral blood smear, were performed on the infants; their NRBCs per 100 white blood cells (WBCs) were also counted.
    Results
    The mean NRBC counts in the infants with and without infection were 30 and 3 per 100 WBCs, respectively (P
    Conclusion
    NRBC count in the peripheral blood smear helps with the diagnosis of neonatal infection and can be used in conjunction with other laboratory tests as a simple and convenient method.
    Keywords: Diagnosis, Infant, Nucleated red blood cells, sepsis
  • Maliheh Kadivar, Mahsa Asadabadi * Pages 33-38
    Background
    Tumors are among the main causes of neonatal intensive care unit (NICU) admission. We aimed to determine the frequency distributions and presentations of tumors in newborns admitted to the NICU of a children’s medical center.
    Methods
    In this observational cross-sectional study, we reviewed medical records of 53 neonates admitted to the NICU of a children’s medical center during 2004-2015. The demographic characteristics, maternal history, ultrasound findings during pregnancy, and family history of cancer were considered along with clinical presentations. To determine the tumor type, imaging and pathological reports were collected from the medical records. Tumors were classified according to the International Classification for Childhood Cancer criteria (ICCC). The gathered data were analyzed using SPSS, version 19.
    Results
    The mean maternal age and gestational age of the newborns were 24.4±4.9 years and 37.4±2.01 weeks, respectively. Twenty-nine (54.7%) subjects were female, and 12 (22.6%) infants were preterm. The parents of 19 infants (35.8%) had consunguity, but positive family history was not identified in any of the newborns. Thirteen (24.5%) patients had congenital anomalies. Neonatal cancer was diagnosed through prenatal ultrasonography in 16 (30.2%) infants, and 17 (32%) cases had malignant tumors. Among these newborns, 37 (69.8%) underwent surgery, 13 (24.5%) patients received medications, 1 (1.9%) patient had chemotherapy, and 2 (3.8%) patients received both surgery and chemotherapy. Ten (18.9%) subjects died at the end of the study. Furthermore, 18 (34%) tumors were mature teratomas, 11 (20.8%) cases were hemangiomas, 7 (13.2%) were neuroblastomas, and 6 (11.3%) cases were lymphangiomas.
    Conclusion
    According to the results of this study, teratoma is the most common tumor among the newborns admitted to NICUs, and head and neck were the most common locations. In addition, neuroblastoma was associated with the highest mortality rate in this study.
    Keywords: Malignancy, Neonatal intensive care unit, Newborn, Tumor
  • Mahboobeh Gholami * Pages 39-42
    Background
    Silymarin is a potent inhibitor of apoptosis. The present study aimed to investigate the effect of prenatal silymarin administration during the gestational period on fetal growth.
    Methods
    This experimental study was conducted on 24 virgin female BALB/c mice weighing 20-30 grams. One male animal was caged with two females overnight, and they were examined for the presence of a vaginal plug in the next morning. Presence of vaginal plugs was considered to be gestational day zero (GD0). The mice were randomly divided into four groups, including three groups of pregnant mice administered with silymarin via intraperitoneal injection at doses of 50, 100, and 200 mg/kg/day (groups 1, 2, and 3, respectively) during GD6-15 (organogenesis) and a control group. Animals in the control group received normal saline via the same route in equivalent volumes. Data analysis was performed in SPSS version 18.0, and the pathological scores were compared using Kruskal-Wallis, ANOVA, and Dunn’s multiple comparison tests. P-value of less than 0.05 was considered statistically significant.
    Results
    Administration of silymarin had no effect on the weight gain of the mothers. However, placental weight gain decreased in the second and third group compared to the other groups (P≤0.001). In addition, head circumference was observed to reduce in all the treatment groups compared to the control group (P≤0.001). Also, the findings showed significant differences in the resorption rate and weight gain in all the treatment groups compared to the control group (P=0.001).
    Conclusion
    According to the results, silymarin administration during gestation may lower weight gain and decrease placental circumference in the fetus of mice.
    Keywords: Birth weight, Growth, Head circumference, Height, Silymarin
  • Mahboobeh Namnabati, Fariba Taleghani, Maryam Varzeshnejad Pages 43-56
    Background
    Medication management is a complex process with multiple stages that involves different health care teams. Based on the evidence, an electronic medication management system offers significant benefits, such as reduced medication errors, improved conformity, enhanced time and cost efficiency, and increased patient safety. This study aimed to design and implement an electronic medication management system and measure the nurse’s satisfaction regarding the application of this system.
    Methods
    In this technical action research, the nurse's satisfaction with the use of the designed system was evaluated. The electronic medication system development and data collection were conducted in two phases. The first phase included the design and development of an electronic nursing medication management system to be used in the neonatal intensive care unit. The second phase involved the evaluation of the nurses’ satisfaction with the use of the electronic system by applying a five-point Likert scale questionnaire.
    Results
    The findings were divided into two categories, including results related to the design of the electronic systems and those regarding the evaluation of nurses’ satisfaction with the use of the electronic systems. The design of the electronic system was successful as the nurse's satisfaction evaluation revealed a high level of satisfaction with the use of the system.
    Conclusion
    Electronic medication management system has more practical advantages than other similar systems. This system helps the nurses to identify and prevent many medication errors and save time in drug care documentation. Therefore, this system is a big step towards satisfaction with nursing medication care.
    Keywords: Electronic medication management systems, Medication care, Neonatal, Nursing satisfaction
  • Arash Bordbar, Ali Mazouri, Mandana Kashaki, Majid Kalani, Maryam Saboute, Rozita Hosseini, Somayeh Farhadi, Ali Ghassemian * Pages 57-64
    Background
    Bacterial sepsis is highly prevalent among premature infants. Amikacin is an antibiotic widely recommended for the treatment of neonatal sepsis, one of the consequences of which might be nephrotoxicity. The present study aimed to compare the efficacy and nephrotoxicity of multiple daily dosing (MDD) and once-daily dosing (ODD) of amikacin in preterm infants suspected of sepsis.
    Methods
    This triple-blind, randomized, controlled clinical trial was conducted on 40 premature infants suspected of sepsis, who were randomly divided into two groups. In addition to ampicillin, one group was administered with the standard daily dose, and the other group received an ODD of intravenous amikacin. Maximum and minimum serum levels of amikacin and urine neutrophil gelatinase-associated lipocalin (NGAL) were measured in both groups. Data were extracted and analyzed based on the research hypothesis and literature review.
    Results
    No significant differences were observed between the study groups in terms of gender, gestational age, mode of delivery, birth weight, and Apgar score. After the intervention, mean plasma creatinine reduced in both groups, while the mean reduction was significantly higher in the group administered with the ODD of amikacin (P=0.0001). However, mean changes in the urine NGAL had no significant difference between the groups (P=0.635). Minimum and maximum serum levels of amikacin in the study groups indicated a more significant reduction in mean level of the infants administered with the ODD of amikacin compared to the MDD group (P=0.0001).
    Conclusion
    Considering the higher maximum and lower minimum levels of amikacin in the neonates receiving the daily dosage regimen, it seems that this regimen is more effective in the treatment of sepsis in preterm infants. Moreover, no significant difference was observed in the efficacy and nephrotoxicity of the daily amikacin dosing in the premature infants suspected of sepsis compared to those treated by multiple doses of amikacin.
    Keywords: Amikacin, Drug regimen, Nephrotoxicity, Prematurity, sepsis
  • Nasrollah Alimohammadi, Soheila Jafari-Mianaei *, Marzieh Hasanpour, Amir-Hossein Banki-Poorfard, Akram Sadat Sadat Hoseini Pages 65-73
    Background
    The infants depend on their parents for growth and survival during the early years of life. Therefore, the parents play a key role in the preservation and improvement of the infants’ physical and psychological health. Religion is one of the most influential factors that affect parenting. Regarding this, the present study aimed to investigate the Islamic perspectives on parent's role during infancy.
    Methods
    This study was conducted within August 2014 to July 2016 (i.e., 24 months) using a qualitative content analysis. All the Shiite Islamic documents (i.e., Quran and Ahadith), which had Persian translation, were surveyed without any time limitation. Documents were in electronical and printed formats. Data analysis was performed using MAXQDA 10 software.
    Results
    The results of analysis led to the emergence of three main categories. These categories included parents as the founders of infant’s physical and psychological health, parents as God’s representatives in nurturing the infant, and infant as part of parents’ flesh and God’s trust. The three obtained categories indicated the dimensions of Islamic perspective on parent's role during infancy.
    Conclusion
    Based on the Islamic thought, God is the main carer and nurturer of the infants, and parents as the nurture way pavers can achieve the best outcomes by fulfilling their duties and invoking God for his assistance and grace. According to the findings of the study, since the infant is the sign of God’s trust and grace to the parents, the parents should make their best to raise a healthy and righteous child. The nurses’ awareness of religious beliefs may improve the quality of care. In this regard, the nurses can help the parents by training, counseling, and supporting them to have a healthy and righteous child.
    Keywords: Infancy, Islamic perspective, Parent's role
  • Mahboobeh Namnabati, Zeinab Hemati *, Fariba Taleghani, Alireza Sadeghnia Pages 74-82
    Background
    Prematurity could result in the long admission of the neonate to the Neonatal Intensive Care Unit (NICU) and development of some complications for both mother and newborn. The early discharge programs make the neonatal transference to home much easier and are beneficial to both parents and newborns. However,there are limited studies investigating the real needs of the preterm neonates discharged early. Therefore, the identification of the post-discharge needs of these newborns could help the nurses, as the most important health care members, to consider these needs and mitigate the complications affecting the neonates.
    This study aimed to describe the care needs of the preterm infants with early discharge from the NICU.
    Methods
    The present study was conducted on 25 participants (i.e., 10 mothers, 3 physicians, and 12 nurses) selected by purposive sampling technique. Data collection was performed by Observer as participant and in-depth interviews by qualitative content analysis for analysis.
    Results
    Data analysis led to the emergence of four categories, namely need to follow nasogastric tube feeding, need for oxygen level monitoring, need to obtain sufficient information about medication, and need to acquire skill for daily care delivery.
    Conclusion
    The enhancement of the nurse's knowledge about the needs of the preterm neonates with early discharge would result in the improvement of their abilities in the relevant domain. Accordingly, these nurses could help the mothers to prevent the incidence of several complications in the neonates, such as readmissions to the NICU. More importantly, these measures could prevent from the consequences of failure to fulfil these needs emerging in the later stages of life.
    Keywords: Descriptive qualitative method, Early discharge, Home care, NICU
  • Maryam Saboute, Ali Mazouri, Nasrin Khalesi *, Nasrin Hoseiny Nejad, Anahita Razaghian Pages 83-88
    Background
    Neonatal hyperbilirubinemia is one of the most common causes of neonatal morbidity and a global health priority. This study aimed to evaluate the effect of intensive phototherapy on management of hyperbilirubinemia with different etiologies.
    Methods
    This retrospective cohort study was conducted on 219 neonates with indirect hyperbilirubinemia, who had the indication for phototherapy, admitted to neonatal intensive care unit of Akbar-abadi Hospital, Tehran, Iran, during 2014-2016. The levels of total bilirubin, hemoglobin, reticulocyte, and glucose 6-phosphate dehydrogenase (G6PD) enzyme were examined and direct Coombs test was performed during hospital stay. The participants were assigned to four groups based on the etiology of hyperbilirubinemia and underwent intensive phototherapy.Finally, the level of total bilirubin was compared among the groups to assess the effect of intensive phototherapy.
    Results
    According to the results of this study, nonhemolytic jaundice was the most frequent cause of hyperbilirubinemia (82.19%). The mean bilirubin levels after 6 and 24 hours of intensive phototherapy were 4 and 6.2 mg/dl, respectively. Intensive phototherapy after 6 hours led to more significant reduction in the total bilirubin level of the neonates with total bilirubin level of higher than 14 mg/dl in comparison to those with the total bilirubin level of 14 mg/dl or less. The total bilirubin level was significantly decreased in all the groups after 6 and 24 hours of intensive phototherapy. Comparison of the rate of decrement of the total bilirubin level among the groups demonstrated that the neonates with ABO incompatibility showed the greatest decline after 6 and 24 hours of treatment (the rate of bilirubin decline: -5.16; P
    Conclusion
    Intensive phototherapy could efficiently lower the total bilirubin level in the neonates with gestational age of 34 weeks and more with hyperbilirubinemia of different causes. Moreover, the efficacy of intensive phototherapy was more significant in the subjects with higher levels of total bilirubin.
    Keywords: Hyperbilirubinemia, Intensive phototherapy, Neonate
  • Saba Farzi, Sedigheh Farzi *, Safoura Taheri, Maryam Ehsani, Azam Moladoost Pages 89-94
    Background
    Infants hospitalized in neonatal intensive care units (NICUs) are often severely ill, highly prone to various diseases, and exposed to complex and prolonged intensive care interventions. Consequently, they are susceptible to the lapses in teamwork and patient safety. Patient safety culture a fundamental step to improve patient safety. The present study aimed to evaluate the perspective of NICU nurses toward the patient safety culture.
    Methods
    This cross-sectional study was conducted in 2016. Participants were selected via census sampling, including 156 nurses working in the NICU of the teaching hospitals affiliated to Isfahan University of Medical Sciences in Isfahan, Iran. Data were collected using a demographic questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC). Data analysis was performed in SPSS version 16 (SPSS Inc, Chicago, IL, USA) using descriptive statistics (mean and standard deviation).
    Results
    Among the 12 dimensions of the patient safety culture, the highest scores were observed in the ‘teamwork within units’ (98.5%),’organizational learning-continuous development’ (87.8%), ‘feedback and communication about errors’ (80.3%), and ‘frequency of events reported’ (78.8%). The lowest scores belonged to the dimensions of ‘handoffs and transitions’ (15.3%), ‘non-punitive response to error’ (21.5%), and ‘staffing’ (37.1%).
    Conclusion
    According to the results, adherence to the dimensions of the patient safety culture was poor in the studied hospitals. Therefore, the patient safety culture requires special attention by providing proper facilities, adequate staff, developing checklists for handoffs and transitions, and surveillance and continuous monitoring by healthcare centers. Furthermore, a system-based approach should be implemented to deal with errors, while a persuasive reporting approach is needed to promote the patient safety culture in the NICUs of these hospitals.
    Keywords: Iran, Neonatal intensive care units, Nurse, Patient safety culture
  • Amir Almasi-Hashiani, Mohammad Ali Mansournia, Mahdi Sepidarkish, Arezoo Esmailzadeh, Saman Maroufizadeh, Reza Omani Samani * Pages 95-101
    Background
    Gestational weight gain (GWG) is an important issue for all pregnant women due to its effect on pregnancy outcomes. Regarding this, the aim of the present study was to assess the relationship of GWG with cesarean section, birth weight, and gestational age at birth in the women with a pre-pregnancy body mass index (BMI) of ≥ 25 kg/m2.
    Methods
    This cross-sectional study was conducted on 2,147 obese or overweight pregnant females who had singleton births as a secondary analysis. The data were collected by filling out a checklist in 103 hospitals, which were equipped with department of obstetrics and gynecology, in Tehran province, Iran, in 2015. Data analysis was performed using binomial logistic regression model in Stata software version 14.
    Results
    According to the results, the prevalence of cesarean section was 74.35%. Furthermore, the mean GWG was 11.7 kg. The odds of cesarean delivery in the women with low and high GWG were 0.62 times smaller and 1.20 times larger than that for normal GWG, respectively (95% CI: 0.42-0.92, P=0.019 and 95% CI:0.90-1.59, P=0.197, respectively). After adjusting for confounding variables, GWG had no significant association with birth weight and gestational age at birth in the overweight and obese women.
    Conclusion
    The findings of this study revealed a significant relationship between GWG and cesarean section. Furthermore, the odds of cesarean section in the women with low GWG was less than that in the women with normal GWG. Regarding this, GWG should be considered as one of the determinants of cesarean delivery. Therefore, it is suggested to conduct further prospective cohort studies to clarify the impact of GWG on pregnancy complications.
    Keywords: Cesarean delivery, Gestational weight gain, Low Birth Weight, Preterm delivery
  • Reza Saeidi, Benyamin Taraghi, Maryam Saeidi * Pages 102-106
    Background
    Retinopathy of prematurity (ROP) is a common cause of blindness and accounts for up to 10% of childhood blindness in developed countries. Also Before surfactant became available in the NICU, an incidence of 11% to 60% was reported in the VLBW population. However, there are few studies on the incidence of ROP among low-birth-weight (LBW) infants in Iran and the aim of this study is determined the incidence of ROP in LBW infants.
    Methods
    this was a cross-sectional study. In this study we screened 152 LBW infants admitted at Imam Reza Hospital, Mashhad, Iran, between October 2013 and October 2015. We gathered patients information from their files and they examined by neonatologist and ophthalmologist. Finally we analyzed the data with T-test and square tes.
    Results
    in our study, 152 LBW infants, including 79 males and 73 females, were evaluated. The mean gestational age was 30.32 -2.84 (26-37). In this study we identified 31 patients (20.39% ) with ROP. 19 patients with 26 to 29 weeks gestational age and 9 patients between 30 to 33 weeks and just 3 patients between 33 to 37 weeks of gestational age.
    However, there were no meaningful relationship was found with gender. (P=0.395)
    Conclusion
    ROP is rising in Iran and low birth weight is an important risk factor for ROP and screening program is very important in this group of newborns.
    Keywords: Low Birth Weight, Newborn, Retinopathy of prematurity
  • Ramesh Bhat. Y.*, V. Soundaram, Leslie Edward Simon Lewis, Purkayastha Jayashree Pages 107-109
    Background
    VACTERL association is usually a sporadic disorder, the possible etiologies of which have been proposed as familial as well as multiple genetic and environmental factors. VACTERL association usually consists of at least three of the core features of vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities. Vertebral anomalies, cardiac malformations, renal anomalies, and limb malformations have been reported to occur in 60-80%, 40-80%, 50-80%, and 40-50% of the patients, respectively. Among the cardiac anomalies, ventricular septal defect is the most prevalent one. Truncus arteriosus is a rarely associated defect. The radial anomalies are the most classic limb defects with different severity levels (types I-IV). Although radial axis defect usually accompanies this association, complete absence of radius is reported only in one third of the cases.
    Case report: In this case study, we reported a neonate having this association consisting of severe cyanotic congenital heart defect (truncus arteriosus) and unilateral type IV radial aplasia.
    Conclusion
    VACTERL association components can have various new findings.
    Keywords: Neonate, Truncus arteriosus, VACTERL
  • Seyedeh Fatemeh Khatami * Pages 110-114
    Background
    Rib osteomyelitis is a very rare form of pediatric osteomyelitis.
    Case report: Herein, we reported a very rare case of chest wall abscess with rib osteomyelitis and rib destruction due to Staphylococcus aureus infection in a 14-day-old preterm male neonate. The diagnosis of this uncommon disease requires a high index of suspicion due to its rarity and non-specific clinical presentation. The radiographic findings of osteomyelitis usually require 7-14 days to appear. Ultrasonography enabled us to diagnose a coexisting intra- and extra-thoracic solid mass with calcification. In addition, the chest high resolution computed tomography scan revealed rib osteomyelitis, which was not possible to be detected through the routine chest radiography. Following the administration of intensive parenteral antibiotic therapy for 21 days, the patient was discharged in good health condition at 42 days of age. He continued oral clindamycin consumption for the next three weeks. At the end of the six weeks of treatment, the chest X-ray revealed the expansion of the fifth rib end; however, the chest ultrasound showed no obvious fluid collection.
    Conclusion
    As indicated in the present case report, the diagnosis of rib osteomyelitis requires a high index of suspicion given its nonspecific clinical manifestations that can easily mimic other diagnoses .The unusual sites of bone infection could be diagnosed by means of HRCT, followed by ultrasound. The prompt treatment leads to a high cure rate with good prognosis.
    Keywords: Preterm newborn, Rib osteomyelitis, Staphylococcus aureus