فهرست مطالب هادی سماعی

Hypocalcaemia has been reported as a complication of phototherapy especially in premature neonates. However, the cause is unknown. The aim of this study was to evaluate the relation between serum and urinary levels of calcium in neonates under phototherapy and to answer the question that whether phototherapy-related hypocalcemia is associated with hypercalicuria or not.Patients and In a prospective cross sectional study, 50 icteric newborns (30 males and 20 females) that were treated by phototherapy entered the study through non accidental sampling. The consent was taken from parents on admission. All were breastfed. Weight was checked. Serum samples for calcium and bilirubin and urine samples for calcium, creatinine and osmolality measurements were sent on arrival (group I), after 48 hours of starting phototherapy (group II) and 24 hours after discontinuing phototherapy (group III). Hypercalciuria was defined as Uca/Ucr >0.8 mg/dl/mg/dl, hypocalcemia was defined by serum calcium less than 8 mg/dl in the term and less than 7 mg/dl in the premature neonates. Chi square test, Repeated measure test, Wilcoxon signed rank test and multivariate were used to compare frequency, means, median and correlation, respectively. P < 0.05 was considered significant. Between 2004 and 2005, 50 healthy newborns (27 premature and 23 term) with mean age of 7.42 days (range 2 days – 28 days), gestational age 36.8 weaks (range 29 wks – 40 wks), weight 3051 gram (range 1500 – 4300 gr), serum bilirubin 19.7 mg/dl (8.5 – 28 mg/dl) and serum calcium of 8.8 mg/dl (range 7-11 mg/dl) were included in study. Mean serum calcium levels in groups I, II and III were respectively 9, 8.65 and 8.7 mg/dl. Also mean of Uca/Ucr in groups I, II and III was 0.03, 0.85 and 0.60 mg/dl/mg/dl, respectively. Similarly mean of Uca to Urinary Osmolality (mg/dl) in groups I, II and III was 0.05, 0.09 and 0.07 mg/dl/mosmol/kg/H2O respectively. Hypercalciuria was detected in 6% in group I, 52% in group II and 32.7% of group III. None of them showed hypocalcemia. Based on Wilcoxon Signed Rank test, there were significant statistical disperences inregard to the median of Uca/Ucr between groups I and II, I and III and II and III (P<0.05). Hypercalciuria was mostly detected in premature neonates. Hypercalciuria was not correlated with age, weight, sex, serum bilirubin, urine osmolality or serum calcium (P>0.05). According to the results of this study, neonates who are treated by phototherapy are at the risk of hypercalciuria. Further investigations for example follow up renal sonography, clarifying the importance of this phenomenon is highly recommended.

Hyalane membrane disease(HMD) is considered as one of the common causes of mortality among premature neonates and exogenous surfactant is used as a vital treatment. The aim of the present study was to evaluate the frequency of different complications that followed prescription of exogenous surfactant in neonates of Ali Asghar Hospital from 2001 - 2003. Patients & In a cross-sectional study, all neonates with HMD who had been admitted to the NICU of Hazrat Ali Asghar Hospital and treated with exogenous surfactant underwent evaluation. 39 cases included 47.2% male and 52.8% female. The mean of age and weight was 32.12±2.89 weeks and 1725±601.8grs respectively. Lung hemorrhage which was seen in 14% of the cases including 2 males and 3 females led to their death. Decrease in blood oxygen content was noticed in 10 cases(27.7%), 6 boys and 4 girls. Hypotension occurred in 13 cases(36%), 9 boys and 4 girls. Total frequency rate of complications was significantly related to decrease in gestational age and birth weight. Mortality was statistically higher in pulmonary hemorrhage. Based on the results of this study and comparing them with the findings of other studies, we can conclude that the rate of pulmonary hemorrhage and the resulting death after exogenous surfactant therapy in this study is higher than others, which needs to be investigated by future studies. However, surveys of this kind have hardly been carried out in our country and this makes our study quite exclusive.

Protein-c deficiency is a rare disease that is two form: Homozygote and Heterozygote. Protein-c circulates in healthy adult Plasma is valu ranging from 70-140 Percent. Protein-C level in newborns are 20-40 Percent of normal adult level. Newborn with homozygote protein-C deficiency almost always manifest skin necrosis, fulminant purpura after birth and or central nervous system thrombosis. Mutation is near the active site of the protein-C and DNA analysis shows double variant. Treatment option includes Fresh Frozen Plasma (FFP) and Protein-C concentrate in the acute phase follows by oral anticoagulant therapy. Three pateints were refered to Hazrat Ali Asghar Pediatrics Hospital, with developed skin necrosis on the abdomen and upper extrimitis, after 24 hours of life. One case had CNS hemorrhage after anti-coagulation therapy. Their protein-C activity were less than 1% and for their parents were less than 60%.

Jaundice is one of the most complications in the Neonatal period. It is observed during the first week of life in approximately 60% of term infants and 80% of preterm infants. Kernicterus is the serious complication of the jaundice in infants, that is constitute of extrapyramidal disturbances, auditory abnormalities and gaze palsies. Serum albumin for bounding to bilirubin is important. Standard serum albumin is 3-3.5 gr/dl. At molar ratio of one, each gram of human albumin binds 8.5mg of bilirubin. Thus standard exchange transfusion in healthy term infants with jaundice is indicated when the bilirubin is 25-30 mg/dl. In this study the mean serum albumin in 400 healthy term infants was 4.006gr/dl in the first three days of life, that was higher than the standard serum albumin. On the basis of this study, exchange transfusion in healthy term infants with jaundice and without hemolytic disease or sepsis is indicated when the bilirubin is 33 mg/dl.

The meconium plug syndrom is a benign form of colon obstruction in the neonate caused by a firm white plug of mucus. These babies usually present with abdominal distention. Abdominal X ray film reveals distended loops of bowels. Barium enema shows a long radiolucency within the desending colon. The plug is passed after the barium enema or a saline rectal irrigation.
Although meconium plug syndrom is found in otherwise completely normal infants because it can be difficult to differntiate from hirschprung disease and to rule out cystic fibrosis and hypothyroidism, a rectal biopsy, sweat test and thyroid function tests may be necessary to obtain in infants with meconium plug syndrom. This syndrom is occasionally seen in neonates due to use of magnesium sulfate after treatment for eclampsia.
In this article we are reporting a rare case of meconium plug syndrom due to hypermagnesemia used for treatment of eclampsia.

In order to find out the incidence and severity of intraventricular hemorrhage (lVH) in premature babies in Iran which probably has not been evaluated and reported so far and compare it with reports of other countries, a prospetive study was done over a two year period. All premature babies at or before 34 weeks gestation which were admitted in the newborn nursery of Ali Asghar Children Hospital were evaluated for IVH. Intraventricular hemorrhage was diagnosed by cranial sonography and autopsy. From 84 premature babies, 28 of them (33%) had IVH. In babies with birth weight of under 1000 grams 50%, in 1000-1500 grams 41% and in over 1500 grams 22% had IVH.ln babies under 29 weeks gestation the incidence of IVH was 56% and between 30-34 weeks 22% had IVH.
40% of babies with IVH had sever (grade 3 & 4), 40% had moderate (grade 2) and 20% had mild (grade 1) IVH.
The incidence and severity of IVH in our newborns are almost the same as developed countries.

In order to evaluate the incidence and frequency of clinical and laboratory findings in newborns with polycythemia in Tehran a retrospective study was carried out in newborns who were admitted in newborn service in Ali Asghar Children Hospital between years 1988-1995 . During this period 3086 newborns were admitted and 32 patients had central hematocrit above 65% (1.03%) . Of the polycythemic infants, 84.4 % were sympthomatic. Frequent signs and symptoms included: cyanosis 28. 1 %, plethora 28.1%, jitteriness 25%, poor feeding 25%, lethargia 21.8%, respiratory distress 12.5% and hypotonia 12.5% . Other findings included hypoglycemia 43.7% and hyperbilirubinemia 25% . Of the polycythemic infants, 15.6% had no clinical or laboratory abnormality. It was noted that SGA & LGA newborns are more prone to polycythemia. With early diagnosis and appropriate treatment the prognosis is excellent.