مقالات رزومه دکتر پریسا محققی

According to the high prevalence of epilepsy and the using of sodium valproate as an antiepileptic drug widely given in these patients, accurate recognition of its side effects and its effects on serum lipids profile, liver enzymes, uric acid level, and thyroid function tests, especially in cases that need long-term treatment seems essential. Sodium valproate is a broad-spectrum drug that has been frequently prescribed as a first-line anticonvulsant since 1970. Similar to other anticonvulsant drugs, sodium valproate comes with some side effects, including transient and harmless outcomes such as weight gain, transient drowsiness, hair loss, hand and arm tremors at rest and activity, reversible thrombocytopenia, and moderate (about 3 times) increase in gamma-glutamyl transferase, as well as harmful complications such as hepatotoxicity, encephalopathy, coagulation disorders, pancreatitis, and bone marrow suppression. Also, sodium valproate interacts with other drugs such as phenobarbital, phenytoin (PHT), carbamazepine, lamotrigine, felbamate, rifampin, ethosuximide, and primidone. It generally confers suitable therapeutic properties, and whether it is used or prohibited or its modification due to negative side effects should be decided individually for each patient. Obesity or an increase in adipose tissue is defined using the body mass index (BMI), where the body weight (kg) is divided by the square of the body height (m). In a child over 2, obesity is defined as a BMI at or above the 95th percentile, and a BMI at the 85th to 95th percentile means that the person is overweight. On the other hand, serum concentrations of specific lipids and lipoproteins in young adults are serious risk factors for the development of cardiovascular disease during life. Several data showed that increased total cholesterol, elevated triglyceride (TG) and LDL-C, and decreased HDL-C levels, cause cardiovascular disease. Therefore, the assessment of variations in serum lipid profile levels following the consumption of anticonvulsants may help select the safest drug to prevent cardiovascular complications in patients. As we know, the complications of sodium valproate may be higher in children than adult. The aim of this study was to evaluate the effects of sodium valproate on weight, body mass index (BMI), vitamin D3, blood insulin, uric acid level, and serum lipids profile in children with newly diagnosed epilepsy.

This prospective study was performed on 30 children between 3 and 8 years of age who admitted to the pediatric ward of Rassol-e-Akram Hospital in Tehran during 2018-2019, suffered from newly diagnosed epilepsy and received sodium valproate as monotherapy to control of seizures. In this study, patients had no metabolic disease or underlying chromosomal condition, obesity, failure to thrive (FTT), or congenital anomalies were included in the study. All patients with, underlying conditions such as chronic hepatic, heart, renal, and metabolic diseases, diabetes, chromosomal disease, obesity, FTT, congenital anomalies, progressive neurological disease, gastrointestinal diseases, coagulation disorders and developmental delay were excluded from the study. Data include demographic information (age, sex, height, weight and waist and hip circumference of children), as well as clinical characteristics such as liver enzymes (ALT, AST, ALK-P), serum lipids level (TG, TC, HDL-C, LDL-C), thyroid tests (TSH, T4), fasting blood sugar (FBS), Uric Acid level, 25 OH Vitamin D3 (Vit-D3) and blood insulin level of children before and six months after the consumption of sodium valproate, were examined

The mean weight of children before and six months after the start of sodium valproate treatment was 18.54±2.99 and 21.13±3.93 (kg), respectively. This difference was statistically significant (P=0.005). Also, the mean weight Z-score of children before and after taking sodium valproate was respectively -2.497 and -2.293, that was statistically significant too. In addition to weight gain, there was also a significant increase in the abdominal and hip circumference of children after taking valproate, whereas the increase in mean BMI before and after valproate administration was not statistically significant (P=0.114). Mean values of weight, body mass index, and circumference of the abdomen and hips of children before and after taking sodium valproate were compared individually in girls and boys. However, mean weight gain, as well as the increase in the waist and hip circumference, had no relationship with gender (P> 0.05). Paraclinical features such as hepatic enzymes (ALT, AST, ALK-P), lipids profile (TG, TC, HDL-C, LDL.C), thyroid tests (TSH, T4), fasting blood sugar (FBS), the concentration of uric acid, 25 OH Vitamin D3, and the content of blood insulin level before and after consuming sodium valproate were measured individually in boys and girls. Also, sodium valproate significantly increased ALT level (P=0.046). This is while sodium valproate had no effect on other liver function markers (AST), thyroid hormones (TSH, T4), fasting blood sugar (FBS), uric acid level, 25 OH Vit-D3, and the children's blood insulin levels (P> 0.05).

This study was carried out in 2018 on 30 children aged 3 to 8 years who were admitted in the pediatric ward of Rasool-e- Akram Hospital with newly diagnosed epilepsy and were treated with sodium valproate to control their seizures. In this study, factors including gender, age, weight, height, and size of waist and hip, as well as hepatic enzymes (AST, ALT), and the results of laboratory testing of lipid profiles, uric acid level, thyroid hormones, vitamin D3 level, and fasting blood sugar were recorded before and 6 months after consuming sodium valproate for each patient. According to the findings of this study, it can be said that sodium valproate is a good and safe drug for children between 3 and 8 years of age, but it should be noted that taking this drug increases the chance of obesity in children. Weight gain following the consumption of sodium valproate was observed in all children in this study. The main side effect of this drug is weight gain. In addition to weight gain, a significant increase was observed in the size of the abdomen and hips of children after taking this drug. Due to the normal serum level of insulin, uric acid and lipids, it seems that the role of sodium valproate in children weight gain is more result of increased appetite than metabolic and hormonal changes. Also, the result of significant increase in ALT enzyme level, in this study, recommended that liver enzymes should be checked before, one and six months after starting treatment as it can prevent the irreversible permanent side effects of this drug.

Meningitis is a common life threatening infection in neonatal period. Diagnostic value of CSF-CRP level in bacterial meningitis in children and adults has been studied worldwide, but there are limited studies on CSF-CRP in neonatal meningitis. This study conducted to assess any relation between CSF-CRP and plasma CRP levels and abnormal CSF findings in neonates suspected to meningitis.

Seventy five hospitalized neonates suspected to meningitis were enrolled in this cross sectional study. All infants were gone through a complete sepsis workup including blood and CSF CRP.

CSF-CRP level had statistically significant correlation with serum WBC (p= 0.048) and also poor correlation with CSF protein level (p= 0.054). Serum CRP level had statistically significant correlation with CSF WBC (p= 0.008).

No correlation found between CSF and serum CRP levels of patients in this study. Although, CSF-CRP is a rapid and easy to interpret test, it can be performed alongside CSF cytology and biochemical analysis, smear and culture as a confirmatory test for definite diagnosis of neonatal meningitis.

The aim of this study was to investigate the effect of bedding preterm infants in nests on their motor behaviors in a neonatal intensive care unit (NICU) in Iran.

In this randomized controlled trial, 44 clinically stable preterm infants, admitted to the NICU, were recruited and randomly divided into two groups of control and intervention. The routine of the unit was to take care of infants on a flat mattress. The intervention was a U-shaped cloth nest in which the intervention group was bedded for 7 days. The control group consisted of infants who were normally cared without any boundaries. All infants were videotaped before and on the last day of the intervention. The motor behaviors, as defined in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) sheet, were analyzed in each of the films.

To compare the number of total extensor motor behaviors between the two groups, the change score in each group was calculated and compared between the two groups. The mean change scores in the intervention and control groups were -21.36±13.5 and 2.32±7.9, respectively. Accordingly, nesting significantly reduced the occurrence of unstable behaviors in the intervention group, compared to that in the control group (P<0.001).

According to the findings, supporting the preterm infant body even by accessible materials could enhance their neurodevelopmental strengths and motor behavior stabilities.

To determine the changes in serum levels of free vascular endothelial growth factor (VEGF), insulin‑like growth factor‑1 (IGF‑1), and growth parameters in infants with retinopathy of prematurity (ROP) who received intravitreal injection of the bevacizumab (IVB).

A prospective interventional case series study, including 10 infants with Type 1 ROP was conducted. Using the enzyme‑linked immunosorbent assay, serum levels of VEGF and IGF‑1 were measured before, 1 month and 2 months after treatment with IVB in both eyes. Growth parameters, including weight, length, and head circumference and their Fenton’s z‑score, were also measured.

Serum VEGF levels were suppressed 1 month after IVB (P = 0.007) and then increased between 1 and 2 months (P = 0.064). Z‑scores of all growth parameters except weight z‑score decreased in the 1st and 2nd months.

Serum VEGF levels showed a transient reduction after IVB which lasted at least 2 months. Growth velocity of premature infants may be affected by anti‑VEGF therapy and should be followed with particular attention.

Newer technologies in neonatal ventilation such as combining volume guarantee with other modes of ventilation could reduce some complications of artificial ventilation by reducing the duration of ventilation and oxygen needs and fluctuations. Retinopathy of prematurity (ROP) is a multifactorial problem mainly affecting preterm infants with different risk factors. Although gestational age (GA) is the main risk factor for ROP, oxygen saturation and fluctuations, arterial pressure of carbon dioxide, and some other parameters of ventilation such as ventilation duration have great impacts on ROP incidence and severity. One hundred and twelve infants with birthweight (BW) under 2000 g or GA under 36 weeks that needed artificial ventilation after admission to the neonatal intensive care unit were randomly assigned into two groups. In the first group, neonates underwent synchronized intermittent mandatory ventilation (SIMV), pressure support ventilation (PSV), or SIMV + PSV with volume guarantee (VG); and in the second group, neonates received ventilation without VG mode. All of the survived infants had ophthalmologic examination at the proper age by a retinal subspecialist to find the different stages of ROP. Mean duration of ventilation was reduced using VG mode from 74.08 ± 47.99 to 47.91 ± 30.47 hours (P < 0.05). The oxygen requirement was less in the ones underwent VG modes and the peak fractional inspired oxygen (FiO2) was higher in infants receiving SIMV + PSV without VG compared to that of infants ventilated with VG mode (52.8 ± 18.4 vs. 40.3 ± 13.0, respectively). The difference between highest and lowest FiO2 was more in the group ventilated without VG (∆FiO2 = 9.52 in the group I and 18.30 in the group II, P < 0.05). Fluctuation of arterial pressure of carbon dioxide (PaCO2) was less prominent in the VG group as compared to the ones ventilated without VG and the mean difference between maximum and minimum PaCO2 was 7.16 in the group I and 13.36 in the group II (P < 0.05). Only three infants were diagnosed with ROP in the group I (with VG mode) in comparison with eight infants in the group II (odds ratio (OR) = 3.25, 95% confidence interval (CI): 1.13 - 9.36). Severe ROP needing treatment was diagnosed in one infant in the group I vs. four infants in the group II (OR = 3, 95%CI: 0.63 - 14.23). ROP incidence in preterm infants could be reduced using VG mode of ventilation, since it is a safer ventilation mode in neonates due to reduction in the mean duration of ventilation, peak FiO2 requirement, and PaCO2 fluctuation.

Recent studies have shown an association between IVH and in-vitro fertilization (IVF) treatment. The purpose of our study was to compare the level of significance of risk factors related IVH between preterm infants born after IVF and non-IVF conceptions. Material and Methods; a historical cohort study was done at 4 Iranian Hospitals in 2013-2014. Based on medical records 155 preterm newborns were divided into case (IVF) and control (normal conception) groups. Both groups' demographic data were extracted and recorded. The incidence of IVH and its' grades were compared between case and control groups. Significant related risk factors were also considered. With regard to demographic characteristics, no differences were observed between 2 groups except for gestational age and mode of delivery (p<.05). The incidence of IVH especially grade II and III were significantly higher in the case group (P = 0.003). Results showed no correlations between GA, birth weight and number of gestations with the incidence of IVH in the case group (0.059, 0.85 and 0.49, respectively).On the other hand among GA, birth weight and number of gestations; multi gestations (p value=0.0001) was an effective risk factor for IVH occurrence in the controls. Conclusion; Results showed that the incidence of IVH in the IVF group was significantly higher than in the non-IVF group. IVF as an independent risk factor may cause high-grade IVH; however, in the controls, multi gestational pregnancy (p value=0.0001) was an effective risk factor for IVH occurrence.

Developmental dislocation of the hip joint is among joint abnormalities and lack of its early diagnosis leads to irreversible complications and disabilities.
The current cross sectional study was conducted on 210 eighteen - month - old premature infants. Premature infants at term gestational age were examined by a neonatologist and underwent a sonographic scanning by a skilled radiologist. The results of the physical examination and ultrasound reports were collected and analyzed.
In the clinical assessment, hip joint examination was diagnosed abnormal in 22 cases (10.4%) and joint dislocation was diagnosed by ultrasonographic examination in 17 patients (8.1%). In one high - risk case, despite normal clinical examination (0.48%), the dislocation was diagnosed by ultrasonographic evaluation. There was a significant relationship between hip dislocation rate, and reduced mean gestational age and birth weight (P 0.05). In diagnosis of joint dislocation, clinical examination (the results of the Ortolani and the Barlow tests) had sensitivity of 94% and specificity of 97% compared with sonography; the positive and negative predictive values were 73% and 99%, respectively.
Clinical examination has high sensitivity and specificity for early diagnosis of developmental hip dislocation. If there are risk factors, ultrasonographic scanning is recommended despite normal physical examination, and ultrasound is not necessary in case of normal physical examination and the absence of risk factors.

Context: Proper accountability to needs of premature infants’ parents requires recognition of these needs and how they change in different conditions.
This Meta-synthesis was conducted to understand the needs of Iranian parents with premature infants through their experiences in order to promote family-centered care.
Data Sources: The search was conducted through the Iranian database (Iran Medex, Magiran, SID) and international resources (PubMed, Scopus, Google Scholar), without time limitation to April 12, 2015.
Study Selection: The inclusion criteria for this study included the qualitative studies conducted in Iran on parents with premature infants. Consolidated criteria for reporting qualitative studies (COREQ) were used to assess the quality of articles.
Data Extraction: This study is a meta-synthesis of 16 qualitative studies based on Noblit and Hare’s (1988) methodology.
The meta-synthesis presented 5 correlated metaphors derived from 13 categories and 78 integrated codes. The metaphors indicated the most important needs of parents who have premature infants for emotional, instrumental, spiritual, appraisal, informational, and communicational support. In most cases, these needs overlapped with blur boundaries. The categories included: cultural challenges of parental role, parental development versus psychological stress, psychological stress stimuli, economic challenges of parental role, physical irritation, the need for family-centered care, the need for policy making regarding the constant presence of parents in the NICU, spiritual prosperity vs. spiritual alienation, spiritual self-care vs. spiritual self-harm, guided participation in caring for the infant, the efforts to meet parental role, informational challenges of parents, and informational-communicational supports.
This Meta-synthesis provided a better understanding of the experiences of Iranian parents with premature infants and different areas of their needs. These findings could be used to design a comprehensive support system for such parents, which incorporate a holistic view of patient concerns, including religion and spirituality.

The concept of family-centered care is increasingly being recognized at the international level.
Development of a support system for parents of premature infants (PPI), based on family-centered care and scientific evidences.
The method is based on four key steps. 1) Explaining parents’ needs, including comprehensive review of quantitative studies, meta-synthesis of qualitative studies conducted in Iran by search of Iranian databases (IranMedex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) and comparative study. 2) A comprehensive review to identify effective interventions in supporting PPI and ranking interventions. 3) Designing a model to support PPI. 4) Evaluating designed system for supporting the PPI.
The results of this study identified five critical steps which the PPI experienced and 14 effective interventions to support them. Preconception: care before the next pregnancy; prenatal: preparing parents to see their baby for the first time, supporting parents in breastfeeding (BF), kangaroo care (KC) and infant massage; neonatal: spiritual self-care, individualized behavioral and developmental care programs, using scales to assess infant's behavior, supporting parents in BF, KC and infant massage, support forums for parents, relieving parents’ stress, sharing information and communication, family nurture interventions, supporting parents in transferring between neonatal units (NU), facilitating collaborative care in NU; discharge: discharge planning, support forums for parents, sharing information and communication and home: home support programs, individualized behavioral and developmental care programs, supporting parents in BF, KC and infant massage. Support forums for parents, sharing information and communication.
Our proposed system provides a parent-centered system which can be implemented to provide high-quality care for PPI.

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.
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.
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.
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.

Context: Proper accountability to needs of preterm infants’ parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world.
Evidence Acquisition: A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau2) and review manager 5 software.
The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents’ assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents’ assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries.
Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.

High risk pregnancies increase the risk of neonatal mortality and morbidity. In order to identify the influence of pregnancy complications on the period of neonatal stay in Neonatal Intensive Care Units (NICUs), an analysis has been carried out in our center. In a cross-sectional-descriptive analytical study, the data including NICU length of stay was gathered from 526 medical records of neonates. We also assessed their maternal complications such as premature rapture of membranes (PROM), urinary tract infection (UTI), preeclampsia, oligohydramnios, and twin/triplet pregnancy. Finally we analyzed the relation between variables by SPSS statistics software version 19. The level of significance was considered P<0.05. 37 of 526 neonatal medical records were excluded. Of the 489 babies hospitalized in NICU for 1 to 54 days; 28.42% born were preterm, 308 with birth weight <2500 gram and 170 with birth weight between 2500 and 4000 gram. There was a significant relation between length of neonatal NICU stay and maternal PROM (P=0.001), preeclampsia (P=0.01), UTI (P=0.02), multiple gestation (P=0.03), and oligohydramnios (P=0.003). We found a positive correlation between numbers of gestation and length of NICU stay (P=0.03). A positive correlation existed between neonatal complication and length of NICU stay (P<0.001). By increasing maternal health level and prenatal care services, neonatal outcome can be improved and length of stay in NICUs decreased.

Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) are two important pathogens in neonatal respiratory tract infections. As low gestational age and birth weight increase the colonization rate with these pathogens, and they are also risk factors of chronic lung disease (CLD), it is difficult to establish a statistically significant relation between these two factors. To determine the colonization rate of preterm ventilated neonates with U. urealyticum and M. hominis, and the relationship between infection and chronic lung disease in these neonates, a prospective study was performed.Patients and Determining tracheal colonization rate of preterm neonates with ureaplasma and mycoplasmsa and its relation to CLD. In a cohort prospective study in Hazrat Rasoul Akram Hospital, with 62 ventilated neonates (< 35 weeks) in the first 24 h of life, where tracheal secretions were aspirated, transported, and cultured in a specific media. CLD was diagnosed as oxygen requirement at 28 days or 36 weeks post conceptional age. From 62 cultures, 7 were positive for U. urealyticum (11.3%, CI95%: 3.4-19.2%) and 3 were positive for M. hominis (4.8%, CI95%: 0-10.2%). From 53 neonates who were alive at 28 days after birth, 11 neonates needed oxygen (20.8%, CI95%: 9.8-31.7%). From 10 neonates with positive cultures, 2 (20%, CI95%: 0-44.8%) died, and from 8 alive neonates, 3 (37.5%, CI95%: 4.0-71.0%) survived without CLD. From 52 neonates with negative cultures, 7 (13.5%, CI95%: 4.2-22.7%) died, and from 45 alive neonates, 39 (86.7%, CI95%: 76.7-96.6%) survived without CLD, and there was a significant difference between neonatal groups with positive and negative tracheal culture progressing to CLD (62.5% vs. 13.3%) (P < 0.001) (Figure 1). Intrauterine infection with U. urealyticum and M. hominis leads to negative neonatal outcome and increased rate of chronic lung disease in preterm neonates (< 35 weeks).

Since a new epidemic (third wave) of retinopathy of prematurity (ROP) sensed throughout the world in recent years, we aimed to assess newer risk factors for advanced ROP which needs treatment in Iranian neonates as a new target output of various neonatal care for this serious disease of newborn infants especially those born prematurely.In an analytic cross-sectional study all neonates <1500 g birth weight and/or <32 weeks gestational age admitted to our NICU as a tertiary level intensive care unit in Milad Hospital, Tehran, Iran during June 2006-June 2007 were included. All data were extracted from medical records and compared in two groups with or without treatment. Seventy one neonate infants entered our study. Twelve neonates (16.9%) progressed to advanced ROP. Final multivariate analysis model revealed that mean leukocyte counts during first 14 days of life (P=0.04), transfusions number (P=0.01) and hypocapnic episodes during first 14 days of life (P=0.02) were significantly different between the two groups of infants independently, even after simultaneous adjustment.Based on our findings, more amenable risk factors should be approached regarding more careful modulation of such overlooked risk factors which may lessen the burden of prematurity.

There are disparate data regarding whether bilirubin is protective or toxic during free radical related illness among neonates. Seventy one infants with gestational age (GA) of <32 weeks and/or birth weight (BW) of <1500 g, who survived beyond 4 weeks and completed physical examinations were enrolled in this study. The infants were divided into two groups based on the presence or absence of advanced retinopathy of prematurity (ROP), grade III intraventricular hemorrhage (IVH), grade III necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), sepsis or severe fungal infection (SFI). The mean of total serum bilirubin (TSB) of the first 14 days of life were measured and compared between these two groups. A significant lower TSB were found in severe form of ROP (P<0.001), grade III NEC (P=0.008), grade III IVH (P=0.021), SFI (P=0.003) and sepsis (P=0.007) in comparison to mild or disease free status. Moreover, the cut-off point of 5.1 mg/dl for the mean of TSB had the sensitivity of 88.1% and specificity of 84.6% to detect severe grades of ROP. Also the cut-off point of 3.25 mg/dl had 97.2% sensitivity and 100% specificity in order to distinguish SFI. It is concluded that bilirubin may play an antioxidant role in vivo as in vitro; and protect preterm infant against these free radical related disorders. Our findings suggest that not only the upper limits of serum bilirubin, but also the lower limits must be taking into account in order to both preventing from neurotoxic effects and free radical based illnesses, respectively.

To determine the role of blood transfusion protocols on retinopathy of prematurity (ROP), a prospective cohort study on 57 premature infants under 1501 grams birth weight was performed. Fourteen day-old infants were divided into two groups randomly. Infants in group 1 (n=27) received packed red blood cell transfusion only if specific medical signs were met and their hematocrit level was under 30%. Infants in group 2 (n=30) received blood transfusion to maintain their hematocrit level > 40% regardless of their signs. All infants had an eye examination by indirect ophthalmoscopy from 28 to 40 days of life for detecting ROP. We did not find any significant difference in ROP incidence between both groups.