kayvan mirnia

 Perfusion index is a dependable indicator for assessing the perfusion status of newborns. A low perfusion index indicates compromised hemodynamic function. The study aims to investigate perfusion index in asymptomatic newborns aged 35 to 41 weeks who did not require medical support.

 Healthy neonates born in four major maternity hospitals of Tehran University from 2019 to 2021 were selected. To ensure consistency and reliability in data collection, a detailed manual was developed and distributed, along with comprehensive training sessions for all personnel involved.

 A total of 994 newborns entered the study. Among them, echocardiography was adversely affected in 218 neonates due to abnormal screening pulse oximetry. Of these 218 neonates, 53 were found to have abnormal echocardiography results. The median perfusion index value in healthy neonates was 1.6%, and the median oxygen saturation was 97%. A percentile perfusion index curve was developed for healthy neonates to establish a normal reference range.

 Developing a percentile perfusion index curve specific to healthy neonates provides a useful reference range for healthcare providers to assess perfusion status in this population, but further research is needed to confirm its accuracy.

While catheter lengths are determined based on guidelines, regional studies should be considered to ensure optimal catheter placement.

This study aimed to compare the incidence of tip malposition and the amount of catheter retraction required to achieve appropriate placement in peripherally inserted central catheters (PICC) inserted in the head and neck, upper extremities, and lower extremities to determine the optimal catheter placement site.

This cross-sectional study was conducted in the Children's Medical Center NICU between 2020 and 2021. After the initial calculation of catheter insertion length based on guidelines, PICC placement was performed by two skilled nurses. The catheter position was then confirmed, and the amount of catheter retraction was compared for each group.

A total of 368 neonates were included in the study. The results showed a statistically significant higher incidence of catheter tip malposition in the upper extremity group (P-value = 0.004). The minimum amount of catheter retraction required to achieve proper placement was 1 cm.

This study suggests that the formula for calculating the length of the catheter in the upper extremities should be adjusted. However, further studies are needed to confirm this.

Altered concentrations of cerebrospinal fluid (CSF) and blood amino acids may be related to epilepsy or the severity of the seizure. In the present study, we assessed the concentrations of amino acids in CSF and plasma in neonates with refractory seizures.

In this prospective cohort study, 27 neonates aged 1 to 56 days with refractory seizures were included. Blood and CSF samples were collected from each neonate within 24 hours after receiving 2nd antiseizure medications. All plasma and CSF samples were sent to the laboratory to measure amino acid concentrations. The associations between CSF and plasma amino acid levels with different variables were evaluated.

Except for leucine (P=0.15) and isoleucine (P=0.07), the levels of all amino acids were significantly higher in plasma than CSF. Significant associations were observed between types of seizure and plasma citrulline (P=0.008) and leucine concentrations (P=0.04). The mean of CSF glutamic acid was also statistically different among neonates with different EEG results (P=0.02).

Our findings indicate that several plasma and CSF amino acids could be candidate biomarkers for neonatal refractory seizures. Further studies with larger sample size are to confirm our findings.

 Sepsis is the leading cause of death in newborns, particularly in underdeveloped countries. Early diagnosis and appropriate treatment are critical in reducing neonatal mortality. Since blood culture results are often unavailable for 48 - 72 hours, other hematologic findings may provide useful information for early diagnosis.

 We examined the relationship between neonatal sepsis and blood indices in order to achieve early diagnosis.

 In this hospital-based retrospective multiple-event case-control study, we allocated the neonates into three groups: Culture-positive sepsis, culture-negative sepsis, and neonates without sepsis. We compared the lab data within these three groups.

 The study included 319 neonates: 209 cases of culture-positive sepsis, 65 cases of culture-negative sepsis, and 45 cases without neonatal sepsis. Pearson's test demonstrated a significant correlation between thrombocytopenia, positive C-reactive protein (CRP), and high cell distribution width with culture-positive sepsis (P = 0.000), indicating a statistical difference between the three groups. The mean CRP and eosinophil levels were higher in the culture-positive group with fungal sepsis.

 In septic neonates with high CRP levels, particularly in conjunction with eosinophilia, fungal coverage should be considered.

One of the major challenges that hospitals and clinicians face is the early identification of newborns at risk for adverse events. One of them is neonatal respiratory distress syndrome (RDS). RDS is the widest spared respiratory disorder in immature newborns and the main source of death among them. Machine learning has been broadly accepted and used in various scopes to analyze medical information and is very useful in the early detection of RDS.

This study aimed to develop a model to predict neonatal RDS and affecting factors using data mining.

The original dataset in this cross-sectional study was extracted from the medical records of newborns diagnosed with RDS from July 2017-July 2018 in Alzahra hospital, Tabriz, Iran. This data includes information about 1469 neonates, and their mothers information. The data were preprocessed and applied to expand the classification model using machine learning techniques such as support vector machine, Naïve Bayes, classification tree, random forest, CN2 rule induction, and neural network, for prediction of RDS episodes. The study compares models according to their accuracy.

Among the obtained results, an accuracy of 0.815, sensitivity of 0.802, specificity of 0.812, and area under the curve of 0.843 was the best output using random forest.

The findings of our study proved that new approaches, such as data mining, may support medical decisions, improving diagnosis in neonatal RDS. The feasibility of using a random forest in neonatal RDS prediction would offer the possibility to decrease postpartum complications of neonatal care.

 The use of herbal drugs for treating neonatal jaundice is a common practice in many societies despite the potential complications. However, little is known about the individuals or groups who typically recommend the use of these drugs for affected neonates.

 This study aims to investigate the main recommendations of herbal drugs for treating neonatal jaundice.

 The format of the present cross-sectional study was designed and implemented based on interviews with parents of infants who have infantile jaundice who used herbal drugs for their neonates during 2019 and 2022 and were admitted to the Children’s Medical Center of Tehran, Iran. Along with baseline data, the socioeconomic situation of families was also evaluated.

 Regarding the role of people in recommending the use of herbal drugs, in 52.1% of cases, the main recommenders to use this substance to treat infant jaundice were the patient's relatives, while the role of parents in recommending the consumption of this compound was 25.5%. Also, 6.4% of the neighbors of the patients’ family were the main recommenders to use herbal drugs for the affected neonates. Interestingly, 4.3% of doctors and 11.7% of pharmacists had the leading role in recommending the use of herbal drugs to treat infant jaundice. Parents who recommended using herbal drugs for their neonates were more likely to be smokers and less affluent.

 Relatives, parents, grandparents, and even neighbors play a significant role in recommending the use of herbal drugs in the treatment and control of neonatal jaundice. The role of doctors and pharmacists in recommending the use of this compound in the treatment of jaundice, especially considering the potential side effects, should not be underestimated.

The present study was conducted with the aim of investigating the relationship between vitamin D deficiency and the serum levels of calcium, magnesium and phosphorus.

  In this descriptive sectional study, infants who were admitted to the neonatal and NICU of Tehran Children's Medical Center Hospital with any diagnosis during 2018-2020 with vitamin D deficiency or insufficiency were included in the study. Serum levels of calcium, magnesium and phosphorus, and their relationship with vitamin D deficiency were recorded and investigated.

  Among 400 included infants, 197 neonates (49.3%) had vitamin D deficiency and 203 (50.7%) had vitamin D insufficiency. The average serum level of vitamin D in studied infants was 11.477±3.55 ng/ml. There was no statistically significant relationship between the serum level of vitamin D in newborns and the serum levels of magnesium and phosphorus (P value = 0.118 and P value = 0.511), but there was a statistically significant relationship between the serum level of vitamin D and the serum level of calcium (P=0.0001). There was no statistically significant relationship between the level of serum vitamin D in newborns with the age and the gestational age of the newborn (P = 0.132 and P = 0.651). Still, a direct and significant statistical relationship was observed with the newborn's weight (P = 0.049). The average length of hospitalization in the examined infants was 16.39 ± 16.36 days. Pearson’s correlation coefficient indicated the presence of an inverse and significant correlation between the level of serum vitamin D in infants and the duration of hospitalization (P=0.036). In such a way with the reduction of vitamin D serum level, the time of hospitalization increased.

  This study showed a statistically significant relationship between low vitamin D serum levels with calcium serum levels. 

Practical Implications: 

 In infants with low weight or hypocalcemia, there is a possibility of vitamin D deficiency. Vitamin D check is recommended to start treatment earlier and decrease the duration of hospitalization and other complications.

 Most cases of newborn hyperbilirubinemia are physiologic; however, excessive unconjugated bilirubin is a potential neurotoxin. Phototherapy treats moderate to severe hyperbilirubinemia. If phototherapy increases immunoglobulin G (IgG) clearance, there is a chance of humoral immune disorders.

 The purpose of the study was to investigate the effect of phototherapy on the level of IgG in neonates.

 This study investigated 40 full-term newborns with hyperbilirubinemia. Blood samples were taken before and 72 hours after phototherapy. The IgG level was measured by calorimetry tests.

 Phototherapy resulted in a decrease in IgG levels. The IgG level significantly decreased from 833.135 to 720.185 mg/dL. Before phototherapy, 12.5% of the population had low IgG levels; however, 32.5% had low IgG levels after the treatment.

 According to the results of the study, intensive phototherapy caused a reduction in IgG levels. Since there was no significant decrease in IgG levels in neonates who received conventional phototherapy, it can be concluded that this treatment is safe in terms of IgG levels.

Immune dysregulation happens after exposure to corona virus disease-2019 (COVID-19) and affects many organs. It is confirmed with a positive COVID-19 test history, fever, and the involvement of 2 or more organs, but it is hard to diagnose in neonates.

There were 2 Persian neonates admitted to the Neonatal Intensive Care Unit or neonatal ward of the Children’s Medical Center, Tehran, Iran, with sepsis in this case presentation. The trunk and extremities were affected by macular rashes in both cases. COVID-19 tests in both cases were negative, but both of their mothers were affected by COVID-19 before delivery. In both cases, systemic and macular rashes responded to corticosteroids.

Macular rash can present multisystem inflammatory disease in neonates. Neonates with a positive history of COVID- 19 in parents or relatives should be considered for this syndrome.

 Ichthyosis is an epidermal disruption that increases insensible water loss. Hypernatremic dehydration is a consequence of skin disruption. This study reviewed the treatment of hypernatremic dehydration in patients with ichthyosis comparing to patients with intact skin.

 We studied five neonates with hypernatremia, including three ichthyosis cases and two normal-skin neonates. This case-series study showed that the sodium correction rate is slower in infants with ichthyosis than in infants with normal skin. The first and second neonates needed less sodium than fluid intake than normal skin infants, although fluid requirement was lower in the third ichthyosis infant than in others due to less skin disruption in this infant.

 Fluid therapy in hypernatremic dehydration in ichthyosis patients is different from neonates with intact skin because of excessive insensible water loss in these patients. It may be needed to give more fluid and less sodium depending on the degree of skin disruption, which may not be determined by physical examination.

 Patent ductus arteriosus (PDA) is a disease presenting on the first days of birth, associated with unpleasant complications such as exaggerated respiratory distress and increased mortality, requiring prompt treatment.

 This study evaluated the relationship between perfusion index and the recovery of patients diagnosed with PDA.

 In this cross-sectional study, 22 neonates with PDA (as the case group) and 22 healthy neonates (as the control group) were selected. The difference in perfusion index (PI) before and after arterial duct closing was determined, and also the relationship between pre-ductal and post-ductal PI in the case and control groups was evaluated. Data were analyzed by SPSS version 21.

 The results showed a significant difference in the mean scores of pre-ductal and post-ductal PI before and after arterial duct closure (P = 0.004). Also, pre-ductal and post-ductal PI scores were significantly lower in the case group than in the control group (P < 0.001)

 According to our findings, PI in infants with PDA is low at presentation and increases after treatment. Therefore, PI can be used as an indicator to evaluate response to treatment during follow-up, particularly when repeated echocardiography is not accessible.

Manyaspects of the severe acute respiratorysyndrome coronavirus 2 (SARSCoV2)pandemicin 2019 have been unclear, especially in newborns, and reports of neonatal diseases are usually associated with perinatal infection.

The purpose of this study was to evaluate clinical and para-clinical manifestations in newborns that contracted the infection after birth.

This observational research was conducted from October 2020 to March 2022 to examine postnatal SARSCoV2 infection in infants admitted to the NICU or neonatal ward at the Children’s Medical Center in Tehran, Iran. Inclusion in the study was open to neonates who had positive RT-PCR results postnatally.

In total, 55 newborns were confirmed to have postnatal SARSCOV2. Fever was the most frequently observed symptom, with 35 (61%). Necrotizing enterocolitis was seen in 18% of neonates, and 30% of them were preterm. Neutropenia was seen in 34% of cases, with five cases having severe neutropenia. All neonates had a normal platelet count. Twenty percent of patients showed C - reactive protein higher than 6 mg/L. Two newborns had co-existing bacterial urinary tract infections. Our neonates didn’t require antiviral, anticoagulant, or corticosteroid medications, and they recovered while receiving only supportive care. Everyone in the group of newborns was discharged without complications, and there were no deaths.

The high rate of fever, high C- reactive protein, and neutropenia in SARSCoV2 neonates suggests that more observational research is needed to compare these symptoms to bacterial sepsis to avoid the overuse of antibiotics in these patients.

Neonatal seizure is a significant problem in this life course, and its timely and effective treatment is crucial. In this study, we compared the efficacy of levetiracetam versus phenytoin for treating the acute phase of neonatal seizures.

In this single-blind case-control study, 60 consecutive children with neonatal seizures referred to the Children’s medical center in Tehran, Iran, in 2018 were studied. Those neonates who had at least 30 minutes of seizure after Phenobarbital treatment were assigned to receive either phenytoin (20 mg/kg) or levetiracetam (initial dose of 40-60 mg/kg) through block randomization. The efficacy and safety of the two drugs were compared between the groups.

The response rate was 83.3% and 86.7% in phenytoin and Levetiracetam groups, respectively, which was not significantly different between groups (P=1.000). Adverse effects were nearly similar between groups (6.7% in the phenytoin group and 3.3% in the Levetiracetam group, P=1.000).

Levetiracetam and phenytoin are both practical and safe for treating neonatal seizures.

Despite growing evidence, there is still uncertainty about potentially modifiable risk factors for neonatal early-onset sepsis (EOS). This study aimed to identify potential clinical risk factors for EOS based on a literature review and expert opinions.

A literature search was conducted in PubMed (MEDLINE), Cochrane, Embase, and Scopus databases. Articles in English, published up to May 2021, on clinical risk factors for neonatal EOS were included. Initially, a questionnaire on risk factors for EOS was developed and validated. The fuzzy Delphi method (FDM) was used to formulate the final version of the questionnaire. The validity of the risk factors was assessed using the Chi square test. P<0.05 was considered statistically significant.

In the review phase, 30 risk factors were approved by two neonatologists and included in the FDM phase. In total, 25 risk factors met the consensus criteria and entered the validation phase. During the observational study, 114 neonates (31 with and 83 without EOS) were evaluated for two months. The results of the Chi square test showed that cesarean section was not a significant risk factor for EOS (P=0.862). The need for mechanical ventilation and feed intolerance was observed in about 70% of neonates with EOS, and therefore considered significant risk factors for EOS (P<0.001). Finally, 26 potential clinical risk factors were determined.

Neonatal-related risk factors for EOS were birth weight, one-min Apgar score, and prematurity. Maternal-related risk factors were gestational age and urinary tract infection. Delivery-related risk factors were premature rupture of membranes, chorioamnionitis, and intrapartum fever.

Surgery in premature neonates following Necrotizing Enterocolitis (NEC) is an awful event. There are many concerns regarding the future of these neonates. Releasing inflammatory substances following perforation can have a significant impact on the premature brain. Based on the ASQ questionnaire, we aimed at finding out whether there is any neurodevelopmental delay following NEC surgery. 

We compared developmental aspects of neonates who underwent NEC surgery with control using the Ages and Stages Questionnaire (ASQ II). 

We compared 29 children that had surgical NEC in their neonatal period with their premature peers. They were homogeneous in age, sex, head circumference, weight, and Apgar count at birth in the neonatal period; they had no significant difference in the incidence of sepsis and ventilation-requiring days and cerebral incidence hemorrhage. At the study time, there was a significant difference in growth parameters, weight (p<0.001), and height (p=0.014). Also, there was no significant difference in head circumference and developmental parameters such as communication, motor, and problem-solving domains.

This study indicates that if these patients do not develop severe neurological complications in the neonatal period, their abilities are close to their premature peers in arrival to community and school. However, we still recommend close monitoring of these cases due to the possibility of impaired central nervous-gastrointestinal coordination.

After the Ministry of the health of Iran officially announced widespread of COVID-19 on 19 February 2020, our attention focused on novel coronavirus. In our case, a2-day- old neonate shows symptoms of sepsis. The main presentation was hypothermia and desaturation. The mother was COVID-19 positive with an active cough. The PCR of the neonate was negative. We don’t claim that the neonate is affected by COVID-19, but this may be an atypical form of sepsis in neonates with positive mothers following COVID-19. A2-day- old female neonate with a gestational age of 40 weeks and a birth weight of 2370 grams was born via the cesarean route from a mother who was a 34-year-old primigravida woman without any history of disease during pregnancy. Two days before delivery, the mother had malaise and dry cough. She was diagnosed as a COVID-19 positive case based on RT-PCR after delivery. On the second day after birth, the parents brought the baby to the emergency room of the children’s medical center hospital with complaints of poor feeding, poor sucking and decreased urination. Physical examination revealed the following signs; hypothermia; T=36℃, diminished primitive reflexes, hypotonia, and oxygen desaturation until 85% without respiratory distress that increased to 98% with oxy hood. We admitted and treated her early-onset sepsis and discharged in excellent condition.Early-onset sepsis as defined is a clinical state that is transferred from mother. The presentations in our case maybe a new form of clinical sepsis following a mother with COVID-19. We don’t claim that our case is COVID-19 positive but in neonates with affected mother’s insidious symptoms should be in concern.

According to the literature, urine analysis to diagnose urinary tract infection (UTI) in neonates is not the basis. It even is not recommended as a part of the evaluation, but some abnormalities in a simple urine test in neonates with UTI may be associated with urinary tract anomaly. Therefore, a simple urine test in neonates with UTI can be helpful for early diagnosis and timely treatment of urinary tract anomalies.

This study was performed as a cross-sectional study. First, 100 neonates hospitalized for various reasons and diagnosed with urinary tract infections were chosen. Before treatment, urine samples were taken from all neonates by catheterization or suprapubic sterility for culture and urine bag for urinalysis. Finally, neonates with positive culture were treated with antibiotics and evaluated; kidney and urinary tract ultrasound and voiding cystourethrography (VCUG) is used to diagnose renal anomalies. The obtained information from urine analysis of neonates without urinary tract anomalies was compared with urinary tract anomalies neonates by SPSS 21 software. To compare the qualitative data, the chi-square and Fisher’s exact tests were used, whereas to compare the quantitative data, we used Wilcoxon test. P < 0.05 was considered statistically significant.

Out of 100 patients who were evaluated, only 30 patients had renal anomalies. No statistically significant correlation was found between gender, cause of hospitalization, positive culture, and type of organism with the renal anomaly. However, pyuria (P-value 0.003), bacteriuria (P-value 0.016), fever (P-value 0.002), nitrite positive (P-value 0.001), and leukocyte esterase (P-value 0.001) showed a statistically significant correlation with the renal anomaly.

Certain indicators such as pyuria, bacteriuria, nitrite, and leukocyte esterase can be seen in a simple urine analysis as criteria for suspicious urinary tract anomalies in neonates with UTIs.

Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Physiologically, the closure of the ductus arteriosus occurs within 48-72 hours after birth in healthy term neonates. This study aimed to compare oral paracetamol and oral ibuprofen in the closure of PDA in preterm neonates.

This study is a single-blind randomized clinical trial. A total of 90 preterm neonates with a gestational age of less than 32 weeks were divided into two groups of oral ibuprofen and oral paracetamol. Oral ibuprofen was administered at a dose of 10 mg/kg on the first day and 5 mg/kg on the second and the third days. Oral paracetamol was administered at a dose of 10 mg/kg every 6 hours for 3 consecutive days. The primary outcome measure was the closure of the ductus arteriosus. The secondary outcome measure was the assessment of any type of complications following the administration of oral paracetamol.

The DA closure rate was 82.2% in the oral paracetamol group and it was 91.41% in the oral ibuprofen group P<0.65, (odds ratio [OR] = 2.22, 95% CI = 0.62-7.97). We did not see any unwanted complication during treatment with oral paracetamol.

The present study showed that oral paracetamol is effective in the closure of PDA. On the other hand, it does not cause any unwanted side effects on the patient.

Congenital malformations are one of the most important and common types of anomalies in infants, and they are considered as the leading causes of disability and mortality in children. These malformations impose enormous costs on families and organizations involved in the treatment, maintenance, and education of patients.

This study aimed to investigate the risk factors affecting the incidence of congenital anomalies in infants born in Iran.

In this retrospective descriptive-analytical study, we registered various information of all newborns examined and their mothers, including gender, family relationship of parents, type of delivery, types of congenital malformations, anomalies of the hands and feet, and anomalies of the nervous and reproductive systems in the maternity wards of hospitals in Iran. Data were gathered using a checklist. The relationships between different factors were assessed by chi-square test, and the factors influencing congenitalmalformations were investigated by logistic regression using SPSS-26 software. The significance level of all tests was 0.05.

According to the results, 7.5% of newborns had congenital malformations. Eclampsia and diabetes mellitus increased the risk of congenital malformations by 15 and 11%, respectively. The risk of congenital malformations in rural areas was 12% higher than in urban areas. Factors such as consanguineous marriages, history of abortion, and gender also affected the risk of congenital malformations.

Necessary measures and plans in the field of premarital counseling, regular pre-pregnancy and post-pregnancy tests and controls, especially in rural and deprived areas, are essential and effective in reducing the incidence of congenital malformations.

This is a new case, affecting a twin that both with Hirschsprung’s disease, one was suffering from long-segment Hirschsprung’s disease with skip segmented. Our surgeon suspected the absence of abnormal vessel tortuosity in the transitional zone; thus, the appendix was sent for permanent pathology. There were ganglion cells in the colostomy site but no ganglion was found in the appendix. Complete biopsies from different parts of the intestine demonstrated positive ganglion cells in the transverse colon, ascending colon, and the distal ileum, jejunum, and duodenum, and negative ganglion cells in the rectum, sigmoid, descending colon, appendix, and 5 cm far from the ileocecal valve were observed. Therefore, the Kimura procedure was done. The most important key in such cases is the surgeons’ observation during operation.

The heart rate characteristic (HeRO score) is a figure derived from the analysis of premature neonate’s electrocardiogram signals, and can be used to detect infection before the onset of clinical symptoms. The United States and Europe accept this diagnostic technique, but we require more tests to prove its efficacy. This method is not accepted in other developed countries so far. The present study aimed to investigate changes in the heart characteristics of two neonates in Akbar Abadi Hospital in Tehran. Experts chose one newborn as a sepsis case, and the other neonate was healthy. The results were analyzed and compared with previous studies. In this research, a group of five neonates was selected randomly from the neonatal intensive care unit, and cardiac leads were attached to them for recording heart rates. We selected two neonates from the five cases, as a case (proven sepsis) and control, to analyze heart rate variability (HRV). Then, we compared the differences in the heart rate of both neonates. Analysis of HRV of these two neonates showed that the pattern of HRV is compatible with reports from US studies. Considering the results of this study, heart rates and their analysis can provide useful indicators for mathematical modeling before the onset of clinical symptoms in newborns.

Patent Ductus Arteriosus (PDA) is considered one of the most prevalent types of congenital heart disease. The closure of the ductus arteriosus physiologically occurs at the first 48-72 hours after the birth in healthy term infants. Different causes can result in the pathological opening of ductus arteriosus. This study aims to investigate the effect of oral acetaminophen on the closure of PDA in preterm neonates.

The present study is a trial without control. Forty-five preterm neonates with a gestational age of <32 weeks were studied. Acetaminophen was orally administered with a dose of 10mg/kg every 6 hours for three days. Closure of ductus arteriosus was considered as the success of treatment. Data were analyzed using SPSS 15. Data were reported as )frequency-percent) and mean ± SD. To evaluate the normal distribution of data, we used a Kolmogorov-Smirnov test. Statistical significance was defined as P<0.05.

The study population consisted of 20 male and 25 female infants with the mean gestational age of 28.95 ± 1.66 weeks. Cesarean-born infants and vaginal-born infants consisted 17.8% and 82.2% of the study population, respectively. The proportion of PDA closure after administration of oral acetaminophen was 82.3%.

The current study indicates that oral acetaminophen is highly effective in closing PDA. Considering its trivial side effects, it has the potency to be a convenient option for treating this condition.

Circumcision is the most common surgery in male infants in Islamic countries. Therefore, Knowledge of its side effects and appropriate therapies is essential. In this case report, we describe a 12-days neonate with Glans Ischemia, two days after circumcision. We admitted the neonate and treated him with oral Pentoxifylline and antibiotic for three days. Thus Pentoxifylline can be implemented as a treatment in post-circumcision ischemia of the glans penis in neonates.

Changes in plasma concentration of taurine during hospitalization of acetaminophen poisoned patients have not been studied. Hepatotoxicity is a common consequence of acetaminophen overdose that may lead to acute liver failure. Numerous biomarkers for drug-induced liver injury have been explored. All biomarkers are usually obtainable 48 h following acetaminophen overdose. We have already introduced taurine as a non-specific early biomarker of acetaminophen overdose. This study aimed to follow up changes in plasma concentration of taurine during the first three days of acetaminophen overdose. Sixty-four male patients suffering from acetaminophen overdose were selected for the study. Four blood samples were taken from the patients every 12 h. Sixty blood samples were also taken from sixty healthy humans. The plasma concentration of taurine in both groups was analyzed an already developed HPLC method. Analysis of regression showed a significant correlation between means of plasma concentrations of taurine and acetaminophen, aspartate aminotransferase, Alanine aminotransferase, glutathione peroxidase, and prothrombin time during hospitalization. The high plasma concentration of taurine, 6 h or more after acetaminophen overdose, could be a useful early indicator of liver damage.

Nurses and specialists face serious challenges, including nasal necrosis and infection at intensive care units for premature infants. Considering that therapeutic continuous positive airway pressure (CPAP) is necessary for premature infants needing respiratory support, nasal masks, and prongs transfer positive end-expiratory pressure. The infant’s skin is highly delicate, and such products exert pressure on the nose and make nasal necrosis, in which case premature infants may suffer from infection and loss of nasal septum. Thus, prong support (Cannulaide CPAP) is employed to reduce the pressure. Each infant should use a specific prong since infants’ noses vary in size and shape.

Computer-aided design (CAD) and additive manufacturing (AM) for medical 3D printing were implemented using soft materials (silicone). Accordingly, non-plastic and soft materials were implemented for infants at the neonatal intensive care unit because silicone is a fluid that hardens gradually.

The setting ranges were transferred to the three-dimensional (3D) printer. Different prototypes were printed after applying these settings.

AM rises to meet this challenge by making ergonomic products. This study addresses the innovation and production of liquid silicone prong support through AM. This prototype was tested at Al-Zahra hospital in Tabriz, Iran, and the results turned out to be satisfactory