فهرست مطالب maryam saboute

Hyperbilirubinemia is one of the most common neonatal disorders and one of the risk factors of neurological complications. So this study was conducted to evaluate the correlation between alkaline phosphatase (ALP) and pathological jaundice.   

A case-control was performed on term neonates with and without pathological jaundice who were referred to the Hazrat-e-Ali Asghar Hospital in 2017. In both groups, cases (neonates with pathological jaundice, n=153) and control (neonates with and without pathological jaundice, n=153) levels of alkaline-phosphatase and serum total bilirubin were evaluated with biochemical tests. Moreover, other data were also recorded from their history and clinical examinations. In addition, the severity of jaundice, duration of hospitalization, type of required treatment, and probable complications after the treatment were considered in follow-up. Data were collected by checklist and entered to SPSS v.20. ALP level and its relationship with serum total bilirubin compared between two groups.    

Mean level of ALP was 411.3 ± 134.2 U/L in the case group and 338 ± 131.4 U/L in the control group. Serum total bilirubin level was 11.9 mg/dl in the case group and 6.2 mg/dl in the control group. ALP levels in the case group were significantly more than the control group (p=0.001). There was no correlation between ALP and serum total bilirubin level in neonates in the case group (p=0.532). There was no statistically significant relationship between alkaline phosphatase level and gender of neonates, but the relationship of ALP level with types of delivery was statistically significant (p=0.002). There was not a significant relationship between ALP level with hospitalization duration (p=0.371).  

The result of this study showed that there is no correlation between ALP levels and pathological jaundice in patients, although this issue needs to be approved by the other studies.

Hypertensive disorders of pregnancy including preeclampsia can be associated with preterm birth and infant mortality and morbidity. It seems that intraventricular hemorrhage (IVH) in preterm neonates born to hypertensive mothers is less common compared to the other ones. In this study, we assessed the relationship between hypertensive disorders of pregnant mothers and the incidence of intraventricular hemorrhage in preterm neonates weighing less than 1500 grams.
In this case-control study, 305 singleton preterm neonates with a birth weight less than 1500 g were entered. The presence of IVH in all preterm neonates was assessed using brain ultrasonography and its correlation to hypertensive disorders of their mothers were evaluated.
The prevalence of preeclampsia in mothers with and without pre pregnancy hypertension was 40%, and 15.09% respectively. The prevalence of IVH in preterm neonates was 26.9% (n=82). The incidence of IVH in preterm neonates of mothers with and without preeclampsia was 16.07%, and 29.31%, respectively (p=0.028). The prevalence of IVH in preterm neonates of mothers with hypertension and without hypertension was 12.5% and 29.05%, respectively (p=0.018). Preterm neonates with IVH had a lower mean birth weight, smaller gestational age and lower Apgar scores compared to preterm neonates without IVH with p values of <0.001, <0.001 and <0.01, respectively.
Hypertensive disorders of pregnancy increase the risk of preterm delivery, but the incidence of IVH in preterm neonates weighing less than 1500 gr is lower in infants born to mothers with hypertension including preeclampsia compared to those born to non-hypertensive mothers. And also lower gestational age, birth weight, and Apgar scores were important predicting factors for IVH in preterm neonates.

Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI. This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged < 28 days and had cerebrospinal fluid (CSF) culture via lumbar puncture were extracted from medical records and recorded in some checklists. A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54% of the neonates were male. Out of all neonates, 23 (14.1%) cases had positive blood culture. The positive CSF culture was observed in only two (1.2%) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50% of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50% and 24.2%, respectively; P=0.432). The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2%. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results.

As there are different views on the effects of aminophylline on neonatal renal function, we intended to observe the effects of aminophylline on renal dysfunction in neonates with prenatal asphyxia.

This randomized trial was conducted in the Obstetrics and Gynecology Hospital, Tehran, Iran, from June 2016 to May 2017, in neonates with moderate to severe asphyxia during birth. Fifty-six neonates were divided randomly into two groups. The intervention group received one dose of 5mg/kg slow intravenous aminophylline injection and the placebo group received 2 mL/kg of intravenous 10% solution of dextrose saline during the first hour of life. They were monitored and compared for renal functional indices, electrolytes, and complications of asphyxia during the three days of life.

The mean of Cr (37.9 ± 8.8 vs 38.5 ± 9.4 and 20.8 ± 4.8 vs 30.1 ± 5.2 μmol/L), GFR (21.55 ± 4.7 vs 20.25 ± 4.4 and 30.8 ± 7.1 vs 20.1 ± 6.5 mL/minute/1.73 m2), Na (135.1 ± 12.4 vs134.5 ± 11.2 and 128.9 ± 11.5 vs 134.2 ± 10.9 mEq/L), and urine output (98.2 ± 25 vs 96.8 ± 23 and 148.7 ± 35 vs 108.8 ± 20 cc) were in the aminophylline treated and placebo group on the 1st and 3rd days, respectively. The mean difference of Cr (-9.3 (-8.9; -9.7) μmol/L); (P = 0.02), GFR (10.7 (10.1; 11.3) mL/minute/1.73 m2) (P = 0.009), Na (-5.3 (-5.9; -4.7) mEq/L) (P = 0.002), and urine volume (39.9 (24.9; 54.9) cc) (P = 0.001) presented statistically significant differences on the third day between the intervention and placebo group.

Aminophylline was effective in preventing renal dysfunction in neonates with asphyxia. Neonates who received aminophylline indicated a significant improvement in GFR and urine output on the first day of life.the formula is not displayed correctly!

Nephrotic syndrome (NS) is a common renal disease in the pediatric population, which can be complicated with venous thromboembolic events. In the present study, the researchers evaluated the risk factors of venous thrombotic events in children with nephrotic syndrome. In this descriptive cross sectional study, the researchers evaluated 43 cases of NS including 35 uncomplicated and eight complicated patients with venous thrombotic events, who were admitted to the nephrology ward of Ali-Asghar Children Hospital from 2011 to 2015. Two groups were matched for age onset of NS. Data were recorded on age, gender, body mass index (BMI), histopathologic varieties of NS, and serum albumin level. The mean age of cases with venous thrombotic events was 7.31 ± 4.1 years. There were six females. Of eight cases with venous thrombotic events, five cases suffered of pulmonary thromboembolism (PTE) and five cases of deep vein thrombosis (DVT). The mean serum albumin level in the thrombotic group was 1.87 ± 0.4 g/dL. The histopathologic results showed two cases of membranous proliferative glomerulonephritis (MPGN), three cases of minimal change disease (MCD) and one case of focal segmental glomerulosclerosis (FSGS). The researchers found significant differences between mean serum albumin level and histopathologic results in the case and control groups. Venous thrombosis and pulmonary emboli are important complications in pediatric NS. The risk of VTE increases with lower serum albumin level. The risk of VTE increases with lower serum albumin level. The researchers suggest the use of anti-thrombotic agents as prophylaxis in nephrotic patients with serum albumin level of less than 2 g/dL.

Feeding intolerance is a common complication in preterm neonates and is responsible for prolonged hospitalization. This study aimed at assessing the effects of high-dose oral erythromycin on feeding intolerance in preterm infants.

A randomized, double blinded, placebo-controlled trial was performed during 2014 and 2015 (Tehran-Iran). Preterm neonates aged >14 days, who met the feeding intolerance criteria were selected for the study and their medical records were randomly assigned into 2 groups by simple randomization. Infants in group A received 10 mg/kg oral erythromycin every 6 hours for 2 days, followed by 4 mg/kg oral erythromycin every 6 hours for 5 days; and infants in group B received placebo with the same route. The number of days until reaching complete oral feeding, day of discharge from NICU, and complications related to intervention were recorded and compared between the 2 groups. Independent samples t test, Mann-Whitney, Fischer exact test, and Chi square were used to analyze the relationships between variables. P-value less than 0.05 was considered statistically significant.

A total of 20 infants in group A received erythromycin and 20 infants in group B received placebo. Erythromycin could not alter the mean volume of feeding, duration of parental feeding, length of hospitalization, and frequency of feeding discontinuity (p>0.05); however, mean days to reach complete feeding in group A was significantly shorter than in group B (9.80 vs. 16.80 days; p=0.001).

High-dose erythromycin as a rescue measure with no potential adverse effect is beneficial in reducing the time taken to achieve full enteral feeding. However, more extensive investigations are needed to determine the best administration dosage.

Breast milk provides adequate protein to facilitate growth for term infants. Appropriate nutrition is necessary for the growth of preterm infants. Extremely-low-birth-weight (ELBW) infants require higher protein intakes to achieve adequate growth.
The present study aimed to evaluate the effect of protein supplements on the physical growth of infants weighing less than 1,000 grams through the serial measurement of their anthropometric indices (weight, height, and head circumference) during admission at the neonatal intensive care unit (NICU).
This triple-blind, randomized clinical trial was conducted on 64 infants weighing less than 1,000 grams, who were admitted to the NICU of Akbar Abadi Hospital in Tehran, Iran during 2015-2016. Data on the daily nutritional intake of the subjects were recorded until discharge from the hospital. Data analysis was performed in SPSS version 24.
In total, 63 infants were enrolled in the study. Mean daily weight gain of the infants was 55.92±36.90 and 30.80±13.91 grams in the case and control groups, respectively (P=0.001). Mean weekly linear growth in the case and control groups was 0.77±0.67 and 0.76±0.29 centimeter, respectively (P=0.939). Mean weekly head circumference growth in the case and control groups was 0.51±0.10 and 0.34±0.16 centimeter, respectively (P According to the results, protein therapy in the premature, extremely-low-birth-weight (ELBW) infants could improve the rate of weight gain and head circumference growth. Given the importance of weight gain in premature ELBW infants, it is recommended that protein therapy be employed in these newborns. Various studies have denoted the few side-effects of protein therapy, which indicates the safety of this method to resolve the lack of weight gain in these infants.

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.
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.
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 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.

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.
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.
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).
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.

The use of parenteral nutritional supplementation of phosphorus may lead to exhibit higher plasma phosphate concentrations and less radiological features in premature neonates susceptible to osteopenia. The present study aimed to assess the beneficial effects of adding intravenous phosphorus to total parenteral nutrition (TPN) on calcium and phosphorus metabolism in preterm neonates by measuring bone mineral content. This open-labeled randomized clinical trial was conducted on premature neonates who were hospitalized at NICU. The neonates were randomly assigned to two groups received TPN with intravenous sodium glycerophosphate or Glycophos (1.5 mmol/kg/day) or TPN without sodium glycerophosphate. At the end of the four weeks of treatment, the presence of osteopenia was examined using DEXA Scan. After completing treatment protocols, the group received TPN with intravenous Glycophos had significantly lower serum alkaline phosphatase (360±60 versus 762±71, P

Perinatal asphyxia may cause severe damages in different organs such as kidneys, lungs, liver and most importantly CNS. The current study aimed to evaluate and compare the prevalence of liver impairment among asphyxiated and normal neonates.
A retrospective case-control study was carried out in a referral pediatrics Hospital (Iran- from 2013 to 2015). Term and preterm asphyxiated neonates born in hospital were registered as the case group. Serial laboratory tests including CBC, Crateanin, BUN, Na, K, Ca and blood sugar were done. ALT, AST and ALP were also measured at day of third to fifth of life. Healthy neonates who admitted due to hyperbilirubinemia were also considered as the controls and their liver enzymes were checked at day of third to fifth of life. All participant's demographic data and laboratory findings were extracted from medical records. Liver impairment by assessing liver enzymes was compared between case and control groups. The level of significance was considered as p Forty-nine asphyxiated neonates as the case and 20 icteric neonates as the control group entered the study. Of all asphyxiated neonates, 23 cases (46.9%) showed seizure, 25 (52.1%) type II and 23 (47.9%) type III Hypoxic-ischemic encephalopathy. Seven (10.1%) asphyxiated neonates died. More neonates in control group had gestational age > 37 weeks (p Elevated ALT and ALP in 3-5 days of age can be utilized as possible predictors of perinatal asphyxia.

Asphyxia is a common cause of mortality and morbidity among neonates. Following severe asphyxia and ischemia, reperfusion occurs which damages vital organs like the kidneys. This study was conducted to determine the prevalence of AKI based on the definition of a serum creatinine level higher than 1.5 mg/dL, in neonates with asphyxia.
This retrospective study was performed in Ali-Asghar and Shahid-Akbar-Abadi Hospitals, Tehran, Iran in a period of one year. The medical documents of all newborns diagnosed with asphyxia were studied. The asphyxia grade was determined according to the asphyxia Sarnat criteria. The kidney function was evaluated based on the serum creatinine level.
Thirty-eight cases met the inclusion criteria. There were 13 Sarnat grade-1 cases (34.2%), 19 grade 2 cases (50%), and 6 grade 3 patients (17.6%). Three (7.8%) patients (2 patients in grade 3 and one patient in grade 2 of the Sarnat grading scale) developed AKI. AKI was detected in 33% of the patients in grade 3 and 5.2% of the patients in grade 2 of the Sarnat grading scale. Nine patients (23%) died, of whom 83% were in grade 3 and 16.9% in grade 2 of asphyxia.
AKI developed in 7.8% of the cases, of whom 33% were in grade 3 and 5.2% were in grade 2 of the Sarnat grading scale. The low rate of AKI development in our study might be duo to the small sample size and patient mortality in the first 3 days of life.

As a common and often benign problem, hyperbilirubinemia occurs in 60% of term and 80% of preterm neonates. The current treatment methods for the complication are phototherapy and blood exchange. However, in many areas of Iran, use of oral manna is common. This study investigated the effects of manna on neonatal serum bilirubin levels among hospitalized neonates in Akbar-Abadi Hospital (Tehran, Iran) during 2011. This randomized control clinical trial was conducted on 97 neonates (49 in phototherapy group as the controls and 49 in phototherapy plus manna group). The case group orally received 10 g of 30 g/100 ml manna suspension every 12 hours. They also underwent intensive phototherapy similar to the control group. Data was analyzed by SPSS14. There were no differences between the two groups in terms of gestational age, neonatal age, retic count, and hemoglobin levels. Comparison between the two groups did not show any significant differences in serum bilirubin levels 0, 24, and 48 hours after the intervention. Although this study did not show any differences between the two groups, intensive phototherapy might have prevented the possible effects of manna to be revealed. Further research in this field is thus recommended.