mohammad kazem sabzehei

The birth of premature infants remains a challenge in many societies. This cross-sectional study investigates prenatal care and influential factors in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Fatemieh Educational-Medical Center in Hamadan, Iran, from March 2018 to March 2019. We examined premature infants with a gestational age of less than 37 weeks who were admitted to the NICU. Data on demographic and maternal characteristics, length of hospital stay, maternal underlying diseases, probable causes of preterm birth, neonatal complications, treatment types, treatment-related complications, resuscitation needs, ventilation, and mortality rates were extracted from patient records. Among 388 preterm infants studied, 204 (52.6%) were female. The mean gestational age was 31.8±2.8 weeks, birth weight was 1647.4±625.6 grams, and average hospital stay was 10.2±9.3 days. The most common maternal underlying disease was pregnancy-induced hypertension or preeclampsia (22.2%), respiratory distress syndrome, jaundice, and low birth weight were the leading reasons for hospitalization (84%). Neonatal outcomes included 92 (23.7%) deaths, 25 (6.4%) intraventricular hemorrhages, 39 (10.1%) patent ductus arteriosus cases, 20 (5.2%) bronchopulmonary dysplasia cases, and 41 (10.6%) retinopathy of prematurity cases. Regression analysis revealed significant predictors of neonatal mortality, including male gender, maternal underlying diseases, need for cardiopulmonary resuscitation, low Apgar score at one-minute, lower birth weight, shorter gestational age, and NICU stay duration. This study underscores the high neonatal mortality rate among preterm infants. Implementing preventive measures, particularly addressing maternal underlying diseases and low birth weight, can significantly reduce neonatal mortality.

Respiratory support in infants with respiratory distress syndrome (RDS) plays an important role in the reduction of mortality and complications, but the treatment fails in some infants. This study aimed to identify the predictors of continuous positive airway pressure (CPAP) failure in preterm infants with RDS. This cross-sectional retrospective study was conducted on RDS-diagnosed preterm infants admitted to the neonatal intensive care unit of Fatemieh Hospital (Hamadan city) in 2021-2022. The infants were examined in terms of risk factors for CPAP failure. Data extracted from the medical records were recorded in a checklist and analyzed with SPSS version 21 software at a confidence level of 95%. CPAP failure was recorded in 37.6% of the studied 202 infants. The need for resuscitation at birth, low gestational age, low birth weight, multiple births, low 1-min and 5-min Apgar scores, the need for higher FIO2 and PEEP, acidosis, and the need for surfactant administration were significantly associated with CPAP failure. In logistic regression, low gestational age (OR 1.30, 95% CI: 1.082-1.576) and the need for resuscitation at birth (OR 0.426, 95% CI: 0.202-0.898) were the major predictors of CPAP failure. Lower gestational age and the need for PPV in the delivery room are good predictors of CPAP failure in preterm infants with RDS, who receive nasal CPAP as primary respiratory support.

Due to the prevalence of myocardial dysfunction and Patent Ductus Arteriosus (PDA) in a large number of preterm neonates, the prognosis of these infants is highly related to their early diagnosis and treatment. In this regard, the present study aimed to determine the relationship between troponin T level and the prognosis of premature neonates admitted to the Neonatal Intensive Care Unit (NICU) of Fatemieh Hospital in Hamadan.

In this cross-sectional study, a certain number of infants who underwent serum levels of troponin T from 72 hours to one week after birth were assessed for demographic information, length of hospital stay, complications during hospitalization, acidosis, inotropic agents, recovery, and mortality, as well as their relationship with troponin level.

Out of 61 neonates, 22 patients had large PDA with a troponin level of 436±50.2 pg/ml, 14 patients had a small PDA with a troponin level of 260.5±89.8 pg/ml, and 25 patients were without PDA with a troponin level of 277.1±229.7 pg /ml (P = 0.203). There was no statistically significant difference between the three groups. The mean levels of troponin were 423±521 and 274±154 pg/ml in deceased and surviving neonates, respectively (P=0.194). Inotropic was significantly higher in deceased patients (P=0.003), and troponin T level was statistically significant (P=0.008). The relationship between troponin level and severe acidosis (P=0.051) was not significant, with a small difference that could be clinically valuable.

Serum troponin T level was higher in preterm neonates with large PDA and deceased ones who received inotropic agents due to hemodynamic disorders and severe acidosis.

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of mortality and morbidity in neonates. Head cooling is considered the standard treatment that reduces mortality and morbidity by decreasing the adverse effects of the disease. Some medicines having neuroprotective properties may be beneficial in treating HIE.

We aimed to evaluate the effect of erythropoietin (EPO) on short-time outcomes in newborns with HIE.

This study was conducted on 62 newborns with moderate to severe HIE hospitalized in Fatemieh Hospital, affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, from 2019 to 2020. Eighteen patients who received head cooling plus 1000 IU/kg/d EPO were considered the intervention group and compared with 44 neonates who received only head cooling alone. Short-term outcomes, including length of stay (LOS), thrombocytopenia, seizure, need for mechanical ventilation, multiple anticonvulsant drugs, and in-hospital mortality, were compared between the groups using SPSS version 22.

The mean LOS was 21.2 ± 9.6 and 21.5 ± 12.3 days (P = 0.927), thrombocytopenia occurred in 27.8% and 34.1% (P = 0.629), and 84.1% - 88.9% of newborns required mechanical ventilation (P = 1.0). The seizure was observed in 93.2 -94.4% of newborns (P = 0.29), and multiple anti-seizure drugs were required in 35.3% and 48.9% of EPO and control groups retrospectively (P = 0.66). The mortality rate was significantly different between the EPO and control groups (11.1% vs 44%; P = 0.02).

High-dose EPO can reduce the mortality rate of neonates with HIE when used in addition to head cooling compared to head cooling alone.

There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).

The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth.

The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth  compared to the control group (8.3% vs. 27.7%, P=0.014); however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56.2%, P=0.332), the mean respiratory support duration (6.89±3.20 vs. 6.70±3.71 days, P=0.295), the mean hospital stay (19.52±12.364 vs. 17.40±9.57 days, P=0.591), development of bronchopulmonary dysplasia (4.2% vs. 8.5%, P=0.435), and mortality (6.25% vs. 12.8%, P=0.317).

Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LISA

VACTERL association is a congenital abnormality involving several organs. The percentage of involvement of different organs in this illness varies and treatment success depends on the intensity of the accompanied anomalies. This study aimed to investigate the prevalence of VACTERL association in neonates Hospitalized in Be'sat Hospital in Hamadan, Iran. This retrospective study was conducted using the descriptive-analytic method and all the neonates who were hospitalized with esophageal atresia and imperforate anus abnormalities in Be'sat Hospital, Hamadan, Iran, from April 2009 to April 2018 were included in the study. Information on the neonates were extracted from the medical records and after being recorded in the checklist, they were analyzed using SPSS v.16 at a 95% confidence level. 127 neonates were included in this study. 42 neonates (33.1%) had esophageal atresia, 78 (61.4%) had imperforate anus, and 7 neonates (5.5%) had both anomalies. 87 of these neonates (68.5%) suffered from congenital heart disease. Atrial septal defect (31%), simultaneous presence of atrial septal defect and patent ductus arteriosus‎ (24%), and patent ductus arteriosus (23%) were the most common congenital heart diseases, respectively. 32 neonates (25.2%) had VACTERL association. Heart, genitourinary, and spinal anomalies were present in 93.2%, 84.3%, and 9.3% of the neonates, respectively. VACTERL association was significantly observed in neonates with imperforate anus (P = 0.001) VACTERL association is common in neonates who suffer from esophageal atresia or imperforate anus. Considering the high prevalence of anomaly of other organs, in addition to complete physical examination, echocardiography, abdominal ultrasound, and radiography of the spine are recommended.

Severe indirect hyperbilirubinemia causes neurotoxicity, leading to potential permanent injuries to the neonatal nervous system. The present study intended to compare the effectiveness and complications of Single-Surface Intensive Phototherapy (SSIP) and Double-Surface Intensive Phototherapy (DSIP) in treating non-hemolytic hyperbilirubinemia in the neonatal ward of the Besat Hospital, Hamadan, Iran.

In this prospective randomized clinical trial, 150 healthy full-term neonates born between 37-42 weeks gestation with ages <14 days old and birth weights ≥2500 gr who were affected by non-hemolytic hyperbilirubinemia with total serum bilirubin of 15-20 mg/dL were randomly allocated to two groups. Each group (n=75) underwent either SSIP or DSIP. Demographics, bilirubin level alterations, weight, platelet count, number of defecation per day, and body temperature of the patients were monitored and recorded in a specific questionnaire. Data analysis was performed using SPSS version 26.0 software, with the Chi-square and independent t-test.

The pre-intervention levels of indirect bilirubin were 17.07±1.46 mg/dL in the SSIP group and 17.10±1.54 mg/dL in the DSIP group (P-value = 0.853). After 24 and 48 hours of treatment, the mean indirect bilirubin level of the SSIP group reduced to 13.12±1.71 mg/dL and 9.69±1.68 mg/dL, respectively. In the DSIP group, the levels were 11.85±2.17 mg/dL and 8.43±1.56 mg/dL after 24 and 48 hours of treatment, respectively. The absolute reductions of indirect bilirubin were 7.76±3.28 mg/dL for the SSIP group and 8.96±4.49 mg/dL for the DSIP group (P-value = 0.458). Therefore, the indirect bilirubin levels were significantly different between the groups after 24 and 48 hours of treatment and at the time of discharge (P<0.05). There were no significant inter-group differences in weight, platelet count, and incidence of skin rash, while the number of defecation and body temperature were higher in the DSIP group (P <0.05). However, body temperature alterations had no clinical relevance.

Compared to the SSIP, the DSIP showed faster effectiveness and led to a shorter hospital stay, while it did not entail higher levels of complications.

Intraventricular hemorrhage (IVH) is an important cause of mortality and disability in premature neonates. Regarding this, the present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU)at Fatemieh Hospital in Hamedan, Iran, 2016.

This cross-sectional study was conducted on178 neonates with a gestational age of ≤ 32 weeks admitted to Fatemieh Hospital affiliated to Hamadan University of Medical Sciences, Hamedan, Iran, in 2016. The study population was selected using census method. The newborns were subjected to cranial ultrasound on the seventh day of life. and they were assigned into two case and control groups (namely neonates with IVH and those without IVH, respectively). Intra- ventricular hemorrhage was classified into four grades regarding Papile classification. The patients’ demographic specifications, including 1- and 5-minute Apgar scores, type of delivery, birth weight, use of mechanical ventilation, prenatal corticosteroid, gestational age, and some complications (e.g., Pneumothorax), were collected using a checklist. The data were analyzed using SPSS software version 16.

According to the results, prevalence of IVH in premature infants admitted to NICU was approximately 20 %, , 61.2% of the neonates were male. The mean gestational age of the participants was 30.39 weeks. The comparison of delivery type between the case and control groups showed no significant difference between them in this regard(P=0.197). Furthermore, there was a significant difference between the two groups in terms of need for mechanical ventilation (P=0.03), pneumothorax risk of this condition in the preterm neonates is enhanced by some factors, such as low birth weight, 5-minute Apgar score, and gestational age as well as the need for mechanical ventilation. (P=0.001), and 5-minute Apgar scores (P=0.04). Additionally,the incidence of IVH showed a significant relationship with the mean gestational age (P=0.001) and birth weight (P=0.04).

According to the findings, the premature newborns admitted to the NICU revealed a relatively high prevalence of IVH. The condition is aggravated in preterm neonates by some factors such as low birth weight, 5-minute Apgar score, gestational age, and the need for mechanical ventilation.

Background :

Neonatal jaundice is a common condition. Total serum bilirubin (TSB) measuring is standard for bilirubin testing, while transcutaneous bilirubin (TcB) is an alternative method. We aimed to evaluate the correlation between TSB and TcB in term and preterm neonates.

This prospective cross-sectional study was conducted to on 93 term and preterm neonates in Fatemieh Hospital in 2018, Hamadan, Iran. The samples were categorized into two groups, including term and preterm icteric neonates. Neonates were evaluated to determine the necessity of bilirubin estimation with TSB measurement. After the confirmation of jaundice, the blood samples obtained were sent to the laboratory for bilirubin estimation, and at the same time, the TcB measurement was performed by the bilirubinometer. Selectra X-L was utilized by which the blood samples were analyzed through the dichloroanilin method. The Pearson correlation coefficient was used to evaluate the relationship and stringency of the correlation between the approaches.

In general,61% and 38% of neonates were boys and girls, respectively. Before phototherapy, the TSB values were lower than TcB estimations in term and preterm neonates. The estimated Pearson correlation coefficients were obtained at r=0.729 (p <0.001), and r=0.802 (p <0.001) in term and preterm neonates, respectively. After phototherapy, contrary to the obtained results before phototherapy, the TSB concentration was higher than TcB concentrations. The difference between the measured values of the two approaches was more significant in term neonates. The Pearson correlation coefficient estimations were r=0.804 (p <0.001), and r=0.901 (p <0.001) in term and preterm neonates, respectively.

Based on the results, there was a significant correlation between the values of TSB and TcB in term and preterm neonates.

: The Patent Ductus Arteriosus (PDA) occurs in 50% of infants under 1000 g and 30% of infants less than 1500 g. Treatment failure can exacerbate respiratory distress and its complications. Acetaminophen is a new drug with fewer side effects. The present study was designed and performed to evaluate the effect of this drug  and  intravenous ibuprofen on the treatment of Patent Ductus Arteriosus.

In this case-control study, 50 preterm infants who were less or equal to 14 days of age and diagnosis  of PDA   by echocardiographic were included and randomly divided into two groups. The first group was treated with intravenous ibuprofen and the second group was treated with intravenous acetaminophen for three days. At the end, the necessary information, including echocardiographic findings were analyzed using SPSS software version 16.

The findings of the present study showed that both ibuprofen and acetaminophen had equal effect in the closing of PDA in preterm infants.There was no significant difference in the duration of  hospitalisation between two  groups (P = 0.259). Possible side effects include intra-ventricular hemorrhage, thrombocytopenia, serum creatinine greater than 1.5 mg / dl, decreased urinary volume, necrotizing enterocolitis, positive blood culture and bronchopulmonary dysplasia were not significantly different between the two groups. The only significant complication was gastrointestinal bleeding, which was almost equally prevalent in both groups.

Acetaminophen  such as ibuprofen is effective as the main treatment of patent ductus arteriosus (PDA) and it could be a safe alternative to ibuprofen.

Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines.

This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates’ clinical findings and interventions were collected and analyzed.

In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight <2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P<0.001).

The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.

Hypoglycemia and hypocalcemia are common metabolic disorders in high-risk infants that may cause serious complications in case of late diagnosis.

This study intended to determine the prevalence of hypoglycemia and hypocalcemia among high-risk infants.

A cross-sectional study was conducted on all the infants prone to hypoglycemia and hypocalcemia admitted to the neonatal ward of Fatemieh Hospital in Hamadan from September 2016 to October 2017. If infants’ blood glucose was less than 40 mg/dL within the first four hours after birth and less than 45 mg/dL within 4 - 24 hours after birth, they were diagnosed with hypoglycemi. If their blood calcium was less than 7 and 8 mg/dL in preterm and full-term infants, respectively, within 12 - 24 hours after birth, they were diagnosed with hypocalcemia.

A total of 883 infants participated in this study. The prevalence of hypoglycemia and hypocalcemia was 39.1% and 1.8%, respectively. The mean birth weight was 2124.1 ± 272.8 g, and the gestational age was 35 ± 1.88 weeks. Hypoglycemia had a significant relationship with preterm birth (P = 0.002), lower mean birth weight (P = 0.001), and low Apgar score at 1 and 5 minutes after birth (P < 0.05). Hypocalcemia had a significant relationship with small for gestational age (SGA) (P = 0.007), lower mean birth weight (P = 0.025), and low Apgar score at one and five minutes after birth (P < 0.05).

It is recommended to measure blood glucose and blood calcium in high-risk infants, including infants of diabetic mothers (IDMs), preterm infants, and infants with lower birth weight (LBW), SGA, and low Apgar score at one and five minutes after birth.

Congenital anomalies are considered as one of the major causes of neonatal death. The prevalent pattern of congenital anomalies may vary diachronically or geographically. With regard to the pervasiveness of under-five mortality (probability of dying between birth and exactly 5 years old) in Hamadan province in the recent years, the present study intended to determine the risk factors of congenital anomalies of newborns in Hamadan province in 2017.

The present case-control study was conducted in the hospitals affiliated to Hamadan University of Medical Sciences for 6 months in 2017. The study targeted all the newborns from birth to hospital discharge. The neonatal cases with congenital anomalies were identified through clinical examination. A report sheet was assigned to a healthy newborn, as a control, per each case of congenital anomalies born on the same day and in the same hospital. Once data was collected, they were statistically analyzed by means of SPSS V. 16 software.

According to the current results, the prevalence of congenital anomalies was 0.85% (8.5 per 1,000 live births). Genitourinary (40%), musculoskeletal (25.2%), eye, ear and neck (18.5%), chromosomal (5.9%), respiratory tract (3.7%) and cardiovascular system (2.2%) were the most common congenital anomalies, respectively. Consanguineous marriage, concomitant use of contraceptive methods and male sex were found to be the most important risk factors for congenital anomalies.

The present study aimed at identifying the various types and prevalence of congenital anomalies in Hamadan province. Regular prenatal examination and early diagnosis for prevention, early intervention and scheduled termination of pregnancy are recommended. Besides, public awareness of the disadvantages of consanguineous marriage and other pertaining risk factors affecting the incidence of congenital anomalies is also recommended.

Some of the severe diseases in the neonatal period lead to a myocardial injury that, if not detected promptly, would affect prognosis. Detection of acquired myocardial injury in the early stages of the diseases may be possible with simultaneous examination by echocardiography and determination of serum troponin I levels.

In this cross-sectional study, between December 2016 and December 2018, myocardial function of 60 (33 males, 27 females) term neonates with a mean birth weight 3175.5 ± 441.18 grams who were at least 72 hours under ventilation, was studied using conventional and tissue Doppler echocardiography and measuring serum troponin I levels by ELFA method.

Mean and standard deviation of serum troponin I level, left and right MPI in neonates under study were 0.22 ± 0.64, 40.11 ± 0.11, and 0.41 ± 0.13, respectively. The correlation coefficient between serum troponin I level related to right MPI was +0.502 (P < 0.001) and left myocardial performance index was +0.524 (P < 0.001), and other criteria correlated to troponin I on right side of heart were Em, Sm, TAPSE, TR gradient in patients with PH was related to troponin I levels (P < 0.001).

Serum level of troponin I is helpful in determination of right and left myocardial dysfunction especially in the presence of pulmonary hypertension in the neonates under mechanical ventilation.

Background Preterm birth significantly affects the neonates’ survival. It also increases the risk of neonatal complications, prolongs the hospitalization period, and imposes high costs on the public health system. This study is aimed to assess the risk factors of the preterm birth. Materials and Methods This case-control study was carried out at a maternal referral hospital in Hamadan. The participants consisted of 470 preterm infants born in less than 37 weeks of gestational age (case group), and 470 term infants with normal gestational age (control group). Several variables including the neonatal birth weight, gestational age, type of delivery, the maternal age, history of infertility, birth order and maternal disease were compared in both groups. The collected data was extracted from the medical file and recorded in a pre-designed checklist; they were then analyzed using SPSS software (version 16.0). Results Mean gestational age (34.4±3.34 vs. 39.1±1.09 weeks, p=0.001), and mean neonatal weight (2475.43±683.28 vs. 3122.64±409.89 gr, p=0.001) were lower in the case group compared to the control group. Multivariate logistic regression analysis showed a statistically significant association between the preterm birth and older maternal age (OR: 1.07), history of infertility (OR: 0.5), mother exposure to smoking (OR: 2.4), intrauterine growth restriction (IUGR) (OR: 0.99), C-section delivery (OR: 0.39) and maternal diseases (OR: 0.96). Conclusion This study showed that older maternal age, history of infertility, mother’s exposure to smoking, IUGR, C-section delivery, and maternal disease were independent risk factors for preterm birth. The identification of these factors is essential in reducing the risk of preterm birth.

Only alimited number of studies have evaluated the association between phototherapy-treated neonatal jaundice and the development of atopic dermatitis (AD) in the early childhood. In this context, the present study is aimed to assess the relationship between the AD development in the childhood and the history of phototherapy in the case of neonatal jaundice.

92 children younger than two years of age who were admitted in Besat hospital and Imam Khomeini clinic (Hamadan, Iran) were enrolled in this case-control study. The subjects were classified into the case (children with AD, n=43), and control (children without AD, n=49) groups. AD was diagnosed by an allergist according to the AD diagnostic criteria. The history of neonatal jaundice treatment with phototherapy as well as the medical records of all the recruited subjects was investigated. The data were collected by physician according to clinical manifestations and medical records. The association between phototherapy-treated jaundiced neonates and developing AD was examined.

92 children were recruited.The mean age of the participants in the case and control groups was 10.56 and 9.89 months, respectively. About 74% (n=14) of the phototherapy-treated neonatal jaundice patients developed AD in their early childhood. Logistic regression analysis was used to evaluate the effect of jaundice treatment with phototherapy on the AD development in the early childhood. The prevalence of AD was higher in the patients with positive history of jaundice treatment with phototherapy (p < 0.05, OR=4.24, 95% CI: 1.38-13.06).

Based on the results, atopic dermatitis in early childhood was significantly associated with neonatal jaundice treatment by phototherapy.

Congenital heart disease is one of the most common congenital anomalies in infants and is the leading cause of death from congenital diseases. The purpose of this study was to determine the prevalence and risk factors of congenital heart disease (CHD) and its outcome in infants admitted to NICU.

In this cross-sectional retrospective study, all infants who were admitted to the NICU of Besat Hospital from 2012 to 2017 with diagnosis congenital heart disease were studied. Demographic data of mothers and infants were collected. Data were analyzed using SPSS software version 16.

Of 2800 hospitalized infants, 97 (96.3%) infants suffered from congenital heart disease that 60 of them (61.9%) were males. The mean birth weight of infants was 2568.81±524.30 g and the mean gestational age of newborns was 36.66±2.62 weeks. 22 percent of the parents were relatives, in 20% of infants there was a family history of congenital heart disease and 50% of mothers had an underlying disease. The most common congenital heart diseases were ventricular septal defect (VSD) (37.1%), an atrial septal defect(ASD)(28.8%), and patent ductus atreiousus (PDA) (8.28%). 15 (15.5%) of the infant died.

Ventricular septal defect and atrial septal defect were the most common congenital heart disease in newborns which may be related to maternal use of antihypertensive drugs during pregnancy.

Many neonates admitted to Neonatal Intensive Care Unit (NICU) need mechanical ventilation for recovery. This study was designed to evaluate the short-term outcome of mechanically ventilated neonates admitted to NICU. In this descriptive cross-sectional study, all the neonates in need of mechanical ventilation in NICU of Besat Hospital, Hamadan, Iran, were enrolled for one year from September 2017 to September 2018. The selected data were of neonatal age at admission time, birth weight, gender, gestational age, indications of mechanical ventilation, lab results, length of hospital stay and the outcome of the disease were extracted from the medical file and analyzed using SPSS software (version 22.0). Of 141 mechanically ventilated neonates, 55.3% (n=78) were males. The mean of neonatal age, mean gestational age and mean birth weight were, 4.67 ± 6.58 days, 35.51 ± 3.88 weeks, and 2779.37 ± 827.06 g, respectively. RDS (58.9%) was the most common indication for mechanical ventilation. The overall rate of neonatal recovery was 51.8%. The results of unilabiate analysis showed a significant relationship between indications of mechanical ventilation, gestational age, neonatal birth weight, acidosis (pH <7.1), duration of mechanical ventilation, duration of hospitalization and the disease outcomes (P<0.05). The results of this study showed that respiratory distress syndrome, low gestational age and birth weight, acidosis and duration of mechanical ventilation would lead to increased death in mechanically ventilated neonates.

Retinopathy of prematurity (ROP) is an evolutionary disorder in the retina of premature infants. Nowadays, the prevalence rate of retinopathy has increased due to the advancement of medical facilities and the increased survival of preterm infants. The aim of this study was to determine the prevalence rate of ROP and its related risk factors among infants admitted to and examined at neonatal intensive care unit (NICU) affiliated to Fatemieh Hospital in Hamadan. This descriptive cross-sectional study was conducted on all premature infants selected with census sampling methods and with a gestational age of fewer than 34 weeks who were hospitalized in NICU for four weeks or more. The premature infants were investigated regarding the incidence of retinopathy and its risk factors. Out of 80 neonates under study, 24 (30%) cases suffered from ROP, of which 16 and 8 neonates were in stage I and II of ROP, respectively.  Moreover, the mean gestational age of newborns was 29.71±2.16 weeks, and more than 75% of ROP were observed in neonates under 29 weeks' gestational age. In addition, the results revealed that ROP correlated significantly with gestational age, low birth weight, 1st and 5th minute Apgar scores, the need to resuscitation, the use of inotropic drugs, and duration of oxygen therapy. However, there was a significant relationship between low birth weight and retinopathy based on the results obtained from logistic regression. The prevalence rate of ROP stands on average regarding the results obtained from Iranian and foreign published data. Among the independent variables that affect retinopathy, low birth weight was the only significant variable affecting the incidence of retinopathy.

  Congenital hypothyroidism (CH) is one of the most common causes of mental retardation in children. This study investigated the developmental status of children with CH screened by Ages & Stages Questionnaires (ASQ) measurement scores. In this retrospective study, neurodevelopmental status of 78 children diagnosed with CH who being followed up at the outpatient Pediatric Endocrinology Clinic of Besat Hospital, Hamadan, Iran, was evaluated by ASQ method. Data on age, sex, birth body weight, height and head circumference, residency location, parental education level, primary venous TSH and T4 level, diagnosis age, treatment start age and initial levothyroxine dosage were extracted from medical records .Data analyzed using statistical software SPSS v16. P-value less than 0.05 was considered statistically significant. Of the 78 patients (34=43.6% female), 32 patients (41%) had developmental disorder. 56 cases (71.8%) were living in urban areas. In terms of type of developmental impairment, global delay: 13 patients (40.6%), problem solving: 11 patients (34.3%), communication: 5 patients (15.6%), fine motor: 2 patients (6.2%) and personal-social: 1 patient (3.1%) were detected. The average of diagnosis and treatment age was 25.65 days in patients with developmental impairment and 17.99 days in those without delay. ASQ results had significant statistical correlation with initial dose of levothyroxine (p=0.017), hypothyroidism diagnosis age (p=0.002) and age of treatment initiation (p=0.018). Early diagnosis and treatment along with initial L-thyroxin dose were most important factor of ASQ scores of children with CH. Higher amounts of the LT4 is required at onset.

Neonatal respiratory distress syndrome (RDS) is a problem that often occurs in preterm neonates. The present study was conducted to compare the efficacy and complications of humidified high flow nasal cannula (HFNC) with those of nasal continuous positive airway pressure (NCPAP) after surfactant therapy in neonates with RDS. This clinical trial was conducted on 60 neonates with the gestational age of 28 - 36 weeks suffering from RDS and admitted to Fatemieh Hospital in Hamadan, Iran, during 2017. Initially, all newborns were administered with exogenous surfactant. Subsequently, the participants were randomly assigned into two groups of HFNC (group 1) and NCPAP (group 2) to receive respiratory support. The NCPAP group was managed with a mask or nasal prong. The HFNC group was given warm and humid oxygen through a short binasal cannula proportional to the weight of each neonate until the recovery of respiratory distress. The mean one-minute Apgar scores were obtained as 6.23 ± 1.55 and 6.60 ± 1.07 in the HFNC and NCPAP groups, respectively. Furthermore, the mean five-minute Apgar scores were 8.0 ± 1.11 and 8.17 ± 0.95 in these groups, respectively. The mothers and neonates in both groups were comparable in terms of demographic and clinical data, except for gestational age and neonatal gender (P = 0.05). Furthermore, there was no statistically significant difference between the HFNC and NCPAP groups regarding the respiratory outcomes (P = 0.05). As the findings indicated, humidified high flow nasal cannula was as effective as nasal continuous positive airway pressure in the management of respiratory distress in premature neonates with the gestational age of 28 - 36 weeks. Consequently, these two interventions could be used interchangeably for the provision of respiratory support among these patients.

Transient tachypnea of the newborn (TTN) is one of the important causes of neonatal respiratory distress and hospitalization in the neonatal intensive care unit (NICU). The current study aimed at identifying the risk factors of TTN in a single tertiary care center. The current prospective, case-control study was conducted on 180 newborns allocated in the 2 groups of with TTN (n = 90) as the case group, and without TTN (n = 90) as the control group for 1 year from April to March 2015 in a public hospital of Hamadan, Iran. Newborn and mother’s information was extracted from their medical records. Diagnosis of TTN was based on clinical and radiological findings, after ruling out other respiratory distress causes. Data were analyzed using logistic regression and P < 0.05 was considered the level of significance. The raw data analysis of regression factors associated with TTN showed that the risk of TTN was higher in late preterm infants (odds ratio (OR): 6.15; 95% confidence interval (CI): 3.17 - 11.92, P = 0.001) as well as male newborns (OR: 0.33, 95% CI: 0.17 - 0.62, P = 0.001), and those born by cesarean (OR: 11.22, 95% CI: 5.33 - 23.62, P = 0.001). Moreover, the risk of TTN increased with Apgar score in the first minute (OR: 0.02.95% CI: 0.00 - 0.05, P = 0.001) and decreased with the fifth minute (OR: 0.02; 95% CI: 0.00 - 0.06, P = 0.001). The results of multiple regression analysis showed that the odds of TTN of late preterm newborns was 2.96 times higher than that of term newborns (OR: 2.96, 95% CI: 1.09 - 8.04, P = 0.033). Furthermore, with increase in Apgar score in the first minute, the risk of TTN reduced (OR: 0.02; 95% CI: 0.01 - 0.07, P = 0.001). Prematurity and Apgar score in the first minute were the risk factors for TTN. Consequently, the risk of TTN can be reduced by the prevention of preterm birth and improvement of perinatal care.

Acceptable control of blood glucose is one of the most important goals of treatment management in diabetic children. An insulin therapy regimen with multiple daily injection or continuous subcutaneous insulin infusion has been admitted as a desirable therapeutic approach in children with diabetes mellitus type 1. This study was designed to evaluate the effect of intensive insulin therapy on HbA1c as an alternative for the conventional two-injection insulin therapy. This descriptive-cross sectional study was conducted on 100 children and adolescents with diabetes mellitus type 1 at Pediatric Endocrinology Outpatient Clinic of Besat Hospital, Hamadan, Iran in 2017. The present study was conducted on the patients that were previously treated with twice-daily NPH and regular insulin, and then with four injections of insulin Aspart per day before each meal and insulin Glargine at bedtime. Demographic data included: age of onset of diabetes, weight, height, body mass index, duration of diabetes, number of hypoglycemic events, number of episodes of diabetic ketoacidosis (a year before and after the change of insulin regimen), number of insulin injections, type of insulin, injection device, and mean of HbA1c (a year before and after the change of insulin regimen). The data were analyzed using SPSS software (version 16) and appropriate statistical tests. The mean age of the patients was 11.41 years. Out of 100 subjects, 60 cases (60%) were female and 75% were male. In addition, 75% and 25% of the cases were urban and rural, respectively. The average body mass index was 19.65. The average number of visits to the clinic and measurement of HbA1c were 3.33 times a year. The mean of HbA1c before and after four injections per day was 8.4 and 8.1, respectively. There was a statistically significant difference (P= 0.03). The mean reduction was significant (P= 0.001) in subjects that were referred to the clinic and performed HbA1c more than three times a year. The frequency of reported hypoglycemia was 1.4 each year and the difference was not statically significant .There were no differences in terms of hypoglycemia events before and after four injections per day. The findings of this study confirmed that multiple daily injection of insulin is associated with improved metabolic control of blood glucose. However, HbA1c levels were not in the range of good control.

Infant respiratory distress syndrome (IRDS) is one of the main causes of serious complications and death in preterm infants. Both Nasal Continuous Positive Airway Pressure (NCPAP) and Nasal Intermittent Positive Pressure Ventilation (NIPPV) are known as the most common treatment strategies for IRDS. The present study intended to compare NCPAP and NIPPV in the treatment of preterm infants with respiratory distress syndrome.
To this double blind clinical trial study during a one-year period (2016 to 2017) in Fatemieh Hospital in Hamadan city (Iran), about 60 preterm RDS infants were randomly assigned into two treatment groups; the NIPPV group received the PIP (14–20 cmH2O), RR: 30-50/min, PEEP (5–6 cmH2O), FiO2 up to 60%. The NCPAP group received PEEP (5-6 cmH2o), Flow: 6-7 L/min, and FiO2 up to 60%
There was not any significant difference in the mean values of gestational age (30.07±1.50 vs. 30.07±2.05; P>0.05), birth weight (1259±263 vs. 1235±285; P>0.05), and 1-minute Apgar score (5.53±1.13 vs. 5.33±1.34; P>0.05) between NIPPV and NCPAP treatment groups. Besides, the rate of recovery, mortality and disease complications was not significantly different between both groups. However, the duration of respiratory support was less in NIPPV than NCPAP (34.9±33.8 vs. 68.4±32 h; P=0.001).
According to the results, there was not significant advantage between the NIPPV vs. NCPAP methods in the treatment of RDS in preterm infants with very low birth weight.

Congenital anomaly is characterized by any anatomical defects present in a baby at birth that may cause major medical, surgical, or cosmetic consequences. the present study aimed to determine the prevalence of congenital anomalies and related factors among infants in Hamadan Fatemiyeh and Behesht hospitals in 2015.
this case series study included all subjects diagnosed with obvious abnormalities by a pediatrician who were admitted to Besat and Fatemiyeh hospitals of Hamadan. Gender, weight, birth week, type of anomaly, number of pregnancy and related parents were assessed as risk factors for congenital anomalies. Data collection was performed using checklists and statistical analysis was performed using SPSS, version 16.
a total of 246 neonates with congenital anomalies were assessed. Among participants 46.3% (n=114) were female and 53.7% (n=132) were male. According to the findings of this study, the majority of neonates (63.8%) weighted less than 2500 grams. Also, 30% of the subjects were first births and 44.4% were second births. The commonest abnormalities were cardiac (39.6%), gastrointestinal (22.2%) and the least common was musculoskeletal anomalies (3.5%)
the obvious congenital abnormalities during infancy include heart defects, renal anomalies, gastrointestinal, and genital abnormalities. In the second pregnancy, male infants are at greater risk for most types of congenital abnormalities than female infants.