seyed abolfazl afjehi

Monitoring regional cerebral oxygen saturation (rScO2)andhemodynamic stability (eg,meanarterial blood pressure [MABP]) in high-risk premature infants is crucial to enhance daily clinical practices in neonatal intensive care units (NICUs).

This study aimed to investigate potential differences between oxygen saturation measurements obtained via near-infrared spectroscopy (NIRS) and pulse oximetry (PO).

This pilot study enrolled20verylow-birth-weight (VLBW) prematureneonates through a non-random, available sampling approach. We gathered maternal and fetal demographic data along with clinical characteristics of the neonates. The study focused on assessing tissue and cerebral oxygenation using PO and NIRS. We specifically monitored changes in mean rScO2 and MABP at various time points: before, during, and 5 and 10 min after the administration of surfactant injection (SI) via the endotracheal tube.

The mean gestational age, neonatal birth weight, and Apgar scores at 1 and 5 min after birth were 28.44 ± 2.57 weeks, 1063 ± 246 g, 6.05 ± 2.57, and 7.94 ± 1.79, respectively. No significant differences were observed between mean rScO2 values measured by NIRS and PO before (P = 0.631), during (P = 0.722), and 5 min after (P = 0.783) SI. However, a significant difference between PO and NIRS-based rScO2 values was found 10 min after SI (96.95% vs 75.0%; P = 0.04). Additionally, there was no significant correlation between mean rScO2 and MABP recorded before, during, and after SI.

There were no differences in oxygen saturation measurements (recorded by PO) and rScO2 values (recorded by NIRS) before, during, and immediately after SI. Therefore, using PO in NICUs to assess cerebral oxygenation, autoregulation, and hypoxia appears both reasonable and cost-effective. Further multicenter studies are needed to validate the practical advantages and cost-effectiveness of NIRS as an emerging monitoring system.

Congenital cytomegalovirus (cCMV) is the most common intrauterine viral infection, affecting up to 2.5% of live births worldwide; it is also the most common non-hereditary cause of sensorineural hearing loss (SNHL) in infants.

This study aimed to evaluate the frequency of cCMV and the incidence of sensorineural hearing loss at a large referral hospital in Tehran.

In our cross-sectional study, all infants born between March 2019 and April 2020 (one year) at Mahdiyeh Obstetrics and Gynecology Hospital were enrolled in the present study, and their urine samples were collected forCMVPCR in the first 2 days of life. PCR test results divided these infants into two groups, with and without congenital cytomegalovirus infection. For both groups, the otoacoustic emission screening test (OAE) was performed at birth and one month of age; the auditory brain response test (ABR) was then performed for infants with hearing impairment.

Urine samples of 859 were collected for cytomegalovirus PCR testing; 70.3% of specimens were from male infants. Neonatal urine samples were tested for the presence of cytomegalovirus by PCR; 847 of the specimens (98.6%) were negative, and 12 (1.4%) were positive for cytomegalovirus, CI: (95%). The prevalence of congenital cytomegalovirus infection was 1.18% in girls and 1.49% in boys, revealing no significant difference between the two groups. All infants with congenital cytomegalovirus infection were full-term, between 38 and 42 weeks of gestational age. The first OAE test was impaired in 4 cases (33%) with congenital cytomegalovirus infection.

In our study, congenital CMV infection prevalence was 1.4%. We recommend hearing screening tests (OAE and AABR) be performed for all neonates. If impaired, the infant should also be evaluated for cCMV infection in addition to auditory follow-up. It is recommended that this study be continued in a multicenter manner with a larger number of samples and a longer period to fully evaluate the prevalence of complications in cCMV.

 Neonates of infertile couples are golden babies, and taking care of them is of paramount importance. However, it is not yet clear if the prognosis is different between these neonates and those from fertile couples.

 The present study aimed to assess neonates conceived by assisted reproductive technology (ART).

 In this cohort study, 165 newborns conceived by ART and 165 naturally conceived newborns were included. The prospective study was conducted from April 2020 to October 2021. A neonatologist examined all newborns after birth, and outcomes were followed up over one year and compared with neonates of fertile couples using appropriate statistical tests.

 The preterm neonates (60% vs. 38%) were higher in ART cases (P < 0.001) than in the other cases. Also, the mean gravid and parity were lower, but the nulliparity was higher in the ART group (P < 0.001) than in the other cases. Moreover, multiple pregnancies (45% vs. 10%; P < 0. 001) and the C/S rate (91% vs. 67%) were higher in ART cases (P < 0.001) than in the other cases. Similarly, the preeclampsia rate (16 % vs. 6%; P = 0.004) and the number of females were higher in the ART group (P = 0.035) than in the other groups. However, birth weight (P = 0.002) and the Apgar were significantly lower (P = 0.002; P = 0.012) in the ART group than in the other groups. IUGR was significantly higher (17% vs. 7%) (P = 0.006), while NEC and RDS were more common in the ART group (P < 0.001) than in the other groups. In addition, more extended hospital stay (P < 0.001) and more common re-admission and weight < the 5th percentile after one year were observed in the ART group (P = 0.021) than in the other groups.

 According to the findings, pregnancy after ART has more side effects before and after birth and in infancy, not only because of multistation but also due to manipulations in ART.

Approximately 4–7 percent of all live births are led to a very low birth weight (VLBW) situation where the morbidity and mortality rate are very high. A large number of VLBW newborns in the intensive care unit (ICU) require mechanical ventilation due to various conditions. To reduce mortality in this group, identification of risk factors is important. This study aimed to determine the prognosis of mechanical ventilation in VLBW neonates at Mahdiye hospital in Tehran, Iran.

This study is a prospective cohort study. VLBW neonates who consecutively were put on mechanical ventilation during the study period were en-rolled. Then, the enrolled neonates were divided into two groups: neonates who died after implementing the ventilator were in group-I and neonates who survived after re-ceiving mechanical ventilation were in group-II. Demographic, clinical, and paraclinical variables were gathered to find out the predictors of mortality of ventilated neonates. The data were analyzed by SPSS software version 21.

During the study period, a total of 177 neonates were ventilated due to differ-ent causes. 56% were male with a male to female ratio of 1.27:1. Mean birth weight and gestational ages were 1024.8 ± 247.5 grams and 27.9±2.2 weeks respectively. Out of 177 mechanically ventilated VLBW neonates enrolled for this study, 53% died. Significant factors determining mortality rate were mean weight, mean gestational age, pulmonary hemorrhage, advance resuscitation, and duration of hospital stay (p<0.05). APGAR score, gender, Pneumothorax, IVH>II, Sepsis, and Maternal Disease were not significantly associated with mortality in VLBW neonates requiring mechanical ventila-tion (P>0.05).

This study showed that among the analyzed factors weight <1000gm, ges-tation <28weeks, pulmonary hemorrhage, and complications during ventilation were the most significant predictors of mortality in ventilated VLBW neonates in the intensive care unit.