فهرست مطالب seyyed abolfazl afjeh

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.

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.

The current study aimed to investigate the effect of enteral Granulocyte-Colony Stimulating G-CSF(Factor) on feeding tolerance in very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. This historical-controlled clinical trial was conducted on VLBW and ELBW neonates admitted to MahdiehHospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, between July 2016 and March 2017.In the intervention group, 81 neonates with birth weights of 710-1480 were given enteral 5 μg/kg/day of G-CSF (whichhas been approved by the US FDA) for 7 consecutive days. On the other hand, the control group included 191 neonateswho did not receive G-CSF with birth weights of 600-1490 admitted during 24 months prior to the study. The twogroups were compared in terms of adverse effects of treatment, primary and secondary outcomes. The mean of gestational age and birth weight in the G-CSF group were reported as 29.96±2.47 weeks and1204.81±201.68 grams, and these values in the control group were measured at 29.77±2.13 weeks and1189.47±207.89 grams, respectively. Neonates who received G-CSF demonstrated better feeding tolerance, asreflected by the earlier achievement of 50, 75, 100, full enteral feeding of 150, and maximal enteral feeding of 180mL/kg/day (p < 0.05), with earlier weight gain and a shorter hospital stay. The rate of necrotizing enteroc olitis(NEC) in the G-CSF group was measured at 3.7% that was significantly lower, as compared to the control group(P=0.005). Approximately 8.9% of the neonates in the control group expired which was higher than the G-CSFgroup (P=0.06). All neonates tolerated the treatment and there was no statistically significant difference betweenthe two groups. As evidenced by the obtained results, the enteral administration of G-CSF to VLBW and ELBW neonatesimproved feeding tolerance and it was well tolerated without any associated side effects.

Non-invasive ventilation (NIV) has brought about a significant change in care and treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. The present study was designed and conducted to evaluate different strategies of initial respiratory support (IRS) in VLBW neonates hospitalized in the neonatal intensive care unit (NICU).
This prospective study was conducted over three years (March 21, 2011 to March 20, 2014). Each eligible VLBW baby with RDS diagnosis received a specific IRS, including room air (RA), oxygen therapy (O2 RX), n.CPAP, NIPPV, MV ± SURF, based on clinical evaluation; then, the next strategies were selected based on the disease progression. Obtained data was entered in SPSS and the groups were compared for disease consequences or death. Then, contributing factors to the failure of NIV strategies, and the need for endotracheal mechanical ventilation (eMV) were determined.
In total, 499 neonates were included in the study. The mean birth weight was 1,125 ± 254 g and the gestational age was 29.2 ± 2.5 weeks. The IRS included: RA = 43, O2.RX = 60, n.CPAP/NIPPV = 219, INSURE = 83 and MV ± SURF = 177. In terms of the need for IRS upgrading during hospitalization, neonates not on mechanical ventilation (64.5%) were divided into three groups. In 45.3% of cases, the IRS did not change (Never upgrading); in 24.5% of cases, the level of IRS increased but there was no need for eMV in the first three days of life (Specific); in 24.8% of cases, there was need for eMV within the first three days of life (Absolute) and during hospitalization (after the first three days of life) 5.3% of cases were in need of eMV (General).
In terms of correlation between the effective variables in IRS upgrading, univariable analyses showed that low gestational age, low birth weight, multiple pregnancy, maternal disease, low one-minute Apgar score, and need for surfactant therapy had significant correlation, and multivariable analysis showed that low gestational age, low birth weight and maternal disease were risk factors independently correlated to IRS upgrading, CLD and death.
Early use of NIV in preterm neonates with mild to moderate respiratory distress and spontaneous breathing significantly reduced the need for intubation, surfactant, mechanical ventilation and thereby pulmonary and non-pulmonary complications and neonatal mortality.

Methylene blue was first described for the treatment of methemoglobinemia but practical usage of the compound for surgical purpose is common. The aim of this report is to describe a case of hemolysis in neonatal period as a potential hazard of methylene blue toxicity without presence of G6PD deficiency.
In October 2015, a 36-week GA female infant with 2.05 kg weight was delivered by cesarean section with APGAR score of 9/9 from a healthy mother, with common type esophageal atresia. She underwent surgical repair with drainage tube placement on second day of life in our subspecialty referral center, Tehran, Iran. Her blood group type was A and her mother was AB with no family history of hematologic disease. On fifth day postoperative, 2 mL of methylene blue solution that was prepared by dissolving its powder in the hospital laboratory were fed per oral for confirmation of the integrity of esophagus after repair. 8 days after methylene blue ingestion, we met suddenly the occurrence of severe anemia and hyperbilirubinemia with Hb: 6 gr/dL (post-operative Hb: 15 gr/dL) , retic count: 4.8%, total bill/direct: 20/ 0.3, indirect coombs negative ,G6PD: sufficient, ALT: 30 U/L, and AST: 66U/L. At follow-up 2 months after the initial operation, barium meal showed moderate stricture at the site of anastomosis.
We considered two main reasons for hemolysis in our patient. The first explanation is that our patient received 20 mg/kg MB as solution which was nearly 5 - 10 times more concentrated than the recommended dose. The second is that the absorption of MB from mediastinal/plural space could be more than expected. Our justification for this event is the anastomosis site stricture at follow-up that was suggestive of Methylene blue leak to mediastinal/plural space on first day after repair. Therefore, paying attention to the preparation of methylene blue solution from its powder is essential. Determination of G6PD status as a risk factor for development of methylene blue toxicity is recommended. However, G6PD with two rechecks was sufficient for our patient.

Prolonged empiric antibiotics therapy in neonates results in several adverse consequences including widespread antibiotic resistance, late onset sepsis (LOS), necrotizing enterocolitis (NEC), prolonged hospital course (HC) and increase in mortality rates.
To assess the risk factors and the outcome of prolonged empiric antibiotic therapy in very low birth weight (VLBW) newborns.
Prospective study in VLBW neonates admitted to NICU and survived > 2 W, from July 2011 - June 2012. All relevant perinatal and postnatal data including duration of antibiotics therapy (Group I 2W) and outcome up to the time of discharge or death were documented and compared.
Out of 145 newborns included in the study, 62 were in group I, and 83 in Group II. Average duration of antibiotic therapy was 14 days (range 3 - 62 days); duration in Group I and Group II was 10 ± 2.3 vs 25.5 ± 10.5 days. Hospital stay was 22.3 ± 11.5 vs 44.3 ± 14.7 days, respectively. Multiple regression analysis revealed following risk factors as significant for prolonged empiric antibiotic therapy: VLBW especially stage II, 12 (8.3%) newborns died. Infant mortality alone and with LOS/NEC was higher in group II as compared to group I (P Prolonged empiric antibiotic therapy caused increasing rates of LOS, NEC, HC and infant mortality.

Neonatal hyperglycemia, which is relatively common in very low birth weight (VLBW) infants, is associated with increased risk of morbidity and mortality. To study the incidence of neonatal hyperglycemia, associated risk factors and the outcome of it in VLBW infants hospitalized in a level III NICU in Tehran. All VLBW newborns admitted to the NICU of Mahdieh Hospital from April 2009 to March 2011 were considered eligible for this retrospective study. All relevant prenatal and perinatal data, as well as details of the hospital stay until discharge or death, were extracted from the case notes and analyzed. Hyperglycemia (blood suger above 150mg/dL) was observed in 179 (31.7%) of the 564 VLBW infants included in the study; 48 infants (26.8%), had received insulin. Risk factors included: low gestational age, (OR = 4.07, 95% CI = 2.09–7.93, P < 0.001), extremely low birth weight (ELBW), (OR = 5.97, 95% CI = 3.77–9.44, P < 0.001), dopamine administration (OR = 2.19, 95% CI = 1.32–3.65, P = 0.003), intralipid (OR = 1.52, 95% CI = 1.04–2.22, P = 0.03), Low APGAR score at 5 minutes (OR = 4.44, 95% CI = 2.48–7.94, P < 0.001), RDS and its complications (OR = 4.20, 95% CI = 2.55–6.93, P < 0.001), were independently associated with hyperglycemia. Other findings with hyperglycemia were: high incidence of IVH >grade II (OR = 2.88, 95% CI = 1.28–6.49, P = 0.01), hospital stay more than 28 days in survivors,(OR = 3.56, 95% CI = 2.02–6.25, P < 0.001), mortality (OR = 4.42, 95% CI = 3.00–6.52, P < 0.001) and more retinopathy of prematurity (ROP ≥ stage II) in survivors (OR = 2.05, 95% CI = 1.11–3.78, P = 0.02). Neonatal hyperglycemia developed in approximately one-third of our VLBW neonates. Relative prevalence and associated findings underscore the need for preventive measures and prompt management.

Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal morbidity and mortality. We try to identify risk factors in mother and fetus that result in birth of newborns needing resuscitation at birth. Case notes of all deliveries and neonates born from April 2010 to March 2011 in Mahdieh Medical Center (Tehran, Iran), a Level III Neonatal Intensive Care Unit, were reviewed; relevant maternal, fetal and perinatal data was extracted and analyzed. During the study period, 4692 neonates were delivered; 4522 (97.7%) did not require respiratory assistance. One-hundred seven (2.3%) newborns needed resuscitation with bag and mask ventilation in the delivery unit, of whom 77 (1.6%) babies responded to bag and mask ventilation while 30 (0.65%) neonates needed endotracheal intubation and 15 (0.3%) were given chest compressions. Epinephrine/volume expander was administered to 10 (0.2%) newborns. In 17 patients resuscitation was continued for >10 mins. There was a positive correlation between the need for resuscitation and following risk factors: low birth weight, preterm labor, chorioamnionitis, pre-eclampsia, prolonged rupture of membranes, abruptio placentae, prolonged labor, meconium staining of amniotic fluid, multiple pregnancy and fetal distress. On multiple regression; low birth weight, meconium stained liquor and chorioamnionitis revealed as independent risk factors that made endotracheal intubation necessary. Accurate identification of risk factors and anticipation at the birth of a high-risk neonate would result in adequate preparation and prompt resuscitation of neonates who need some level of intervention and thus, reducing neonatal morbidity and mortality.

This study was planned to determine the rate, the predisposing factors, and the outcome of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants hospitalized in the neonatal intensive care unit (NICU) of a tertiary care hospital in Tehran. All VLBW neonates admitted to the NICU, from April 2007 through March 2010 were enrolled. All relevant perinatal data, including the hospital course up to the time of discharge were documented. Repeated ophthalmologic examinations were done by a single ophthalmologist to observe the progression and subsequent resolution of ROP. Out of 414 infants undergoing ophthalmologic examination, ROP was detected in 71 infants (17.14 %); 3.4 % stage I, 8.7 % stage II, and 5.1 % stage III. ROP stages IV or V were not detected. After adjustment for different variables, the following independent risk factors were identified: VLBW (P = 0.002, OR = 4.89), multiple gestation (P = 0.001, R = 3.51), resuscitation at birth (P = 0.003, OR = 3), blood transfusion more than 45 mL/kg (P = 0.02, OR = 4.91), oxygen therapy for more than five days (P = 0.009, OR = 3.11), and age more than 10 days to regain birth weight (P = 0.008, OR = 1.06).Thirty-three patients with stages II and III ROP were treated with laser therapy, all of them improved and none progressed to blindness. Our findings identify the major risk factors for ROP; skillful management of high-risk pregnancies, prevention of preterm births, appropriate neonatal care, high index of suspicion, routine screening, and prompt treatment are crucial to prevent the development and progression of ROP.

Probiotics are thought to interfere with the mechanisms involving in the pathogenesis of necrotizing enterocolitis in neonates.. This study was planned to assess the effect of prophylactic probiotics for the prevention of necrotizing enterocolitis in low birth weight neonates..Patients and This prospective triple-blinded, interventional, randomized clinical trial enrolled 136 low birth weight newborn infants with a minimum birth weight of 700 g, from September 2010 to September 2011. The study and control groups were compared regarding; 1- occurrence of NEC, 2- time to reach full feeding, defined as days required to reach full enteral feeding, 3- duration of hospital course, and 4-incidence of sepsis and death. The study group was fed with milk and Protexin (restore) and the control group was fed with milk and a placebo that was physically indistinguishable from the probiotic powder. SPSS version 16 was used, and P-value less than 0.05 was considered significant.. One hundred thirty six neonates were enrolled in the study. Seventy six (54.4%) were male. The mean of gestational age and birth weight were 31 weeks and 1407 grams, respectively. The mean age to start feeding was 4.36 days. There was not any significant difference in the NEC cases between the two groups.. This study did not show any benefit from prophylactic probiotics in the prevention of necrotizing enterocolitis in low birth weight neonates which could be probably due to low dose probiotics used..

Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal asphyxia. The aim of this study was to identify risk factors that result in the resuscitation of newborns at birth in Mahdieh Hospital. This cross sectional study was done during one year and risk factors for neonatal resuscitation, level of resuscitation and short outcomes (survival or death), wre extracted from charts and were analyzed. During the study period, 4692 neonates were delivered; 97.7% did not require respiratory assistance. 2.3% needed resuscitation with bag and mask in the delivery unit; of these, 1.6% responded to bag and mask ventilation while 0.65% needed endotracheal intubation and 0.3% were given chest compressions. Epinephrine/volume expander was administered to 0.2%. In multiple regression analysis, low birth weight, meconium stained liquor and chorioamnionitis were revealed as independent risk factors for advance resuscitation. Neonatal mortality was 10 in 1000 live birth; asphyxia with 23.4% was one of major causes of neonatal mortality. Incidence of asphyxia was 0.3%, 24.7% and 50% in neonates without resuscitation, basic resuscitation and advance resuscitation, respectively. It seems that low birth weight, meconium stain amniotic fluid and chorioamnionitis are major risk factors for neonatal resuscitation in delivery room.

Nosocomial infections increase mortality rate in neonates. Studies have attributed the use of H2 blockers as one of the various factors that increase the risk of nosocomial infections.. To define the relationship between nosocomial infection and Ranitidine in very low birth weight (VLBW) infants admitted in the NICU of a tertiary care hospital..Patients and All VLBW infants admitted during the study period of 3 years from April 2008 to March 2011 were included. All relevant pre-and peri-natal data including all administered medications was collected from the case notes and documented on a pre-designed questionnaire. Rate of nosocomial infection (NI) had been compared between patients who were administered Ranitidine and those who did not receive this medication.. During the study period, 564 VLBW infants were admitted in the NICU; 157, (27.8%) contracted nosocomial infections, 130 (82.8%) developed pneumonia, 21, (13.4%) had sepsis with positive blood cultures and 6 infants (1.1%) developed necrotizing enterocolitis. Factors remaining independently significant for development of NI after adjustment were as follows: RDS (P = 0.001. OR = 3.29; 95%CI = 1.64–6.6); CLD (P < 0.001. OR = 3.83; 95%CI = 2.06–7.11); anemia (P = 0.005. OR = 1.96; 95% CI = 1.23-3.13); use of Ibuprofen (P = 0.03. OR = 1.99; 95%CI = 1.06-3.74), and treatment with Ranitidine (P = 0.009, OR = 1.92, 95%CI = 1.18-3.12).. Use of Ranitidine was associated with a significantly increased risk of nosocomial infections in VLBW infant..

This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in newborns hospitalized in a Neonatal Intensive Care Unit (NICU) in Tehran, Iran. A prospective cohort study was carried out in the NICU of Mahdieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. There were 81 neonates enrolled. VAP occurred in 14 (17.3%), at a rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E. coli (21.4%), Klebsiella (21.4%), and Pseudomonas (14.1%). The only VAP predictor was sputum [odds ratio (OR) = 5.11, P = 0.02]. Mortality rate for VAP was 2/14 (14.3%). Duration of mechanical ventilation [hazard ratio (HR) = 0.96, P = 0.01], birth weight (HR = 0.81, P < 0.001), and purulent tracheal aspirate (HR = 0.25, P < 0.006) were independent predictors of overall survival. VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols.