Iranian Journal of Neonatology
Volume:12 Issue: 3, Summer 2021

Aloe vera is more effective than routine treatment in relieving the symptoms of phlebitis. However, fewstudies, to the best of our knowledge, have been conducted in Indonesia to explore the effectiveness of Aloe vera onphlebitis among hospitalized children from a wide age range. The present study aimed at evaluating the effectivenessof Aloe vera in reducing the degree of phlebitis among hospitalized children in Indonesia. This study was quasi-experimental with a pretest-posttest design and a control group. The sample of thisstudy was 42 children (21 respondents in both groups) with phlebitis who were admitted to a public health center inWest Java, Indonesia from May to July 2019. The intervention and control groups were provided with an Aloe veraextract compress (5 ml) and compress of 70% Alcohol, respectively. Visual Infusion Phlebitis (VIP) scale was used as amonitoring tool in the present study. The Mann-Whitney test was used to evaluate the difference in the degree ofphlebitis between the intervention and control groups. Wilcoxon test was also used to evaluate the differences beforeand after the intervention. The majority of respondents were in the neonatal period (45.23%) with normal nutrition status (54.76%).The average duration of hospitalization was seven days, and intravenous therapy solution non-electrolyte andantibiotics were received. The mean post-test scores decreased in both groups. There was a statistically significantdifference between the phlebitis score both in the Aloe Vera and 70% baseline-specific experimental classes, during 8,16, 32, 40, 48 hrs after treatment (p < 0.05). The average VIP score in the Aloe vera group is higher than that of 70%alcohol. It indicates that the VIP score in the Aloe vera group is further reduced. This study found that Aloe vera could significantly reduce the degree of phlebitis compared to 70%alcohol. The findings of this study could be an alternative recommendation in managing phlebitis among hospitalizedchildren.

Neonatal jaundice may lead to a severe level if it is not well monitored. The long-term consequences of severe neonatal jaundice may result in devastating neurologic sequelae, including bilirubin encephalopathy and kernicterus. Exchange transfusion has remained the most effective modality for lowering serum bilirubin concentration. The present study aimed to determine the proportion and factors associated with exchange transfusion procedure among neonates with severe jaundice in Kelantan from 2015 to 2017.
This cross-sectional study was carried out among neonates with severe jaundice in Kelantan between 2015 and 2017 using jaundice surveillance data from Kelantan Health State Department.
Out of the study subjects, 45 (19.7%) neonates had severe jaundice requiring an exchange transfusion procedure. From 2015 to 2017, the prevalence of severe neonatal jaundice requiring exchange transfusion raised from 17.0%-23.7%. The significant factors associated with exchange transfusion were neonatal infection, low birth weight, ABO blood group incompatibility, and maternal blood type O.
As evidenced by the obtained results, exchange transfusion among severe neonatal jaundice in Kelantan followed an increasing trend within the study period. Associated factors leading to exchange transfusion among severe neonatal jaundice were neonatal infection, low birth weight, ABO incompatibility, and maternal blood type O. The recognition of these factors would be of great help in developing effective strategies aimed at the prevention of exchange transfusion procedure and its subsequent complications.

Congenital duodenal atresia (CDA) is a common and surgically treated digestive tract anomaly that develops in the early stage of pregnancy. It often coexists with trisomy 21 and other inborn defects. Surgery is the only way of treatment. This study aimed to investigate the relationship of CDA with early diagnosis, course of pregnancy, coexisting congenital defects, and further development of children.
The data were collected using the medical history and a self-designed survey which consisted of 22 questions about the perinatal interview, coexisting inborn defects, after birth symptoms, time and methods of diagnosis, as well as the treatment outcome.
The surveys were sent to 31 patients who were diagnosed and treated because of CDA in our clinic between 2004 and 2019. According to the collected data, 73.7% of the patients were diagnosed prenatally with the mean time of diagnosis at 28th weeks of gestation. Moreover, 37% of the patients were preborn, and almost half of the patients had low and very low body weight. More than 2/3 of children presented coexisting inborn abnormalities. Among after birth symptoms, the most common ones were abdominal distention and lack of meconium. The majority of children were operated within 24 hours after birth.
Prenatal diagnosis of CDA results in an earlier time of primary operation. Newborns diagnosed antenatally present fewer symptoms after the operation, fewer reoperations, and a shorter time of oral feeding toleration. The coexistence of other congenital defects increases patients’ mortality. The important factors that deteriorate the postoperative course are prematurity and low body weight. In order to avoid long-term complications, it is of utmost importance to provide follow-up.

Periconceptional folic acid supplementation is an effective way to prevent neural tube defects (NTDs) and other congenital anomalies. It is shown that 9.7% of healthcare providers practiced periconceptional folic acid supplements in Ethiopia. Fewer than 50% of women receive information on folic acid before or only during pregnancy. This study was conducted to assess folic acid supplementation counseling practices among health care providers.
This institution-based cross-sectional study was conducted on 421 healthcare providers in selected public hospitals, Addis Ababa, Ethiopia. The hospitals were selected using a lottery sampling method, and a systematic random method was used to enroll participants. A structured self-administered instrument was used to gather information from participants. Data were checked for completeness and entered into Epi-Data software (version 3.1) and exported to SPSS software (version 25) for analysis. Descriptive statistics were used to describe participants' characteristics, and logistic regression, such as bivariate and multivariable analysis, were tested for associations. The level of significance was determined at a p-value of <0.05 and a 95% CI.
In this study,periconceptional folic acid supplementation counseling practice wasfound in 51% of participants. Profession,salary, work load, patient flow, and assisted birth of a neonate with NTD were the factors associated with counseling practice (adjusted odds ratio [AOR]=3.215, 95% CI:1.085-9.523,  AOR=0.213, 95% CI:0.95-0.487, AOR= 0.427 95% CI:0.213-0.859, AOR=0.223, 95% CI: 0.1-0.498, and AOR=15.107 95% CI:8.157-27.979, respectively).
Health care providers demonstrated a good level of knowledge and counseling practice about the folic acid supplement in this study. Medical doctor, salary, workload, patient flow, assisted birth of a neonate with NTD were found predictors for counseling practice.

Infantile colic (IC) (a frequent reason for infantile referral to pediatricians) is a common indiscoverable problem posing concerns for parents. Varieties of theories for the etiology of IC have been raised, and different therapeutic approaches have been recommended in this regard. This study aimed to assess and compare the efficiency of dimethicone versus symbiotic in the treatment of IC.
This randomized clinical trial was conducted on 149 infants with the diagnosis of IC based on the Wessel criteria from 2017 to 2018. The study population was randomly divided into two groups of Dimethicone (n=73) (five drops of dimethicone, three times a day for three weeks) and Symbiotic (n=76) (five daily drops of symbiotic for three weeks). Utilized symbiotic contained fructooligosacharide periodic and probiotic of 109CFU of Bifidobacterium lactis. Duration of an infant crying per day, numbers of crying per day, sleep duration per day, and number of defecation per day were obtained prior to the study and at the end of each week.
There was no statistically significant difference between the groups regarding age, gender, and values of breastfeeding (P>0.05). Crying duration, numbers of crying, and sleep duration per day improved significantly in the dimethicone group (P<0.05) within the time as the symbiotic-treated group (P<0.05); however, the comparison of the two groups for IC treatment revealed no statistical differences (P>0.05).
The findings of the current study presented that dimethicone and symbiotic could successfully improve IC symptoms regarding crying times, as well as the duration and sleeping time per day. Comparison of these two remedies for IC treatment revealed no significant differences.

This study aimed to evaluate the competence of the score for neonatal acute physiology (SNAP-II) as a tool to anticipate morbidity and mortality of neonates with early or late sepsis in neonatal intensive care units (NICUs).
This prospective cohort study was conducted on all neonates of > 32 weeks with sepsis in tertiary NICUs at Cairo University Children Hospital and El Galaa Hospital For Armed Forces Officers Families, Cairo, Egypt, within May-October 2019. The eligible samples consisted of 100 neonates with septicemia who met inclusion and exclusion criteria and were enrolled. the score for neonatal acute physiology-II was calculated within 24 h of sepsis onset and followed up for 2 weeks for mortality and organ dysfunction (OD). The collected data were analyzed in SPSS software (version 25).
It was revealed thatSNAP-II was significantly higher in neonates who passed away, compared to the survived neonates (46±17 vs. 12±10, respectively; P<0.001). Moreover, SNAP-II was significantly higher in neonates who developed OD within 14 days of sepsis onset, compared to those without OD (37±17 vs. 9±7, respectively; P<0.001). The score for neonatal acute physiology-II at 14.5 was considered the best cut-off point in predicting OD with a sensitivity of 100%, positive predictive value of 70.4%, specificity of 81.2%, and negative predictive value of 100%. In addition, SNAP-II at 23.5 was considered the best cut-off point in predicting overall mortality with 100% sensitivity, 58.6% PPV, 85.5% specificity, and 100% NPV.
Higher SNAP-II within 24 h of the early- or late-onset neonatal sepsis was a reliable predictor of OD and death.

Hyperammonaemia is a serious cause of mortality and morbidity duringin the neonatal period, regardless of the aetiology. Quickly differentiatingon between inherited metabolic diseases (IMDs) and other causes is important in terms of for treatment and prognosis. We This study aimed to determine the diagnostic and prognostic differences between IMD- and non-IMD-related causes with based on a literature review.
Clinical and laboratory data of newborns treated for hyperammonaemia between 2016 and 2019 were evaluated retrospectively.
Hyperammonaemia was detected in 60 out of 1963 (3%) patients, and 25% of these patients were diagnosed with IMD. The most common non-IMD etiologies were sepsis (31.6%) and prematurity (31.6%). Significant differences were detected between the two groups inregarding gestational age (P=0.001) and birth weight (P=0.005)were detected (p=0.001 and p=0.005, respectively). Moreover, another significant difference was observed between the two groups in terms of glutamine (P=0.004), alanine (P=0.004), and citrulline (P=0.001) levels and as well as the proportions of glutamine to arginine (G/A)P=0.001), citrulline (G/CP=0.0001), ornithine (G/OP=0.003), and alanine (G/A) (P=0.003).
Metabolic screening tests should be performed to rapidly diagnose hyperammonaemia. In addition to the diagnosing diagnosis of IMDs, it can promptly differentiate non-metabolic causes.

No studies, to the best of our knowledge, have been conducted on the effect of Clofibrate in reducing hyperbilirubinemia in preterm infants. Therefore, this study aimed at investigating the therapeutic effect of Clofibrate in treating hyperbilirubinemia of preterm neonates.
This clinical trial was performed from April 4 to December 20, 2019, on neonates in Hamadan in western Iran. The allocation remained concealed to the researcher, neonates’ parents, and analyzer during the study. A dose of Clofibrate of 25 kg/mg was given on the first day of hospitalization. The neonates in the placebo group received the oral placebo 25 kg/mg in the same way as the oral Clofibrate. The data were analyzed using SPSS 16 with P-value < 0.05.
No statistically significant difference was observed in the baseline characteristics of the two groups based on the neonate’s age and gender, delivery method, and gestational age. The prescription of Clofibrate significantly reduced the duration of hospitalization (p= 0.002) and phototherapy (p= 0.001). Prescribing a single oral dose of Clofibrate (25 mg/Kg) along with phototherapy in preterm neonates significantly reduced total serum bilirubin levels at 24 and 48 hours after treatment compared with phototherapy alone (p= 0.001). However, this association was not significant in admission (p= 0.095).
The findings of this study showed the effect of Clofibrate in treating hyperbilirubinemia of preterm neonates. In addition, prescribing Clofibrate significantly reduced the duration of hospitalization and phototherapy.

Mother-to-child transmission of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has become a matter of great concern in post-partum wards and neonatal units. With little prior experience of this novel infection, there are contradictory findings in the literature regarding breastfeeding androoming-in for newborns of mothers with COVID-19 disease. To assess the transmission risk of SARS-CoV- 2 in neonates who were fed expressed breast milk of COVID-19 positive mothers.
This prospective study included 16 neonates born to COVID-19 positive mothers. The neonates were nursed in a neonatal unit separate from their mother. Expressed breast milk was fed by health care givers ensuring proper safety measures. Nasal and throat swabs of neonates were tested twice for SARS CoV-2, firstly, at 48 h of life and secondly, before discharge.
Pneumonia was present in 3 (20%) mothers, and C- reactive protein was raised in 9 (60 %) mothers. Birth weight was low in 8 (50%) neonates. Respiratory distress syndrome and meconium aspiration syndrome were present in two and one newborns, respectively. Nasal and throat swabs of all 16 newborns tested negative for SARS-CoV- 2 infection twice, at 48 h of life and before discharge.
Expressed breast milk feeding can be considered safe in neonates born to COVID-19 positive mothers. Even sick mothers with COVID-19 can continue to express breast milk after ensuring proper safety measures.

Recent surge in the diagnoses of congenital hypothyroidism (CH) has necessitated the measurement of newborn TSH levels and understanding of the way various antenatal and perinatal factors influence its dynamicity. It is a cross-sectional study on newborns delivered or admitted to the All India Institute of Medical Sciences Raipur (AIIMS Raipur), Chhattisgarh, India. Dried blood spot analysis of newborn thyroid-stimulating hormone (nTSH) was carried out on 1,216 newborns after ethical clearance. The TSH levels were presented in percentage to determine the distribution in the study population. The mean values were compared within the groups categorized under each variable. The newborns' variables in this study included birth weight, Ponderal index, and neonatal complications. The studied maternal variables included antenatal visits, maternal age, gestational age, anemia, and mode of delivery. The mean (standard error of the mean) for nTSH was obtained at 3.37 (0.12) mIU/L and 97% of newborns were below 8 mIU/L. Mean nTSH was significantly high in mothers older than 30 years (P=0.019) and those with anemia during the antenatal period (p <0.001). It was significantly raised in babies with complications (P=0.004). Besides, higher values were also observed in low birth weight babies and those with low Ponderal Index. Higher nTSH was observed among newborns born to mothers with a thyroid disorder, those delivered prematurely and/or by cesarean section, and those with no antenatal visits. It is highly essential to take a precautionary note on the antenatal status of mothers in terms of advanced age, premature delivery, associated maternal diseases, mode of delivery, newborn’s birth weight, and complications which are supposed to influence the dynamicity of thyroid hormones in newborns and result in CH.

Despite the significant improvement in neonatal intensive care, neonatal death is still one of the most important challenges worldwide. Understanding the causes of neonatal mortality is important for health policymakers.
This study aimed to assess neonatal mortality in an Iranian referral level Ш Neonatal Intensive Care Unit (NICU).

This cross-sectional study was conducted on the neonates who were referred to a level Ш NICU between 2014 and 2019. Data collection was performed by the research assistants, using a pre-designed checklist from the neonatal medical records. All the neonatal records of the patients who died during the infancy period were collected. Data were analyzed using SPSS (version 23).

In total, 388 (12%) out of 3,078 inpatient neonates died In this study. The mean gestational age of neonates who died was 34.9 weeks and 53% of them were males. In addition, 92 (23%) of them died when they aged between 0-7 days and hyponatremia was the most common (30.9%) abnormal laboratory finding among them. The main causes of mortality included sepsis (26%), congenital multiple anomalies (21%), prematurity (20%), surgical procedures (15%), congenital heart disease (8%), inborn metabolic disorder (6%), hypoxic-ischemic encephalopathy (2.8%), and some unknown reasons (1.2 %), respectively. Sepsis, as the most common disorder in neonatal mortality among the patients, was detected in 74 (58.27%) preterm infants, and Acinetobacter was the main microbial detected pathogen. The rate of sepsis was significantly different in different gestational ages (P<0.001).

Based on the obtained results, sepsis, prematurity, and congenital multiple anomalies are the most common causes of mortality among neonates. Causes of mortality during the first month of life were different indicating the need for evidence-based interventions and proper policymaking in the field of neonatal health.

Jaundice is one of the most common neonatal complications. Therefore, promptly diagnosing and treating it is vital. This study aimed to determine the effect of Fenofibrate and phototherapy compared to the phototherapy alone on total serum bilirubin (TSB) at 24 and 48 h (primary outcome) and side effects (secondary outcome).

English (Cochrane Library, Web of Science, Medline, CINAHL, PsycINFO, PubMed, and Google Scholar) and Persian (SID and Magiran) databases were searched using verified keywords (MeSH library) without time constraint. The risk of bias was assessed using the Cochrane Handbook. RevMan software (version 5.3) was used for meta-analysis and the mean difference was calculated as effect size. In heterogeneous cases, the random effect was reported instead of the fixed one. 

The total number of studies found in all databases was 5482. Six articles were included in the present study. The results of the meta-analysis showed no statistically significant difference in TSB levels within 24 (Mean difference: -5.56; 95% Confidence Interval (95% CI): 4.53 to -16.05; P = 0.27) and 48 h (-4.77; 2.57 to -12.10; P= 0.20) between Fenofibrate with phototherapy group and the phototherapy alone group. No side effects have been reported in included studies.

Although the results of the five studies showed the significant effect of Fenofibrate as adjuvant therapy on reducing TSB level, the meta-analysis failed to show the same result in the study groups. It is recommended to perform more trials following all principles of randomized controlled trials to find an effective treatment for hyperbilirubinemia.

Reduction of stress in mothers of neonates with congenital anomalies is necessary to improve their coping behaviors and attachment to their neonates. In this regard, the present study aimed to determine the effect of mindfulness-based stress reduction (MBSR) program on “coping behaviors” and attachment of mothers of neonates with congenital anomalies. This randomized clinical trial (code: IRCT20190123042471N1) was conducted on 70 mothers of neonates with congenital anomalies under medical treatment in two medical-education centers of Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2019. The subjects were selected based on the inclusion criteria and were randomly assigned to two groups of intervention and control (n=35 per group). The intervention group, which included 10 subgroups of 1-3 subjects, received a modified four-session MBSR program (once a week, 1-1.5 h per session). The control group received routine care in the hospital during their hospitalization. The Coping Health Inventory for Parents questionnaire and Maternal Postnatal Attachment Scale tool were completed by the intervention and control groups, both before and after the intervention. The data were analyzed in SPSS (version 25.0) using multivariate analysis of variance. The MBSR program affected the pattern of coping behaviors and maternal-neonatal attachment. There was an increase in the mean scores of coping behaviors and maternal-neonatal attachment in the intervention group, compared to the control group (p <0.05). The MBSR program is recommended as a cost-effective and reliable method for promoting coping behaviors and attachment of mothers to their neonates hospitalized in neonatal intensive care units.

Coronavirus disease 2019 (COVID-19) is an emerging viral disease with a high rate of transmissibility that has spread and become the first pandemic of the century. There are limited data available regarding COVID-19 during pregnancy. An important question is whether pregnant mothers transmit the virus to their fetuses or newborns.

Case report: 

This study was conducted to investigate the vertical transmission of the COVID-19 virus from pregnant mothers to fetuses. This study reported the case of a preterm newborn admitted to the neonatal intensive care unit of Imam Khomeini Hospital Urmia, Iran, from a COVID-19-positive mother with severe respiratory illness. A preterm female newborn with a gestational age of 34 weeks, 1,800 g weight, and 1-minute and 5-minute Apgar scores of 4 and 5, respectively, was born through the emergency cesarean section from a 39-year-old gravid 1 mother. She was positive for COVID-19, in two consecutive reverse transcription polymerase chain reaction tests which were performed 48 h apart from each other.

According to the limited available documents of our case, the researchers claimed that vertical transmission of COVID-19 was possible at this time.

Dengue in pregnancy is associated with adverse maternal and fetal outcomes, including perinatal transmission.

Case report:

 We report a case of neonatal dengue in a baby born to a 29-year-old primigravida at 38 weeks of gestation. She developed acute dengue fever 2 days prior to delivery. Her dengue nonstructural protein 1 antigen was reactive. She delivered a term baby girl via spontaneous vaginal delivery. Her fever persisted in the post-partum period which was associated with post-partum hemorrhage, altered coagulation, and liver function. She was clinically diagnosed to have hemophagocytic lymphohistiocytosis complicated with disseminated intravascular coagulation and treated with intravenous (IV) dexamethasone and multiple blood products, including fresh frozen plasma and platelet concentrate. She recovered in over the next 5 days. The baby girl was born with a birth weight of 3040g and developed fever on the third day of life with poor perfusion, associated with mottling and hypotension. The baby was treated with IV fluids, inotropes, and supportive care. The fever subsided after 48 h, along with clinical improvement, but continued with thrombocytopenia. The baby did not have any bleeding. Platelet recovery started on the 11th postnatal day (i.e., the 8th day of illness), and platelet count was normalized at 2 weeks. Dengue serology immunoglobulin M by enzyme-linked immunosorbent assay was positive for both mother and baby. The clinical diagnosis was confirmed by laboratory tests.

Dengue fever in mothers very late in pregnancy can cause symptomatic dengue infection in neonates.

It has been indicated that pregnant women and neonates are susceptible to COVID‐19 infection. Nevertheless, the unresolved question is about the possibility of COVID‐19 infection in neonates born to COVID‐19 mothers. The present study aimed to assess the routes through which neonates may be infected with the virus: vertically or nosocomially.

Case report:

This study reports the case of a neonate with COVID-19 infection who became symptomatic 30 h after birth. His pharyngeal swab specimen was reported as positive by real-time reverse transcription-polymerase chain reaction (RT-PCR). It happened while the newborn’s mother was tested for the COVID-19 twice, and she received negative results both times.

According to the incubation period of COVID‐19 which is at least 1 day, the possibility of nosocomial transmission is less than other cases reported so far. Moreover, the mother had no COVID-19 symptoms during the last month of delivery. Further clinical research is necessary to determine the routes of maternal transmission of COVID-19 to neonates.

Abdominal masses secondary to urinary retention are rare among female neonates and approaching this pathologic condition, inevitably, poses a diagnostic challenge. Hydrometrocolpos is one example of this disease category which is responsible for only 15% of such cases whose association with polydactyly appears to be even less common. The present study aimed to report the accounts of two neonates with cystic abdominal masses diagnosed as urinary type hydrometrocolpos secondary to urogenital sinus anomaly. Autosomal recessive disorders are characterized by vaginal atresia with hydrometrocolpos, polydactyly, congenital heart defects, and non-immune mediated hydrops fetalis. The triad of hydrometrocolpos, polydactyly, and cardiac anomaly in the two patients presented herein is strongly suggestive of a case of McKusick-Kaufman syndrome.

Case report:

 This study reported two neonates with abdominal mass, polydactyly, and genitourinary tract malformation, with no family history. Relief of urinary obstruction by exploratory laparotomy, aspiration of fluid, and vaginal reconstruction gradually reversed the hydronephrosis and renal failure. 

It can be concluded thatin hydrometrocolpos causing urinary obstruction, decompression of hydrometrocolpos can save the kidneys.