Comparison of Phototherapy Effect with and without Phenobarbital on the Newborns with Hyperbilirubinemia.

Objectives: Jaundice occurs in 60% of full-term and 80% of pre-term newborns. This study compared the effect of phototherapy with and without phenobarbital on icteric newborns. Materials & Methods: This study is a randomized clinical trial conducted from July until March 2018 at Imam Reza Hospital, Mashhad University of Medical Science, Iran. Full-term and near-term neonates with more than 2000 grams who were hospitalized in the mentioned period for jaundice were entered into the study. The newborns were divided into two groups using block randomization. Data were analyzed by SPSS version 19. Results: The average gestational age was 36.4 weeks (SD 2.39) in the intervention group and 36.9 weeks (SD 2.16) in the control group, with no significant difference between them. The mean hospital stay for the intervention group was 72 hours (SD 1.66), compared to 55 hours (SD 1.88) for the control group. At discharge, the serum bilirubin level in the intervention group was 11.53 mg/dL (SD 0.77), while it was 10.80 mg/dL (SD 1.09) in the control group, a statistically significant difference. Conclusion: According to this study, phototherapy with phenobarbital is not more effective than phototherapy alone in neonatal hyperbilirubinemia.

Abuse and Neglect of Healthy Newborn by Parents: A Social Problem with a Long History.

A Two-day-old girl who was found in garbage by police and transferred to hospital. She was irritable and dehydrated; also there were burn injuries around her knees and right cheek. Her weight was 3100 grams and physical examinations were normal. Opium was found in urine. Phenobarbital (4 mg/kg/day intravenous every 12 hours) was started for her irritability. After 20 days, infant was entrusted to a welfare organization with coordination of social support of hospital. The prevention of child abuse and neglect is an urgent public health concern. Home visit by welfare organization has been proposed as a promising approach to prevent health and developmental problems among children. We report this case of an abused and neglected newborn.

The association between 25-dehydroxy vitamin D and lower respiratory infection in children aged less than "5" years in Imam Reza hospital, Bojnurd, Iran.

OBJECTIVE: To clarify the association between vitamin D deficiency and acute respiratory infection in children below age 5 years. METHODS: The cross-sectional study was conducted at Imam Reza Hospital in Bojnurd, Iran, in June 2013 and comprised 90 children below 5 years of age suffering from respiratory infections. They was selected on the basis of purposive sampling and were then categorised into two equal groups of 'acute' and 'non-acute' respiratory infection. Data collection was done using a questionnaire and serum level of 25-dehydroxycalcciferol was measured. SPSS 11 was used to analyse and interpret the data. RESULTS: In the group of children with respiratory disorders, 9 (42.9%) exhibited vitamin D deficiency. There were no significant differences between the two groups in terms of demographic characteristics such as age, intrauterine age, weight, birth-weight, head circumference, height, gender, living area and respiratory distress (p>0.05 each). Vitamin D deficiency showed no meaningful statistical relation with acute respiratory infections (p>0.05). CONCLUSIONS: More studies with higher sample size and are recommended.

Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran.

INTRODUCTION: According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants' Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU). MATERIALS AND METHODS: Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests. RESULTS: Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]). CONCLUSION: In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates.

Maternal serum magnesium level and low birth weight neonate.

BACKGROUND: The aim of study was to compare the serum level of magnesium in mothers having low birth weight with those having normal birth weight neonates. METHODS: In a case-control study, women who delivered low birth weight neonate (cases), compared with normal birth weight (controls) in serum concentration of magnesium. Blood samples collected within 24 h after delivery. Concentration of magnesium assessed by standard atomic absorption spectro-photometry. Multiple linear regression analysis was performed to control of potential confounding variables. RESULTS: A total of 116 mothers (67 cases and 49 control) were studied. Mothers in two groups did not differ in age, body mass index, and socioeconomic or demographic factors. Maternal magnesium concentration did not differ between two groups 0.86 ± 0.11 m.mol/l versus 0.94 ± 0.22 m.mol/l respectively (P = 0.09). CONCLUSION: There is no significant difference between serum magnesium levels of low birth weight infants' mother and normal weight infants' mother.

Comparison of clinical and sonographic prevalence of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is one of the most widely discussed abnormalities in neonates. The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to over diagnosis, which might cause over treatment. Variations in the incidence of developmental dysplasia of the hip are well known. During six months study since September 2006 all 1300 neonates (2600 hips) were born in our hospital examined clinically and sonographically (587 hips) in the first 48 hours of life. Sonography was performed according to Graf's method, which considers mild hip sonographic abnormalities as type II a. Type IIb Graf were considered pathologic. Sonography screening of 587 hips detected 36 instances of deviation from normal indicating a sonographic DDH incidence of 12.5%. However, only 8 neonates remained abnormal and required treatment, indicating a true DDH incidence of 6 per 1000 live birth. Risk of diagnosis clinically and sonographicaly were 2.5 and 4.5 percent respectively and was significant (P<0.00001, x(2)=1170). In order to avoid over diagnosis in first days examination, repeated clinical and sonographic examination is required.

Ophthalmic, hearing, speaking and school readiness outcomes in low birth weight and normal birth weight primary school children in Mashhad-Iran.

Low Birth weight infants are at risk of many problems. Therefore their outcome must evaluate in different ages especially in school age. In this study we determined prevalence of ophthalmic, hearing, speaking and school readiness problems in children who were born low birth weight and compared them with normal birth weight children. In a cross-sectional and retrospective study, all Primary School children referred to special educational organization center for screening before entrance to school were elected in Mashhad, Iran. In this study 2400 children enrolled to study and were checked for ophthalmic, hearing, speaking and school readiness problems by valid instrument. Data were analyzed by SPSS 11.5. This study showed that 8.3% of our population had birth weight less than 2500 gram. Visual impairment in LBW (Low Birth Weight) and NBW (Normal Birth Weight) was 8.29% vs. 5.74% and there was statistically significant difference between them (P=0.015). Hearing problem in LBW and NBW was 2.1% vs. 1.3 and it was not statistically significant. Speaking problem in LBW and NBW was 2.6% vs. 2.2% and it was not statistically significant. School readiness problem in LBW and NBW was 12.4% vs. 5.8% and it was statistically significant (P<0.001). According to the results, neurological problems in our society is more than other society and pay attention to this problem is critical. We believe that in our country, it is necessary to provide a program to routinely evaluate LBW children.

Prevalence and risk factors of hypospadias in a private hospital in northeast iran.

OBJECTIVE: The aim of this study was to determine prevalence and risk factors of hypospadias in newborn infants of a private hospital in Mashhad city located in northeast Iran. METHODS: All live birth deliveries in maternity hospital were enrolled from Oct 2006 to Sep 2008. All hypospadias cases were compared with the next male live births for possible risk factors. This study included only solitary hypospadias cases, those associated with other anomalies were excluded. Both parents were asked to fill out the same written questionnaires seperately. Data was analyzed by using SPSS. FINDINGS: During two years 6149 babies were born in our hospital; 25 cases (0.4%, 4 in1000 live births) of hypospadias were identified. Hypospadias occurred in 0.76% of male deliveries. Most cases of hypospadias were born in summer and winter was the season which least number. Positive family history (P=0.04) was regarded as a potential risk factor that was present in 44% of cases in hypospadias group. Iron supplement consumption in first trimester of pregnancy in control group was significantly more than in hypospadias group (P=0.001) and also usage of folic acid in control group before and in first trimester of pregnancy was taken more by mother in control group than in hypospadias group (P=0.049 and P=0.001 respectively). CONCLUSION: Prevalence in this population was intermediate (4 in 1000 live births). Summer was the most epidemiology factor for occurring of hypospadias probably due to conception in cold season. Iron and folic acid supplementation may have preventive effect in hypospadias.

Effect of Birth Weight and Socioeconomic Status on Children's Growth in Mashhad, Iran.

Background. Socioeconomic status and birth weight are prominent factors for future growing of children. Also Studies show that this criterion is associated with reduced cognitive outcomes, school achievement, and adult work capacity. So in this paper we determined the effects of some socio-economic statuses and birth weight on physical growth of children in Mashhad, Iran. Method and materials. This is a cross sectional study that determined effect of socio-economic status and birth weight on weight, heighting and BMI of school age children. Healthy six years old children who were screened before enter, to school were eligible for participating in our study between 6 June 2006 and 31 July. Weight and standing height were documented at birth and measured at 6 years old. Then, their BMI were calculated in childhood period. Data were analyzed by using SPSS software. Result. Results show that some socio-economic variables and birth weight is associated with and, perhaps, influence the variation of growth in the children. The variables which show the most consistent and significant association were birth weight, sex, economic status and education of parents. Conclusion. In this paper, we found that birth weight, economic status and education parents of neonates have directly significant effect on growth childhood period. We recommended that paying attention to these criteria for improving growth of children in our society should be considered by authorities.

Comparison of maternal and umbilical cord blood selenium levels in term and preterm infants.

OBJECTIVE: Selenium is an essential trace element and has a main role in cellular antioxidant defense system. In very preterm babies, low selenium is associated with an increased risk of complications such as chronic neonatal lung disease and retinopathy of prematurity. This study was designed to determine and compare maternal and umbilical cord blood selenium levels in term and preterm infants. METHODS: From February 2008 to April 2008, 30 term (gestational age>37 weeks) and 30 preterm infants (gestational age<34 weeks) and their mothers were enrolled. Selenium concentrations in umbilical cord and maternal venous blood were measured by atomic absorption spectrometry. RESULTS: The mean selenium concentration in term infants was higher than in preterm infants (124.80+/-13.72 microg/L vs 100.30+/-11.72 microg/L, P=0.0001). The mean selenium concentration in mothers of term and preterm infants was not significantly different (117.03+/-17.15 microg/L vs 110.56+/-17.49 microg/L, P=0.15). Cord selenium concentrations were strongly correlated with gestational age and birth weight (r=0.66, p<0.0001 and r=0.59, p<0.0001, respectively) when the data of all infants were analyzed together. None of the 60 women had a serum selenium level below the laboratory lower limit of normal (70.0 microg/L). Maternal selenium levels were correlated with cord selenium levels in their infants (r=0.40, p<0.001) when data of all newborn infants and mothers were considered together. CONCLUSIONS: Mothers have a relatively good selenium status and serum selenium is not a significant predictor of preterm delivery in Isfahan. The cord selenium concentration in term infants is significantly higher than in preterm infants, but the cord selenium concentrations in both groups are in a suggested normal range.

The effect of breast milk and lanolin on sore nipples.

OBJECTIVE: To compare the effect of rubbing breast milk versus lanolin in the treatment of symptoms of sore nipples. METHODS: We carried out this randomized clinical trial on 225 mothers with sore nipples in the Neonatal Intensive Care Unit of Imam Reza Hospital in Mashhad, Iran from April 2001 for 2 years. We randomly divided the patients into 3 groups. The first group rubbed the hind milk on their nipples at the end of each breast-feeding session, and the second group used lanolin locally on the nipple 3 times a day, and cleaned the nipple with a wet cloth before infant feeding. The third group did not use anything (control group). We corrected the breast-feeding technique of all mothers throughout the study. After the first visit, we reexamined the patient on the third, fifth, seventh and tenth days. We obtained information with interviewing and physical examination by using a questionnaire. We based the sore nipple improvement on absence of irritation according to mothers opinions. We analyzed the obtained information using the SPSS version 11.5 software, and the used tests were Chi-Square test, Mann-Whitney test, and Kruskal-Wallis test. RESULTS: The first group (breast milk users) included 78 patients, the second group (lanolin users) included 74 patients, and the third group (control group) included 73 patients. The 3 groups were similar in gravidity, delivery method, pre-delivery breast feeding education, the beginning time of the first breast feeding, prior success breast feeding experiences, detergent agents usage for nipples, use of formula, and pacifier. Clinical manifestations, such as appearance time of symptoms, irritation and breast wound were not significantly different. The healing time was different in these 3 groups (p=0.038) according to the mean ranking in the groups. The healing time in the lanolin group was longer than the breast milk group (p=0.029) and the control group (p=0.028). No side effects were noted during the study. CONCLUSION: This study suggests that, due to the better healing of the sore nipple with breast milk, its availability, without payment and side effect, breast milk is recommended for the treatment of sore nipples.

Effect of clofibrate in jaundiced term newborns.

OBJECTIVE: Clofibrate is a glucuronosyl transferase inducer that has been proposed to increase the elimination of bilirubin in neonates with hyperbilirubinemia. The aim of this study was to characterize the therapeutic effect of clofibrate in neonates born at full term and present with non-hemolytic jaundice. METHODS: A clinical controlled study was performed in two groups of healthy full term neonates. Thirty neonates were treated with a single oral dose of clofibrate (100 mg/kg) plus phototherapy (clofibrate-treated group) while another 30 neonates (control group) received only phototherapy. RESULT: The mean plasma total bilirubin levels of 12th, 24th and 48th hours were significantly lower in the clofibrate-treated group as compared with the control group (P < 0.0001, P < 0.0001 and P = 0.004, respectively). Treatment with clofibrate also resulted in a shorter duration of jaundice and a decreased use of phototherapy (P < 0.0001). No side effects were observed. CONCLUSION: Although other pharmacological agents such as metalloporphyrins and Sn-mesoporphyrin also seem to be effective in decreasing bilirubin production, these products are not available for routine use and cannot be used because the safety of these drugs has to be confirmed prior to their widespread use. Therefore, clofibrate is now the only available pharmacological treatment of neonatal jaundice.