One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up.

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure after surfactant administration in preterm neonates with respiratory distress syndrome.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of humidified high-flow nasal cannula (HHHFNC) therapy, and compare it with the effect of nasal Continuous Positive Airway Pressure (NCPAP) in neonates with respiratory distress syndrome (RDS). METHOD: In this clinical study, consecutively admitted 27-32 weeks preterm infants with RDS who received surfactant through a brief intubation (INSURE method) were randomly assigned immediately after extubation to HHHFNC or NCPAP. Primary outcomes were oxygen saturation values and oxygen need at 6, 12 and 24 h after surfactant administration as well as duration of oxygen and respiratory support, need for intubation and mechanical ventilation and incidence of apnea. Secondary outcomes were duration of hospitalization and incidence of complications such as pneumothorax. RESULTS: Sixty-four infants met the inclusion criteria and were enrolled in the study, 32 per arm. Two cases in HHFNC group dropped due to congenital pneumonia/sepsis. No differences were seen between groups in primary and secondary outcomes except for arterial oxygen saturation values (SaO2) 24 h after surfactant administration that were significantly higher in the NCPAP group [95.97% ± 1.96% vs. 95.00% ± 1.80% (P = .04)] with similar oxygen needs. The treatment failure was observed in four (11.8%) infants of the NCPAP group compared to five (16.7%) cases of the HHHFNC group (P = .57). CONCLUSION: Based on the results of the present study, the HHHFNC can be as effective as NCPAP to treat the neonates with RDS after surfactant administration.

Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens.

BACKGROUND: Neonatal sepsis is accounted for 30-50% of annual neonatal deaths in developing countries. We performed a systematic review and meta-analysis study to evaluate the national prevalence and identification of the etiological pathogens of neonatal sepsis in Iran. METHODS: A comprehensive literature search was done on the national and international databases for studies published between 2000 and 2019. The DerSimonian and Laird random-effects model was used to calculate pooled prevalence estimates, with 95% confidence intervals (CIs). Subgroup analyses and meta-regressions regarding the gender, type of sepsis and time during were also performed. Data were extracted, analyzed, and presented according to PRISMA guideline. RESULTS: Of 944 publications identified, 22 studies containing 14,683 neonates met the eligibility criteria. The pooled national prevalence of sepsis in Iran was 15.98% (95%CI, 11.96-20.46%; 1,367/14,683). Prevalence rate in boys (20.42%; 95%CI, 9.03-34.8%) was slightly higher than girls (18.5%; 95%CI, 7.4-32.8). A decreasing trend in prevalence of neonatal sepsis was found in recent years, although not statistically significant (c = -0.005; P value = 0.4). The most prevalent causative bacterial pathogens were Enterobacter spp. (23.04%), followed by Klebsiella pneumoniae (17.54%), coagulase-negative Staphylococci (14.06%), Escherichia coli (13.92%), Pseudomonas aeruginosa (12.67%), and Staphylococcus aureus (11.48%). CONCLUSION: Our findings showed a high prevalence of neonatal sepsis in suspected neonates, suggesting the need to implement preventive measures, routine assessment, and close monitoring of neonates. Also, Enterobacter spp. and Klebsiella pneumoniae were identified as the principal bacterial pathogens responsible for neonatal septicemia in Iran.

Predictors of Cranial Ultrasound Abnormalities in Intrauterine Growth-Restricted Fetuses Born between 28 and 34 Weeks of Gestation: A Prospective Cohort Study.

BACKGROUND: Doppler parameters have been commonly used for the prediction of neonatal outcomes. However, controversies exist with regard to the value of Doppler parameters in predicting the risk of neurological outcomes among neonates. OBJECTIVE: This prospective cohort study attempted to assess the value of Doppler parameters in predict ing cranial ultrasound abnormalities (CUAs) in intrauterine growth restriction (IUGR) among fetuses at 28-34 weeks of gestation. METHODS: This was a prospective cohort study of 83 delivered IUGR fetuses and 75 control fetuses matched for gestational age (GA). The value of mentioned Doppler parameters and GA in predicting the risk of CUAs, including periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and basal ganglia lesions (BGLs), was analyzed. RESULTS: The incidence of CUAs among IUGR fetuses (66.3%) was significantly higher (p < 0.001) than in the control group (40%). The incidence of neonatal mortality among IUGR fetuses was significantly higher (p < 0.001) than in the control group. Absent or reversed end-diastolic velocity (AREDV) in the umbilical artery (UA) and the ductus venosus (DV) after adjustment for GA was associated with increased odds of IVH, PVL, BGLs, and any CUA. CONCLUSIONS: GA at birth and AREDV in the UA and the DV within 1 week before childbirth were reliable predictors of CUAs during the neonatal period.

Cord Blood Alkaline Phosphatase as an Indicator of Neonatal Jaundice.

BACKGROUND: Management of hyperbilirubinemia remains a challenge for neonatal medicine because of the risk of neurological complications related to the toxicity of severe hyperbilirubinemia. OBJECTIVES: The purpose of this study was to examine the validity of cord blood alkaline phosphatase level for predicting neonatal hyperbilirubinemia. PATIENTS AND METHODS: Between October and December 2013 a total of 102 healthy term infants born to healthy mothers were studied. Cord blood samples were collected for measurement of alkaline Phosphatase levels immediately after birth. Neonates were followed-up for the emergence of jaundice. Newborns with clinical jaundice were recalled and serum bilirubin levels measured. Appropriate treatment based on serum bilirubin level was performed. Alkaline phosphatase levels between the non-jaundiced and jaundiced treated neonates were compared. RESULTS: The incidence of severe jaundice that required treatment among followed-up neonates was 9.8%. The mean alkaline phosphatase level was 309.09 ± 82.51 IU/L in the non-jaundiced group and 367.80 ± 73.82 IU/L in the severely jaundiced group (P = 0.040). The cutoff value of 314 IU/L was associated with sensitivity 80% and specificity 63% for predicting neonatal hyperbilirubinemia requiring treatment. CONCLUSIONS: The cord blood alkaline phosphatase level can be used as a predictor of severe neonatal jaundice.

Short Term Outcome of Neonates Born With Abnormal Umbilical Cord Arterial Blood Gases.

BACKGROUND: Umbilical arterial blood gas (UABG) analysis is more objective than other methods for predicting neonatal outcome. Acidemic neonates may be at risk for unfavorable outcome after birth, but all neonates with abnormal arterial blood gas (ABG) analysis do not always have poor outcome. OBJECTIVES: This study was carried out to determine the short term outcome of the neonates born with an abnormal ABG. PATIENTS AND METHODS: In a cohort prospective study 120 high risk mother-neonate pairs were enrolled and UABG was taken immediately after birth. All neonates with an umbilical cord pH less than 7.2 were considered as case group and more than 7.2 as controls. Outcomes like need to resuscitation, admission to newborn services and/or NICU), seizure occurrence, hypoxic ischemic encephalopathy (HIE), delayed initiation of oral feeding and length of hospital stay were recorded and compared between the two groups. P value less than 0.05 was considered as being significant. RESULTS: Comparison of short term outcomes between normal and abnormal ABG groups were as the fallowing: need for advanced resuscitation 4 vs. 0 (P = 0.001), NICU admission 16 vs. 4 (P = 0.001), convulsion 2 vs. 0 (P = 0.496), HIE 17 vs. 4 (P = 0.002), delay to start oral feeding 16 vs. 4 (P = 0.001), mean hospital stay 4 vs. 3 days (P = 0.001). None of the neonates died in study groups. CONCLUSIONS: An umbilical cord PH less than 7.2 immediately after birth can be used as a prognostic factor for unfavorable short term outcome in newborns.

The comparison of serum interleukin-6 of mothers in vaginal and elective cesarean delivery.

BACKGROUND: Interleukin-6 (IL-6) has a major role in hematopoiesis, immune and acute phase response and its serum level seems to be associated with the mode of delivery. The purpose of this study was to compare the level of IL-6 in mothers who delivered via cesarean section and vaginally. METHODS: This cross-sectional study was done on 40 mothers with vaginal delivery and 40 mothers with elective cesarean delivery in 2012 in Ayatollah Rouhani Teaching Hospital in Babol, northern Iran. Five ml blood samples were taken from each mother. Blood samples were examined by enzyme-immune assay for the determination of IL-6 in both mothers and neonates. Other information, such as the mother's age, newborn sex, gravity, parity, the number of live births of each mother, and the status of infants in terms of being term or pre-term, was recorded. RESULTS: The mean age of cesarean section and vaginal delivery patients was (29±5.01) yrs and (27.3± 4.93) yrs. The maternal IL-6 concentration in vaginal birth (170.13 ±15.9) was significantly (p<0.05(higher than cesarean section (33±29.94) CONCLUSION: The result shows that serum IL-6 levels in patients with vaginal delivery was higher than those with elective cesarean section delivery. So, vaginal delivery is preferred for all patients except those in whom vaginal delivery is contraindicated.

Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review.

BACKGROUND: Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. CASE PRESENTATION: We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. CONCLUSION: Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis.