Comparison of the Percentage of Umbilical Cord Nucleated Red Blood Cells in Preterm Neonates during Vaginal Delivery and Emergency Cesarean Section.

Background: There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates. Materials and Methods: The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool. Results: The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth-minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short-term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates. Conclusions: Based on the results of the present study, emergency C-section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high-risk neonates through umbilical cord NRBC measurement immediately after delivery and special care.

Comparison of severity and prognosis of jaundice due to Rh incompatibility and G6PD deficiency.

INTRODUCTION: Undiagnosed and untreated hyperbilirubinemia in infants may result in Kernicterus Spectrum Disorder and poor prognoses. Rhesus incompatibility and glucose-6-phosphate dehydrogenase (G6PD) deficiency are among the known causes of infantile jaundice. This study was designed to define the severity and prognosis in jaundiced infants with Rh incompatibility or G6PD deficiency. METHODS: A total of 144 term, 2- 14 days old jaundiced infants (bilirubin > 20 mg/dl) with Rh incompatibility(85 infant) or G6PD deficiency(59 infant) were included in this cohort study with 24-month follow-up through available sampling at Ghaem hospital between 2015 and 2022. Denver II test was used at 6, 12, 18, and 24-month ages after discharge. Infants with Rh incompatibility or G6PD deficiency were assigned into two groups of favorable and poor prognosis. Following that, the bilirubin levels of these infants were compared at the time of admission. RESULTS: The bilirubin level in G6PD deficient infants with poor prognoses (37.96 ± 9.25 mg/dl) and neonates with Rh incompatibility (36.23 ± 5.08 mg/dl) almost was the same (P = 0.232). 40 babies (47%) caused by Rh incompatibility and 33 (56%) babies caused by G6PD deficiency had a poor prognosis (P = 0.465). Average bilirubin in babies with RH incompatibility with favorable prognosis is 21.8 and poor prognosis is 36.2 mg/dl. In infants with G6PD deficiency, it was 24 mg/dl with favorable prognosis and 38 mg/dl with poor prognosis (P < 0.0001). The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups (P < 0.0001). CONCLUSION: The two-year prognoses of hyperbilirubinemia caused by G6PD deficiency are as poor as that of Rh incompatibility. The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups.Exchange transfusion in cases with bilirubin < 25 mg/dl can improve the prognosis in both groups, especially in infants with Rh incompatibility.

Comparing maternal and neonatal prooxidant-antioxidant balance during delivery

Objective: Oxidative stress (OS) is due to a disturbance in the balance between the production of free radicals and antioxidant defense, resulting in a predominance of free radicals over endogenous anti-oxidant defenses. OS may have many causes. Pregnancy, and especially delivery, are associated with increased OS. The relationship between maternal and infant prooxidant-antioxidant balance (PAB) is unclear. Therefore, the aim of the present study was to compare PAB in mother and baby pairs. Material and Methods: This cross-sectional study was conducted in 104 mothers and normal term infants during 2017-2020. PAB was measured in healthy mothers before delivery and in umbilical cord samples after delivery. Data on the infant characteristics including age, gestational age, birth weight, Apgar score, and maternal history including the duration of mother's education, weight of the last month, and gravidity were collected using a researcher-made questionnaire. The cord and maternal PAB were compared by statistical methods. Results: In this study, the mean PAB of the neonates and mothers was 30.76 and 214.87 HK, respectively. The results revealed a moderate association between the PAB neonate and maternal PAB before delivery but it was not significant. Conclusion: Overall, the level of oxidants and antioxidants reduced during pregnancy and before delivery, and it was found that the relative incidence of neonatal PAB increases by increasing maternal PAB.

Comparison of new biomarkers in the diagnosis of perinatal asphyxia.

Objectives: Precise and early diagnosis of neonatal asphyxia may improve outcomes. Recent studies aim to identify diagnostic biomarkers in neonates at risk for brain damage. The current study was designed to evaluate the diagnostic value of new biomarkers for neonatal asphyxia. Materials & Methods: This prospective study was conducted with an available sampling of infants upper 35 weeks of gestational age, including neonates with asphyxia (case group) and healthy controls, 2014-2022, in Ghaem Hospital, Mashhad, Iran. Data collection was performed utilizing a researcher-made questionnaire, including maternal and neonatal characteristics, as well as clinical and laboratory evaluation. Serum umbilical cord levels of interleukin-6 (IL6), interleukin-1-beta (IL- 1ß), pro-oxidant-antioxidant balance (PAB), and heat shock protein-70 (HSP70), as well as nucleated red blood cells count (NRBC), were determined. Data were analyzed by t-test, Chi-square, receiver operating characteristic (ROC), and regression models. Results: The differences in variables IL6, IL1ß, PAB, NRBC/100WBC, and HSP70 were statistically significant between the two groups (in all cases, P<0.0001). In the diagnosis of asphyxia, the most sensitive marker (89%) was IL1ß more than 2.39 pg/ml and HSP 70 upper than 0.23 ng/ml, while IL6 was higher than 9pg/ml, determined as the most specific marker (85%). Furthermore, a combination of HSP + PAB and IL6 + lL1b + PAB + NRBC/100WBC possesses the prediction power of 93.2% and 87.3%, respectively, for diagnosing asphyxia. Conclusion: According to data analysis, the combination of new biochemical markers (NRBC count, IL6, IL1ß, PAB, and HSP 70) could be a reliable marker for diagnosing infants with asphyxia.

Potential Role of Bilirubin in Preventing Retinopathy of Prematurity.

BACKGROUND: One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. METHODS: This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. RESULTS: Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP. CONCLUSION: According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.

Incidence of Retinopathy of Prematurity in Neonates with Neonatal Sepsis.

BACKGROUND: One of the most important complications of premature birth is retinopathy of prematurity (ROP). Sepsis may increase the incidence of this complication. The aim of this study is to compare the incidence of ROP in neonates with and without sepsis. METHODS: In a retrospective case-control study, preterm infants admitted to the neonatal intensive care unit (NICU) of Ghaem hospital from 2014 to 2022 were examined. The case group consisted of 155 preterm infants with definite sepsis (positive blood culture and clinical signs of sepsis) and the control group included 145 preterm infants without sepsis whose maternal and neonatal characteristics were collected; they were examined by a retinologist and evaluated for ROP at 32 weeks or four weeks after birth. Finally, we used the chi-square and the t test to compare the two groups. RESULTS: Out of 155 preterm infants with sepsis, 70% and out of 145 preterm infants without sepsis, 58% had ROP (P=0.023). Also, low birth weight, low initial Apgar score and low 5-minute Apgar score were significantly associated with ROP (P<0.05). CONCLUSION: Based on the results of this study, sepsis is a serious risk factor for ROP. We can reduce its incidence and complication by preventing sepsis in premature infants.

Comparison of Retinopathy of Prematurity Incidence in Preterm Infants of Mothers with Preeclampsia and Infants of Healthy Mothers.

Introduction: Preeclampsia is one of the four leading causes for pregnancy complications, maternal-fetal and neonatal mortality. This study was aimed at comparing the incidence of retinopathy of prematurity in neonates of mothers with preeclampsia and neonates of healthy mothers. Methods: This cross-sectional study was performed among 213 mothers, including 49 healthy mothers and 164 mothers with preeclampsia whose neonates were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran, during 2016-2021. The participants were chosen using the convenience sampling method. The data collection tool was a researcher-made checklist including items on laboratory evaluation, maternal and neonatal characteristics, and eye examination. The data were analyzed using t-test and Chi-square. Results: In the two groups, gestational age (P = 0.112), first-minute Apgar score (P = 0.209), and fifth-minute Apgar score (P = 0.949) were not significantly different. There was a significant difference between the two groups in terms of maternal age (P = 0.0001), type of delivery (P = 0.0001), premature rupture of membranes (P = 0.003), and eye condition (P = 0.033). Conclusion: The results of our study show that preeclampsia affects the prognosis of infants, and in neonates with preeclamptic mothers, the rate of premature rupture of the membranes, cesarean delivery, and retinopathy of prematurity were higher.

Comparison of Vitamin D Levels in Premature Infants with and without Retinopathy of Prematurity.

BACKGROUND: Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP. METHODS: This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016-2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants' first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool. RESULTS: Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP. CONCLUSION: The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.

Evaluation of hematologic factors and bilirubin following exchange transfusion in neonatal hyperbilirubinemia.

INTRODUCTION: Exchange transfusion (ECT) is one of effective treatments for rapid reduction of the bilirubin serum levels. The main purpose of this study was to offer greater insights into the effects of ECT on the hematologic factors and bilirubin in neonatal hyperbilirubinemia. METHODS: This cross-sectional study was performed on 380 neonates over 35 gestational weeks, and 2-14 days old with a bilirubin of above 17 mg/dl who had undergone ECT at Ghaem Hospital of Mashhad in Iran from 2011 to 2021. Blood samples were examined before, immediately after, 6 h and 60 h after ECT for complete blood cell count (CBC), platelet count and bilirubin serum level analysis. RESULTS: In this study, the mean age of neonates was 5.21 ± 3.55 days with a mean birth weight of 2810 ± 710 gr. The mean platelet count (PLT), white blood cell (WBC) and the serum level of bilirubin were estimated at 260,000/mm2, 12,400/mm2, 23 mg/dl before ECT and 97,000/mm2, 7370//mm2 and 12.6 mg/dl immediately after ECT, respectively (P-value <0.001). CONCLUSION: The results indicated that the mean serum levels of bilirubin, platelets, and leukocytes dropped to 55%, 30%, and 60% of their baseline levels before ECT, respectively, but they all spiked after ECT.

Predictability of prognosis of infantile hypernatremic dehydration: a prospective cohort study.

BACKGROUND: Infantile hypernatremic dehydration (IHD) is a life-threatening disease with potential cerebral adverse effects. PURPOSE: This study was conducted to evaluate the prognosis of IHD. METHODS/SEARCH STRATEGY: Using convenience sampling 183 term infants with IHD (Na+ > 150 mg/dl) were enrolled in a cohort study with 36 months follow-up during 2007-2017. A researcher-made questionnaire was used for data collection. Follow-up visits were performed using the Denver Developmental Screening II test after discharging from hospital. The t-test, chi-square test, regression models, and receiver-operating characteristic curve were performed for data analysis. FINDINGS/RESULTS: 17.5% of neonates were diagnosed with abnormal outcomes. Postpartum breast growth, breastfeeding frequency and duration, convulsion, consciousness, urination frequency, urea, Cr, sodium and brain CT scan (p = .000) showed significant differences (p < .05) between the infants with normal and abnormal outcomes. Combination of the above variables had a high predictive power (98.6%) for determining the unfavorable prognosis in infants with IHD. IMPLICATIONS FOR PRACTICE: Sodium, urea and creatinine are high-sensitive/specific determinants of IHD prognosis. Combination of some risk factors is highly predictive for unfavorable prognosis of IHD. IMPLICATIONS FOR RESEARCH: Combination of variables such as sodium, urea, creatinine, lethargy, state of fontanels, convulsion, loss of consciousness, state of the breast during postpartum, inverted nipple and brain CT scan has a high predictive power in the determination of unfavorable prognosis in IHD.

Evaluation of pro-oxidant antioxidant balance in retinopathy of prematurity.

INTRODUCTION: Retinopathy of prematurity (RoP) is a vasoproliferative disorder caused by the abnormal development of retinal vessels in premature neonates. It is one of the major causes of childhood blindness, which is increasing with the increasing survival rate of low birth weight and premature neonates. This study has aimed to evaluate the role of oxidative stress and peroxidant antioxidant balance (PAB) in the pathogenesis and prediction of RoP. MATERIALS AND METHODS: A total of 154 neonates weighing <1500 g admitted at the NICU of Ghaem Hospital, Mashhad, Iran, were enrolled in this cross-sectional study between 2018 and 2020. Blood samples were collected on the first day of birth to assess the peroxidant and antioxidant balance. The demographic, prenatal, and clinical course and postnatal problems were also recorded. The neonates were examined for RoP and divided into control (healthy) and affected (ROP) groups. RESULTS: There were significant differences between the two groups in gestational age, duration of oxygen therapy, and first and fifth minute Apgar score (P < 0.005). The mean PAB in infants without and with ROP was 19.79 HK (Hamidi-Koliakos) and 38.45 HK, respectively (P < 0.0001). Also, the mean PAB in neonates with ROP grade 1 and 2 was 36.69 HK and 45.53 HK, respectively (P = 0.002). CONCLUSION: According to our findings, the PAB level can be helpful in predicting ROP incidence. With increasing PAB, the possibility of ROP severity will increase.

Evaluation of Maternal and Infantile Levels of Vitamin D in Preterm Infants.

INTRODUCTION: Vitamin D deficiency is highly prevalent during pregnancy and in premature infants. This study was done to investigate the maternal and infantile levels of vitamin D in preterm infants. METHODS: Using available sampling during 2018-2020, the maternal and umbilical cord serum levels of vitamin D were measured in 294 premature infants in Ghaem Hospital, Mashhad, Iran. A researcher- made questionnaire consisting of neonatal demographic and clinical characteristics was used as the data collection tool. Both maternal and placental vitamin D levels were categorized into four classes: severe deficiency (vitamin D<10 ng/ml), moderate deficiency (10.1≤vitamin D≤20 ng/ml), mild deficiency (20.1≤vitamin D≤30 ng/ml) and normal (vitamin D >30.1ng ml). RESULTS: Vitamin D deficiency was seen in 89% of premature infants (46.6% severe, 30.6% moderate, and 11.9% mild). Serum levels of vitamin D were 18.28±13.94 ng/ml and 14.10±9.70 ng/ml in mothers and infants, respectively. The infants below and above 32 weeks exhibited vitamin D values of 10.97±6.31 ng/ml and 18.05±11.64 ng/ml, respectively. The difference in vitamin D levels between boys (12.59±8.40 ng/ml) and girls (16.05±11.45 ng/ml) was found to be significant (P=0.009). Moderate and severe vitamin D deficiency was more common at earlier pregnancy ages (P=0.001). CONCLUSION: Vitamin D deficiency is more common and severe in preterm infants and their mothers. Controlling vitamin D levels during pregnancy, especially in women at risk of preterm labor and preterm infants, may help reduce prematurity problems.

Comparison of hyperbilirubinemia incidence between the newborns of zinc-taking and non-zinc-taking mothers during the third trimester of pregnancy.

BACKGROUND: Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers. METHODS: In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns' conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test. RESULTS: The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy. CONCLUSION: Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment.

WITHDRAWN: Comparing Nucleated Red Blood Cells in Neonates with and without Retinopathy

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Interleukin-6 as A Prognostic Biomarker in Perinatal Asphyxia.

OBJECTIVE: Early diagnosis is has a crucial role in both prevention and treatment of asphyxia-related complications. The current study aimed to evaluate the prognostic value of interleukin-6 (IL-6) and hypoxic-ischemic encephalopathy grade in the prediction of mortality and the developmental status of neonates affected by prenatal asphyxia. MATERIALS & METHODS: This cohort study was conducted on 38 term asphyxiated infants at Ghaem hospital, Mashhad, Iran, from 2013 to 2017. The HIE grade and serum IL-6 levels were determined at the time of birth. The developmental status was evaluated using the Denver II test at the end of the two-year follow-up. RESULTS: HIE grade 3 resulted in 83% mortality rate and developmental delay among all survivors. The mean IL-6 level was 2.7 ng/ml in the control group (not affected HIE), which increased up to 29, 175, and 136 ng/ml in those with HIE grades of 1, 2, and 3, respectively. According to the ROC curve analysis, the cut-off level of 24 pg/ml could predict the developmental delay with sensitivity and specificity of 96 and 92%, respectively. CONCLUSION: The IL-6 level and HIE grade are potential prognostic biomarkers for the determination of mortality and morbidity in asphyxiated neonates.

Comparison of birth weights of neonates of mothers receiving vs. not receiving zinc supplement at pregnancy.

BACKGROUND: Zinc is an essential element for normal embryogenesis and embryonic and neonatal development. Therefore, we compared the birth weights of neonates born to mothers who consumed zinc supplement during pregnancy with that of neonates born to mothers who did not. METHODS: In a cross-sectional study, we divided 200 pregnant mothers into two groups: case group (mothers receiving zinc supplement during pregnancy) and control group (mothers not receiving zinc supplement during pregnancy) Then, the neonate's cord zinc level and mother's serum level were measured and neonate's growth charts (weight, height and head circumference)were completed. RESULTS: In this study, both groups of mothers were observed to have zinc deficiency; 35% of the mothers who consumed zinc supplements and 81% of the mothers who did not consume zinc supplements (P < 0.001). Based on the results, maternal serum of zinc (P < 0.001), neonatal birth weight (P = 0.008), maternal age (P < 0.001) and parity (P < 0.01) in zinc-supplemented group were higher. Neonatal birth weight was associated moderately with mother's zinc serum levels and poorly with neonatal serum zinc levels. CONCLUSION: Zinc consumption during pregnancy increases serum zinc level of mother and neonatal weight. Neonatal weight has a higher correlation to maternal serum zinc level.

Comparison of Umbilical Cord Serum Vitamin D Levels between Infants with Transient Tachypnea of the Newborn and those without Respiratory Distress.

BACKGROUND: Transient tachypnea of the newborn (TTN) is one of the most frequent causes of respiratory distress in neonates. A relationship has been shown between vitamin D deficiency and respiratory disorders in neonates. This research was carried out to evaluate the serum level of vitamin D in TTN newborns and their mothers compared to the control group. METHODS: This case-control research was conducted during 2016-2019 in a general hospital affiliated with Mashhad University of Medical Sciences, Iran. Thirty-four infants with TTN and 82 neonates in the control group as well as their mothers were investigated. The levels of umbilical cord serum vitamin D in infants with TTN and also their mothers were compared to the control group. RESULTS: The mean levels of serum vitamin D in infants with TTN and their mothers were 8.11 ± 4.32 and 12.6 ± 10.12 ng/mL, respectively (P<0.001), whereas they were 19.21 ± 12.71 and 25.96 ± 16.6 ng/mL in the newborns of the control group and their mothers, respectively (P<0.001). The mean differences (95% CI) of neonatal and maternal vitamin D level between the two groups were 11.10 (7.92-14.28) and 13.36 (7.90-18.08), respectively. In the TTN group, 100% of the infants had vitamin D levels less than 30 ng/mL (79.4% had severe, 17.6% had moderate and 2.9% showed mild deficiency). However, vitamin D levels lower than 30 ng/mL were observed in 76.4% of the neonates in the control group (28.8% had severe, 31.1% showed moderate and 16.3% had a mild deficiency) (P<0.001). CONCLUSION: The serum vitamin D levels of infants with TTN and their mothers were significantly lower than the control group. Therefore, TTN in infants may be reduced through the treatment of vitamin D deficiency in mothers.

Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis.

BACKGROUND AND OBJECTIVES: Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis. MATERIALS AND METHODS: This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data including cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied. RESULTS: Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale. CONCLUSION: The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respiratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leukocytes and proteins in CSF.

Evaluation of Maternal Risk Factors in Neonatal Hyperbilirubinemia.

BACKGROUND: Diagnosis and timely treatment of neonatal jaundice and prevention of dangerous side effects of pathologic neonatal jaundice remain a serious debate. The first step in prevention of jaundice is the identification of predisposing factors. The present study aims to systematically review the maternal risk factors of neonatal hyperbilirubinemia. METHODS: For this study, we searched databases including Science Direct, Cochrane Library, ISI, PubMed and Google Scholar from 1993 to 2017. The keywords searched based on MESH included hyperbilirubinemia, jaundice, infants, mothers and risk factors. The present systematic review was conducted on studies reporting maternal risk factors for neonatal jaundice. The inclusion criteria were: study on neonates; examination of maternal factors or both maternal and neonatal factors. Papers associated with the diagnosis and treatment of neonatal jaundice were excluded from the study, as well as those articles for which only abstracts were available. The limitations of this study include lack of access to all relevant articles, lack of qualified reports in some papers, and the limitation in number of articles related to maternal risk factors, and therefore inability to judge accurately about their effects on neonatal jaundice. RESULTS: Of 500 searched articles, 17 articles (1 prospective article, 2 retrospective papers, 12 cross-sectional papers and 2 historical cohort articles) were finally investigated. Maternal risk factors included hypertension, diabetes, type of delivery, vaginal bleeding, premature rupture of membranes (PROM), maternal age, lack of initiation of feeding during the first hours of life, inappropriate breastfeeding techniques and presence of maternal breast problems. CONCLUSION: The most common maternal risk factors for neonatal jaundice were prematurity, blood type incompatibilities, preeclampsia, hypertension, diabetes mellitus, vaginal bleeding, delivery problems (type of delivery, labor injuries, delivery at home, skin ecchymosis, and cephalohematoma), mothers and community cultural beliefs (use of traditional supplements), breast problems, and decrease in breastfeeding.

Predictive value of biochemical and hematological markers in prognosis of asphyxic infants.

BACKGROUND: Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in the prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications. METHODS: In this cohort with a two-year follow-up study with availability sampling, 196 term asphyxic infants were involved from 2009 to 2018. A researcher-designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1ß(IL-1ß), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student t- test, chi-square, ROC curve, and regression models. RESULTS: IL-6, IL-1ß, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in the prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in the prediction of complications of asphyxia were found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1ß were associated with increased unfavorable outcomes. CONCLUSION: Combinations of: IL-1ß+ IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6+ HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.