A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 1 Esophagus to Colon.

Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.

Perinatal factors influencing the neonatal hearing screening results.

BACKGROUND: Previous studies have indicated that the majority of cases with "failed" results related to transient evoked otoacoustic emissions (OAE) test have the normal hearing. The present study aimed to assess the possible relationships between perinatal factors and the false-positive OAE results. METHODS: A case-control study was carried out in an Iranian Hospital in 2020. Based on the OAE results on the first day of life, newborns were divided into 2 groups; Control group included subjects with "Pass" OAE results. Every neonate with "Fail" OAE result was referred for auditory brainstem response (ABR). Neonates with bilateral fail OAE but normal ABR results (false-positive OAE) were considered as the case group. All recorded data were analyzed to assess the possible correlations between maternal/neonatal factors and the false-positive OAE results. RESULTS: One hundred and eighty-one neonates entered the study. Of all included neonates, 87 (48.1%) cases showed bilateral fail OAE and 94 (51.9%) subjects passed the OAE test. Normal ABR results (false-positive OAE) were observed in all cases with bilateral fail OAE. Comparisons of variables affecting the OAE results showed that of all perinatal factors, neonate's sex (p = 0.046) and cesarean section (p = 0.003) were the only influencing factors that increased the risk of false-positive OAE results. CONCLUSION: Based on the results, the cesarean section delivery and neonate's male sex increased the risk of false-positive results related to OAE test. Implementing other screening tests such as ABR or Automated ABR as the initial screening test could be suggested for such cases.

Prediction of neonatal deaths in NICUs: development and validation of machine learning models.

BACKGROUND: Prediction of neonatal deaths in NICUs is important for benchmarking and evaluating healthcare services in NICUs. Application of machine learning techniques can improve physicians' ability to predict the neonatal deaths. The aim of this study was to present a neonatal death risk prediction model using machine learning techniques. METHODS: This study was conducted in Tehran, Iran in two phases. Initially, important risk factors in neonatal death were identified and then several machine learning models including Artificial Neural Network (ANN), decision tree (Random Forest (RF), C5.0 and CHART tree), Support Vector Machine (SVM), Bayesian Network and Ensemble models were developed. Finally, we prospectively applied these models to predict neonatal death in a NICU and followed up the neonates to compare the outcomes of these neonates with real outcomes. RESULTS: 17 factors were considered important in neonatal mortality prediction. The highest Area Under the Curve (AUC) was achieved for the SVM and Ensemble models with 0.98. The best precision and specificity were 0.98 and 0.94, respectively for the RF model. The highest accuracy, sensitivity and F-score were achieved for the SVM model with 0.94, 0.95 and 0.96, respectively. The best performance of models in prospective evaluation was for the ANN, C5.0 and CHAID tree models. CONCLUSION: Using the developed machine learning models can help physicians predict the neonatal deaths in NICUs.

Acyclovir extravasation in a newborn: a case report.

OBJECTIVE: Extravasation of infused drugs is not a rare problem in medical practice. Acyclovir is a vesicant and an antiviral medication commonly used for young children. In the present study, we presented a neonate with soft tissue damage due to acyclovir extravasation. CASE REPORT: A female newborn (Iranian, Asian) with gestational age 37+2 weeks and breech presentation was born by Cesarean delivery from a mother with a recent history of Herpes simplex virus (HSV) infection (Yas Women's Hospital, Tehran, Iran). Intravenous administration of acyclovir was initiated through a peripheral catheter inserted on the dorsal side of the left hand. A few minutes after the second dose, the patient showed a diffused firm swelling, local discoloration, and induration in the dorsum of the hand. The peripheral catheter was removed immediately. Hyaluronidase was injected subcutaneously in five different regions around the catheterization site. Intermittent limb elevation and cold compression (for 10 minutes) were applied. Serial follow-ups and examinations were performed hourly to check limb inflammation, ischemia, and compartment syndrome. The limb swelling and discoloration significantly improved 4 hours after the second dose of hyaluronidase. CONCLUSION: Early diagnosis of acyclovir extravasation and immediate management could prevent severe complications in neonates. Further studies are needed to suggest a standard approach and treatment protocol for acyclovir extravasation.

Towards solving the genetic diagnosis odyssey in Iranian patients with congenital anomalies.

Understanding the underlying causes of congenital anomalies (CAs) can be a complex diagnostic journey. We aimed to assess the efficiency of exome sequencing (ES) and chromosomal microarray analysis (CMA) in patients with CAs among a population with a high fraction of consanguineous marriage. Depending on the patient's symptoms and family history, karyotype/Quantitative Fluorescence- Polymerase Chain Reaction (QF-PCR) (n = 84), CMA (n = 81), ES (n = 79) or combined CMA and ES (n = 24) were performed on 168 probands (66 prenatal and 102 postnatal) with CAs. Twelve (14.28%) probands were diagnosed by karyotype/QF-PCR and seven (8.64%) others were diagnosed by CMA. ES findings were conclusive in 39 (49.36%) families, and 61.90% of them were novel variants. Also, 64.28% of these variants were identified in genes that follow recessive inheritance in CAs. The diagnostic rate (DR) of ES was significantly higher than that of CMA in children from consanguineous families (P = 0·0001). The highest DR by CMA was obtained in the non-consanguineous postnatal subgroup and by ES in the consanguineous prenatal subgroup. In a population that is highly consanguineous, our results suggest that ES may have a higher diagnostic yield than CMA and should be considered as the first-tier test in the evaluation of patients with congenital anomalies.

A case-based reasoning system for neonatal survival and LOS prediction in neonatal intensive care units: a development and validation study.

Early prediction of neonates' survival and Length of Stay (LOS) in Neonatal Intensive Care Units (NICU) is effective in decision-making. We developed an intelligent system to predict neonatal survival and LOS using the "Case-Based Reasoning" (CBR) method. We developed a web-based CBR system based on K-Nearest Neighborhood (KNN) on 1682 neonates and 17 variables for mortality and 13 variables for LOS and evaluated the system with 336 retrospectively collected data. We implemented the system in a NICU to externally validate the system and evaluate the system prediction acceptability and usability. Our internal validation on the balanced case base showed high accuracy (97.02%), and F-score (0.984) for survival prediction. The root Mean Square Error (RMSE) for LOS was 4.78 days. External validation on the balanced case base indicated high accuracy (98.91%), and F-score (0.993) to predict survival. RMSE for LOS was 3.27 days. Usability evaluation showed that more than half of the issues identified were related to appearance and rated as a low priority to be fixed. Acceptability assessment showed a high acceptance and confidence in responses. The usability score (80.71) indicated high system usability for neonatologists. This system is available at http://neonatalcdss.ir/ . Positive results of our system in terms of performance, acceptability, and usability indicated this system can be used to improve neonatal care.

The Efficacy and Safety of Rapamycin in Children with Tuberous Sclerosis: A Cross-sectional Study.

Objectives: Mutations in TSC1 or TSC2 genes have been proposed as the main causative factors responsible for developing Tuberous Sclerosis Complex (TSC). Given the effect of these two genes on the mTOR pathway, rapamycin has emerged as a novel therapeutic agent. The present study evaluated the effectiveness and safety of rapamycin on the multiple manifestations of TSC. Materials & Methods: Twenty-three eligible children were enrolled in the present cross-sectional study. They were prescribed rapamycin 1mg tablet twice daily for the first two weeks of treatment and then once daily for at least one year. Periodic evaluations through follow-up visits were performed. Besides, growth and developmental statuses were evaluated. All data, including the number and size of brain tuberomas, size of renal angiomyolipomas, and skin lesions, were gathered and recorded, and then analyzed. Results: During the study period, the mean number of epileptic episodes significantly reduced (p<0.0001), and nine cases were seizure-free at the final visit. The mean number of brain tuberomas decreased from 19.3±11.0 at the initial visit to 11.1±5.6 and 8.2±3.2 in the subsequent visits (p<0.001). The mean size of brain tuberomas similarly decreased from 17.9±18.5 cm at enrollment to 13.7±5.1 cm and 6.9±5.1 cm in the second and third visits, respectively (p=0.029). The mean size of renal angiomyolipomas significantly decreased (p<0.001). A significant trend toward a decrease in the number of skin lesions was observed (p<0.0001). No relationship was observed between the effects of rapamycin and the patient's age or sex (p>0.05). Changes in patients' growth and developmental features were not statistically significant through subsequent visits (p=0.507). Conclusion: This study revealed the effectiveness and safety of rapamycin on TSC among our patients.

Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter: a case report.

BACKGROUND: Although the use of a peripherally inserted central catheter (PICC) has many advantages for the treatment of neonates, catheter malposition may result in serious complications that could be life-threatening. We report the case of a 10-day-old neonate with cardiac tamponade secondary to a PICC line who was successfully treated by pericardiocentesis. CASE PRESENTATION: An Iranian (Asian) preterm male neonate was born by Cesarean section with a birth weight of 1190 g and a first-minute Apgar score of 7. Based on an increased respiratory distress syndrome (RDS) score from 4 to 7, resuscitation measures and intubation were performed at the neonatal intensive care unit (NICU). On day 3 after birth, a PICC line was inserted for parenteral therapy. A chest X-ray confirmed that the tip of the PICC line was in the appropriate position. Mechanical ventilation was discontinued 72 h post-NICU admission because of the improved respiratory condition. On the day 10 post-NICU admission, he suddenly developed hypotonia, apnea, hypoxia, hypotension, and bradycardia. Resuscitation and ventilation support were immediately started, and inotropic drugs were also given. Emergency echocardiography showed a severe pericardial effusion with tamponade. The PICC line was removed, and urgent pericardiocentesis was carried out. The respiratory situation gradually improved, the O2 saturation increased to 95%, and vital signs remained stable. CONCLUSIONS: Dramatic improvement of the neonate's clinical responses after pericardial drainage and PICC removal were suggestive of PICC displacement, pericardial perforation, and cardiac tamponade.

Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable?

BACKGROUND: Anticipating the need for at-birth cardiopulmonary resuscitation (CPR) in neonates is very important and complex. Timely identification and rapid CPR for neonates in the delivery room significantly reduce mortality and other neurological disabilities. The aim of this study was to create a prediction system for identifying the need for at-birth CPR in neonates based on Machine Learning (ML) algorithms. METHODS: In this study, 3,882 neonatal medical records were retrospectively reviewed. A total of 60 risk factors was extracted, and five ML algorithms of J48, Naïve Bayesian, multilayer perceptron, support vector machine (SVM), and random forest were compared to predict the need for at-birth CPR in neonates. Two types of resuscitation were considered: basic and advanced CPR. Using five feature selection algorithms, features were ranked based on importance, and important risk factors were identified using the ML algorithms. RESULTS: To predict the need for at-birth CPR in neonates, SVM using all risk factors reached 88.43% accuracy and F-measure of 88.4%, while J48 using only the four first important features reached 90.89% accuracy and F-measure of 90.9%. The most important risk factors were gestational age, delivery type, presentation, and mother's addiction. CONCLUSIONS: The proposed system can be useful in predicting the need for CPR in neonates in the delivery room.

Comparative analyses of umbilical cord lead concentration in term and IUGR complicated neonates.

BACKGROUND: Lead as a toxic heavy metal can readily transfer through the placenta; this condition may increase the risk of lead toxicity for a developing fetus. Therefore, we undertook this study to evaluate the association between umbilical cord blood lead levels and the risk of intrauterine growth restriction (IUGR) occurrence. METHODS: A cross-sectional study was done at an academic hospital (Tehran, Iran, 2017). The population study was term and IUGR complicated neonates. Immediately after birth, 3-ml umbilical cord blood was collected in some tubes and sent to a laboratory to assay plasma lead levels. Demographic data related neonates and their mothers were gathered from the medical record. All recorded data were analyzed to compare the cord blood lead levels among normal term and IUGR neonates as the primary outcome. RESULTS: Totally 152 neonates, 76 in each group with inclusion criteria entered the study. Of all neonates, 71 subjects (47%) were male. The mean (±SD) cord blood lead levels was 6.5 ± 4.2 µg/l. Of all neonates, 102 (67.1%) had high cord blood lead levels (≥5 µg/dl) and 50 subjects (32.8%) had low cord blood lead levels (<5 µg/dl). The mean gestational age, birth weight and head circumference of term neonates were significantly higher than IUGR complicated neonates (p-value = .0001). On the other hand, no significant difference was observed between two groups regarding the mean cord blood lead concentrations (6.2 ± 2.2 and 6.8 ± 5.6 µg/dl; p-value = .855). ANOVA analyses showed no relationships between cord blood lead levels and all assessed qualitative variables except from mother's educational status (in IUGR group; p-value = .048 and in term group; p-value = .010). CONCLUSION: Our results highlighted that IUGR occurrence was not associated with fetal blood lead levels alone. Moreover, highly educated mothers had neonates with low blood lead levels, showing that maternal education may be a potentially protective factor against this toxin exposure in newborns. The majority of neonates in the present study had high blood lead concentrations that show a necessity for more efforts and strategies regarding protection against potential deleterious effects of lead toxicity.

Timing of Elective Cesarean Section and Growth and Psychomotor Developmental Indices in 6-Month-Old Infants.

BACKGROUND: In the present study, we evaluated post-natal growth and psychomotor development status of infants at 6 months of age based on their gestational age at elective cesarean sections. METHODS: This is a prospective cohort study performed in 2014-2015 in Iran. The study population consisted of 6-month-old infants with gestational ages of 38-40 weeks delivered by elective cesarean section. The subjects were divided into 3 groups: Group A (neonates with gestational age of 380/7 weeks), group B (neonates with gestational age of 390/7 weeks), and group C (neonates with gestational age of 406/7 weeks). At the infant age of 6 months, the mothers were called for follow-up visits. Growth and psychomotor status of all subjects were assessed by expert pediatricians based on the Age and Stage Questionnaires. Recorded data related to outcomes in neonatal period and 6 months later were analyzed to determine associations between groups' variables. RESULTS: A total of 952 subjects were found eligible for study participation. The mean birth weight, length and head circumference were significantly higher in group C compared with the other groups (P=0.005). Regarding growth parameters, a significant association was found between gestational age at birth and all other growth indices at 6 months of age (P=0.005). The mean weight at 6 months of age was higher in group B in comparison with group A (P=0.001) and C (P=0.007). Infants born at 380/7 weeks were shorter in comparison with those born at 390/7 (P=0.002) and 406/7 weeks (P=0.005). Head circumference was significantly lower in group A than group B (P=0.02) and C (P=0.05). Regarding psychomotor indices at 6 months, a significant association was found between gestational age at birth and problem-solving skills (P=0.003). Delays in problem-solving skills were more frequent in neonates born at 380/7 weeks compared with those born at 390/7 (P=0.005) or 406/7 weeks (P=0.003). This difference was also significant between the two groups who were born at 390/7 and 406/7 weeks (P=0.01). CONCLUSION: The results from this study demonstrated that postponing the time of planned elective cesareans beyond 39 weeks of gestation may improve infant's growth and psychomotor outcomes.

Clinical Features and Laboratory Findings of Visceral Leishmaniasis in Children Referred To Children Medical Center Hospital, Tehran, Iran during 2004-2011.

BACKGROUND: Visceral leishmaniasis (VL) is one of the most important parasitic diseases endemic in northwestern and southern areas of Iran. The aim of the present study was to review the records of children hospitalized with VL in order to characterize the clinical features of children as well as laboratory finding in Children Medical Center Hospital, Tehran, Iran. METHODS: The medical records of all children with a final diagnosis of VL were reviewed from 2004 to 2011. Demographic, clinical information, laboratory finding and treatment were considered. RESULTS: A total number of 34 children with confirmed VL through 2004-2011 were included in the study. The most prevalent sign and symptoms were fever (97.1%), pallor and weakness (97.1%), appetite loss (61.8%), splenomegaly (97.1%) and hepatomegaly (88.2%). The most frequent laboratory abnormalities were hematological including anemia (97.1%), thrombocytopenia (91.2%) and leukopenia (67.6%). Direct agglutination test (DAT) was performed in 23 cases and all of them showed anti-Leishmania antibodies with titers of ≥ 1: 3200. In addition, 90% of patients had positive rK39 results. Identification of Leishmania in the aspirates of the bone marrow was found in 83.3% of patients. CONCLUSION: Regional surveillance system in order to monitoring of leishmaniasis trends as well as detection of new emerging foci is recommended.

Iron deficiency anemia in infants aged 12-15 months in Ahwaz, Iran.

BACKGROUND: Iron deficiency anemia (IDA) is one of the most common nutritional problems in the world, especially in developing countries. Infants aged between 4 and 24 months are among the population groups that are most affected by iron deficiency (ID). The aim of this study was to investigate the prevalence of ID and IDA in infants aged 12-15 months, living in Ahwaz, southwest of Iran. MATERIALS AND METHODS: One hundred and twenty-six infants participated in the study. The mean corpuscular volume and hemoglobin (Hb), serum ferritin and hematocrit levels were measured. Anemia was defined when Hb < 11 g/dL and ID when ferritin < 12 microg/mL. RESULTS: The prevalence of ID and IDA was 31.7 and 26.2%, respectively. The tendency to have IDA in infants fed with cow's milk and infants who did not receive ferrous sulfate was higher than in the other subjects. CONCLUSION: ID and IDA are common among infants aged 12-15 months living in Ahwaz, Iran. Maintenance of exclusive breastfeeding up to the 4-6th month of life and iron supplementation for the target group is needed.