Comparison of two regimens of vitamin D supplementation for vitamin D-deficient neonates.

INTRODUCTION: Vitamin D deficiency is common in pregnant women, and supplementation of vitamin D is necessary for the infants of these women. This study explored the efficacy of an alternative way of vitamin D supplementation in an area with a high prevalence of vitamin D deficiency in mothers. METHODS: This was a non-randomised clinical trial conducted in 2010 in Yazd, Iran. Full-term healthy infants born to vitamin D-deficient mothers (n = 82) were divided into the high-dose regimen (HDR; single oral bolus 30,000 IU vitamin D3, n = 34) and the standard-dose regimen (SDR; 400 IU/day vitamin D3 within two weeks of life, n = 48) groups. 25-hydroxyvitamin D (25OHD) was measured using chemiluminescent immunoassays, and 25OHD level > 20 ng/mL was deemed sufficient. RESULTS: Over 90% of infants in the HDR group attained vitamin D sufficiency within one month, while comparable sufficiency was reached in the SDR group only after four months. At two months, the proportion of infants attaining 25OHD > 30 ng/mL was 93.3% and 27.9% in the HDR and SDR groups, respectively (p = 0.003). None of our infants achieved 25OHD levels > 100 ng/mL. CONCLUSION: For infants born to vitamin D-deficient mothers, oral supplementation of 30,000 IU vitamin D3 during the first month of life, followed by a routine recommended dose of 400 IU/day, should be considered. The four-month lag for attaining vitamin D sufficiency in 90% of infants in the SDR group may have clinical implications and should be further investigated.

Neurological manifestations of an old disease: a case report.

OBJECTIVE: Neurological manifestations of neonatal disorders have various causes, among them neonatal tetanus, albeit rare, is a potentially fatal and preventable disease, which is seen in underdeveloped and developing countries. Although the disease has been eradicated from I.R. Iran, pregnant women immigrating to Iran from neighboring countries, especially from eastern border, may carry a risk of neonatal tetanus to the child due to inadequate tetanus immunization and inappropriate post-delivery care. It is then important to maintain a high index of suspicion for early diagnosis and prompt treatment, when infants present with poor feeding and abnormal behavior. Case presentation Here, we report the clinical course of a newborn with neonatal tetanus, who was admitted with complaints of poor feeding and muscle rigidity, more than a decade after eradication of the disorder.

Frequency of Hearing Impairment among Full-term Newborns in Yazd, Iran.

OBJECTIVE: Permanent congenital hearing loss, a common congenital anomaly, may affect speech and language acquisition, academic achievement and social development. Current standards emphasize early recognition of congenital hearing loss. This study was conducted to find the prevalence of hearing impairment in term newborns in Yazd, Iran. METHODS: This was a descriptive-analytic study conducted in Yazd on 7250 term newborns. Otoacoustic emissions (OAEs) test was performed in all newborns during the first 24 hours after birth. Those who failed to respond at the first step were retested 15 days later. Those who failed to respond at the second step too, were tested by acoustic brainstem responses (ABR) test. Chi square test was used for data analysis. FINDINGS: From 7250 newborns in the first step 598 (8.2%) and 682 (9.4%) ears (right and left, respectively) failed. In the second step 51 (0.7%) and 58 (0.8%) ears (right and left, respectively) failed. Consanguinity and route of delivery had significant effect on the frequency of hearing loss. CONCLUSION: The overall frequency of congenital hearing loss in this study was found high.

Single dose of 50 mg/kg clofibrate in jaundice of healthy term neonates: randomised clinical trial of efficacy and safety.

OBJECTIVE: To evaluate the effect of single oral dose of 50 mg/kg clofibrate in hyperbilirubinemia of term healthy neonates in Yazd, Iran. METHODS: A parallel single- blinded randomized clinical trial, conducted on 60 healthy term neonates admitted between July and December 2007 to Shahid Sadoughi Hospital. Inclusion criteria were neonates with gestation age of 38-42 wk, birth weight of 2500-4000 g, product of normal vaginal delivery, breast-fed and total serum bilirubin (TSB) level of 17-29.9 mg/dL. Neonates with sepsis, anemia, severe asphyxia, hemolytic diseases, major congenital anomalies, indirect hyperbilirubinemia and underlying hepatic disorders were excluded. Selection of patients was based on random allocation via table of random numbers and the patients distributed into two groups. In group one, 30 neonates were treated with phototherapy alone and in 30 of other group treatment done with single dose of 50 mg/kg clofibrate and phototherapy. The primary endpoint with respect to efficacy in reducing of TSB was achieving TSB to less than 14 mg/dL as measured at the beginning, 12, 24 and 48 h after the start of phototherapy. Secondary outcomes were hospital stay days, duration of phototherapy and side effects of treatments during hospital stay and on the second day after discharge. RESULTS: No significant differences were seen from the viewpoint of rout of delivery, gender, gestational age, birth weight, hemoglobin and bilirubin level at time of admission and weight in discharge time in the two groups. After 48 h of intervention, 27 (90%) neonates in clofibrate group and 15 (56.7%) in control group had TSB of less than 14 mg/dL (p 0.02). Mean TSB 12 h after treatment (mean ± SD: 14.82 ± 1.7 mg/dL vs. 16.67 ± 1.77 mg/dL, P 0.001), 24 h after treatment (mean ± SD: 11.97 ± 2.92 mg/dL vs. 14.61 ± 2.52 mg/dL, P 0.001) and 48 h after treatment (mean ± SD: 7.91 ± 2.45 mg/dL vs. 12.74 ± 2.21 mg/dL, P 0.0001), mean of hospital stay days (mean ± SD: 1.7 ± 0.7 days vs. 3.2 ± 1.2 days, P 0.03) and duration of phototherapy (mean ± SD: 30.2 ± 13.99 h vs. 46.2 ± 15.58 h, P 0.001] were significantly lower in clofibrate group. Only loose stool was seen in two patients of clofibrate group and no significant difference was seen from view of safety of the treatments. CONCLUSIONS: A single dose of 50 mg/kg clofibrate in treatment of neonatal hyperbilirubinemia is effective, safe and cost effective in view of reducing hospital stay days.

Growth parameters of NICU admitted low birth weight preterm neonates at corrected ages of 6 and 12 month.

BACKGROUND: Low birth weight (LBW or birth weight <2500 g) is one of the most serious health problems in today's world. OBJECTIVE: The purpose of this study was to evaluate growth parameters of neonatal intensive care unit (NICU) admitted LBW preterm neonates at corrected ages of 6 and 12 months. MATERIALS AND METHODS: In a prospective cohort (follow up) study, all LBW preterm neonates whom were admitted to Shahid Sadoughi Hospital NICU in 2008, followed up for one year and their weight, height and head circumference evaluated at ages of 6 and 12 months. RESULTS: Twenty four boys and 26 girls with mean gestational age of 31.3±2.7 weeks and mean birth weight of 1480.3±422.8gr were evaluated. The most frequency of underweight and short stature was seen at the age of six months. Exclusive breast feeding infants had the lowest frequency of underweight at the age of six. Frequency of underweight at the age of six months and NICU stay days were more in neonates with birth weight of less than 1000 gr. CONCLUSION: It is necessary to emphasize on the importance of growth assessment of LBW children and proper education of their mothers about nutrition of their children for early and timely diagnosis and management of growth retardation and prevention of subsequent problems.