Evaluation of intratracheal salbutamol effects in addition to surfactant in the clinical course of premature neonates with respiratory distress syndrome.

Background: In addition to surfactant deficiency, secretion of fluid from blood to the lungs and increase in the fluid content of the lung play significant roles in the pathogenesis of respiratory distress syndrome (RDS). Thus, we aimed to evaluate the effect of salbutamol (a beta-agonist) on fluid clearance from the lungs in neonates with RDS. Materials and Methods: This randomized controlled clinical trial included 82 neonates with RDS admitted to the neonatal intensive care units of Alzahra and Shahid Beheshti Hospitals of Isfahan University of Medical Science from 2017 to 2018. Patients were recruited through convenience sampling. They were randomized into two groups, using simple randomization: 42 were only treated with intra-tracheal surfactant (control group) and 40 with intra-tracheal surfactant plus salbutamol (intervention group). The two groups were compared regarding intubation surfactant administration and extubation (INSURE) failure, duration of nasal continuous positive airway pressure, intubation, oxygen therapy, morbidity, and mortality. Results: INSURE failure leading to mechanical ventilation occurred in 3 neonates in the control group and 2 in the intervention group (P = 0.680). Mean hospital length of stay did not differ significantly between groups (P = 0.230). Comparison of controls with the intervention group regarding complications and the incidence of morbidities revealed no statistically significant difference (P > 0.05). Conclusion: Findings of this study were not in favor of the routine use of salbutamol in neonates with RDS as it did not improve the course of the disease among newborns.

Effects of Vitamin E on Neonatal Hyperbilirubinemia in Preterm Newborns.

Background: Neonatal jaundice indicates the presence of pigment in the skin and sclera. Vitamin E is an important component of the cellular antioxidant defense system. Here in the present study, we aimed to evaluate and investigate these therapeutic effects. Materials and Methods: This is a randomized clinical trial performed on 100 premature neonates. Group 1 received 10 units of Vitamin E daily for 5 days. The other group received placebo. Amount of bilirubin was measured at the time of 0, 24, 48, 72, and 96 h after birth. Results: Mean bilirubin in Vitamin E group was increasing until the 2nd day and then got a decreasing trend. In the control group, the increasing trend of bilirubin was going on till the 3rd day. Mean bilirubin increased significantly during the follow-up in both Vitamin E and control groups (χ2 [df] = 20.23 (1), P < 0.001). Although both groups showed an increasing trend in mean bilirubin, on the last day of follow-up, the average amount of increase was lower in Vitamin E group (5.06 ± 2.25 vs. 6.23 ± 3.98). Also in the 3rd and 4th days, mean bilirubin was lower in Vitamin E group. Conclusion: This study supports the usage of oral Vitamin E therapies on reducing the bilirubin levels in neonates. We also showed that this reduced trend occurs after day 3 of life, but in the follow-ups, neonates who were treated with Vitamin E had lower bilirubin levels compared to the placebo group.

Which Site is Better for Skin Sensor Temperature Probe in Newborns Under Open Care System for Prevention of Hypo - Hyperthermia.

Background: Choosing the right temperature probe location is important, especially in VLBW infants. We aimed to determine five points of the skin surface and compare them with the axillary temperature of potentially suitable locations as well as the best location for skin probe placement. Methods: In a cross-sectional study, 400 neonates with gestational age above 26 weeks were enrolled. The axillary temperature was measured using a mercury thermometer at 0 and 30 min. Then, the body temperature was measured using a surface probe on the five skin areas, including the thoracic area, epigastric region, RUQ area, hypogastric area, and left flanking area. Data recorded were compared with the axillary temperature at 0 and 30 min. Results: Mean neonatal axillary temperatures at 0 and 30 min were 36.60 and 36.61, respectively. The mean temperature was recorded using skin probes at 0 and 30 min in the thoracic region (36.34 and 36.35) in the epigastric region (36.45 and 36.47), in the RUQ region (36.50 and 36.52), in the Flank region (36.26 and 36.20), and in the hypogastric region (36.24 and 36.26). The lowest mean difference recorded by surface probes with the temperature measured by the thermometer in the axillary region was related to the surface probe RUQ (mean difference: 0.1 and 0.09), which was not statistically significant. Conclusions: RUQ area probe has the lowest difference with the temperature calculated using the thermometer in the axillary region and is the best place to put the skin probe for prevention of hypo/hyperthermia.

Premedication with intravenous midazolam for neonatal endotracheal intubation: A double blind randomized controlled trial.

BACKGROUND: Pain during the neonatal period has been associated with immediate and long-term adverse effects. One of the most frequent painful procedures that neonates face in neonatal intensive care unit is the endotracheal intubation. Midazolam has been a candidate for premedication before neonatal intubation. Our aim was to evaluate the effects of midazolam as the premedication on endotracheal intubation of premature infants during surfactant administration. MATERIALS AND METHODS: In a double-blind clinical trial, 80 preterm infants were undertaken for tracheal intubation following the use of atropine associated to either midazolam or placebo. Patient's vital signs and general conditions were constantly monitored, and pain was assessed using premature infant pain profile (PIPP) score. RESULTS: The mean ± standard deviation for postnatal age was 95.38 ± 50.04 and 111.63 ± 49.4 min in control and midazolam groups, respectively. The patients in the midazolam group had significantly better outcomes across several intubation outcome measures such as duration of endotracheal intubation (23.5 ± 6.7 vs. 18.8 ± 4.8 s, P = 0.001), oxygen saturation level (88.05% ±13.7 vs. 95.1 ± 1.8%, P = 0.002), intubation failure (34.2% vs. 2.5%, P = 0.0001), awake and resistance during intubation (95% vs. 20%, P = 0.0001), and excellent patient condition during intubation (0% vs. 82.5%, P = 0.0001). In addition, PIPP score was significantly lower in the midazolam group (5.2 ± 2.06 vs. 12.9 ± 2.9, P = 0.0001). CONCLUSION: Premedication with midazolam in newborns before intubation, can hold promising effects that manifests as better overall outcomes, less complications, better vital signs, more comfortable situation, and lesser pain for these patients.

Protective Dressings, Injury, and Device Failure in Preterm Infants Receiving Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial.

OBJECTIVE: To investigate the protective effect of a hydrocolloid nasal dressing on the incidence and severity of nasal injury and continuous positive airway pressure (CPAP) failure in preterm infants receiving nasal CPAP (N-CPAP). METHODS: A randomized controlled trial was conducted over 4 months in 2019 at level 3 neonatal ICUs in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. Eighty eligible infants were born at 32 weeks of gestation or younger and/or with a birth weight of 1,500 g or less and had received between 4 and 72 hours of CPAP. Infants were randomly assigned to two groups; the intervention group used a protective dressing, and the control group received routine care. Data collection tools included a demographic questionnaire and nasal injury assessment score chart. MAIN OUTCOME MEASURES: The incidence and severity of nasal injury in preterm infants undergoing N-CPAP. RESULTS: Infants in the intervention group had a significantly lower incidence and severity of nasal injury compared with the control group: 15 of 40 (37.5%) versus 37 of 40 (92.5%; P < .001). Overall, the injuries identified in this study were mostly mild and moderate, with only three severe injuries in the intervention group and five in the control group. No significant differences were detected in CPAP failure (P > .05). CONCLUSIONS: The studied nasal barrier dressing is a safe and convenient solution to reduce nasal injury in preterm infants receiving N-CPAP.

Detection of bla CTX-M15 and bla OXA-48 genes in Gram-negative isolates from neonatal sepsis in central of Iran.

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the prevalence of neonatal sepsis with a focus on antibiotic resistance and the frequency of the bla CTX-M-15 and bla OXA-48 genes in Gram-negative isolates. MATERIALS AND METHODS: A total of 108 Umbilical Cord Blood (UCB) and 153 peripheral blood samples were cultured via BACTEC from May 2017 to June 2018. The bacterial isolates were identified using phenotypic and genotypic analyses. The antibiotic susceptibility profile of the isolates was determined by disk diffusion. PCR was used to determine the frequency of ß-lactamase genes. RESULTS: Among the 153 infants, 21 (13.7%) proved positive for sepsis. Escherichia coli, Staphylococcus epidermidis and Klebsiella pneumoniae were the most frequent isolates in the peripheral blood cultures. E. coli and Stenotrophomonas maltophilia were isolated from two UCB cultures. The highest resistance among the Gram-positive strains was to cefixime, ceftriaxone, cefotaxime and clindamycin. In the Gram-negative bacteria the highest rates of resistance were to ampicillin (91.7%). The frequency of bla OXA-48 and bla CTX-M-15 genes was 25% and 50%, respectively. CONCLUSION: The high antibiotic resistance among the isolates reveals the importance of monitoring antibiotic consumption and improving control standards in the health care system, especially in neonatal wards.

The Investigation of Rate of Birth Asphyxia and its Relationship with Delivery Mode at Shahid Beheshti Hospital of Isfahan during 2013, 2014, and 2015.

BACKGROUND: Birth asphyxia is considered as one of the biggest challenges faced by perinatal care experts. According to the WHO, in 2005, one-fourth of infant mortality cases occurred due to birth asphyxia. METHODS: This study is a retrospective study done on the newborn population with gestational ages of 36 weeks or higher during the years 2013, 2014, and 2015 to find the relationship between the number of birth asphyxia cases and the years. As a secondary objective, the relationship between the mode of delivery and the cases of birth asphyxia were investigated using logistic regression test. The inclusion criteria consisted of three cases, namely, gestational age of 36 weeks or higher, 5 min Apgar of <5, and umbilical cord pH of <7.1. The exclusion criteria involved hydrops fetalis, cyanotic heart disease, chromosomal abnormality, and congenital infections. RESULTS: From the two independent variables of the study, only the variable "year" showed a significant difference between the years 2013 and 2015 (P < 0.01). The delivery mode did not have any statistically significant influence on the newborns' affliction with birth asphyxia (P = 0.993). CONCLUSIONS: According to the results, there is a significant difference between the rate of birth asphyxia in Iran and its global rate in 2015, and regarding its multiple growth from 2013 to 2015, conducting a more comprehensive and extensive research on birth asphyxia risk factors at a delivery time seems justified and inevitable.

Investigating the Effect of Reflexology on the Breast Milk Volume of Preterm Infants' Mothers.

BACKGROUND: Reflexology is an interventional method which may lead to improved breast milk. Because the mechanism of milk production is complex, detailed research is required on the relationship between lactation and reflexology. Therefore, the aim of the present study was to determine the effect of reflexology on the volume of milk among mothers with premature infants. MATERIALS AND METHODS: This clinical trial was conducted among 50 mothers with premature infants in two groups of 25 patients admitted to the neonatal intensive care unit of Alzahra and Shahid Beheshti hospitals of Isfahan, Iran from August 2015 to November 2015. The patients were selected through convenience sampling method and divided into control and reflexology groups through random allocation. In the reflexology group, massage of the sole of the foot and foot was done in six sessions. The control group received regular breastfeeding training. Data were analyzed using descriptive and inferential statistics. RESULTS: Repeated-measures analysis of variance test indicated that the mean volume of breast milk in reflexology group (F = 44.002, p < 0.001) and control group (F = 43.09, p < 0.001) differed significantly at different times. Independent t-test showed that the mean increase in milk volume from day 1 to day 5 after the intervention compared to before the intervention was significantly higher in the reflexology group compared to the control group 1days after the intervention (t=5.25, p <0.001), 2 days after the intervention (t= 4.81, p <0.001), 3 days after the intervention (t=3.55, p =0.001), 4 days after the intervention (t= 2.98, p =0.004), 5 days after the intervention (t= 2.50, p =0.020). CONCLUSIONS: The results indicate that reflexology is effective on the volume of milk of mothers, and this low-cost and easy procedure can be used along with regular lactation training.

A New Case of Neu-Laxova Syndrome: Infant with Facial Dysmorphism, Arthrogryposis, Ichthyosis, and Microcephalia.

Neu-Laxova syndrome (NLS) is an autosomal recessive disorder characterized by central nervous system anomalies, facial dysmorphic features, anomalies of limb and genitalia, intrauterine growth retardation, skin disorders, and other congenital abnormalities. In this article, we present a newborn infant who was born with facial dysmorphic features, flat nose, ichthyosis, rocker bottom feet, and fixed flexion contractures. We believe that these clinical findings in this patient are consistent with features of NLS.

The Effect of Inhaled Budesonide on the Prevention of Chronic Lung Disease in Premature Neonates with Respiratory Distress Syndrome.

BACKGROUND: Considering all the latest achievements in neonatal respiratory care, bronchopulmonary dysplasia (BPD) is still among the most prevalent morbidity causes in premature infants. Involvement in this process results in longer period of hospitalization for the newborn and in the long run makes the living conditions more difficult. Taking the multifactorial pathogenesis into account, approaches to tackle chronic lung disease (CLD) are mainly focused on interventions and prevention procedures. This study tries to investigate the potential capability of inhaled budesonide in the prevention of BPD in newborns with gestational age of <28 weeks with the respiratory distress syndrome (RDS). METHODS: This study was a randomized clinical trial done on seventy newborns with gestational ages of 23-28 weeks with RDS in Isfahan Shahid Beheshti Educational Hospital from June 2014 to April 2016. Patients were randomly assigned to two groups of intervention with budesonide and control. There were 35 newborns in each group. Upon recording demographic characteristics, the newborns in two groups were compared based on the length of noninvasive ventilation, the need for invasive mechanical ventilation, the number of surfactant administrations, pneumothorax, intraventricular hemorrhage, patent ductus arteriosus (PDA), CLD, and death. RESULTS: The length of the need for nasal continuous positive airway pressure showed no statistically significant difference between the groups (P = 0.54). The number of newborns who needed invasive mechanical ventilation also revealed no meaningful difference (P = 0.14). Similarly, the number of newborns who were characterized as affected by CLD also showed no significant difference between the groups (P = 0.053). Moreover, the number of newborns who experienced pneumothorax was not significantly different for the groups (P = 0.057). The number of newborns who received three administrations of surfactant had also no statistically meaningful difference between the groups (P = 0.69). However, the number of newborns who received two doses of surfactant was statistically lower in budesonide intervention group than the control (P = 0.041). The prevalence of intraventricular hemorrhage with degrees of I, II, and III also showed no statistically meaningful difference between the groups with P = 0.74, 0.32, and 0.49, respectively. The occurrence of PDA had no meaningful difference between the groups (P = 0.66). Relative death cases also revealed no significant difference between the groups (P = 0.53). CONCLUSIONS: The current study revealed a decrease in CLD prevalence for newborns in interventional group; however, this decrease was not statistically meaningful. The newborns, in the intervention group, who had received two doses of surfactant (survanta) showed a significant decrease, which can be the basis for further research in this field.

Comparison of Nurses and Parents' Viewpoints Regarding the Needs of Parents of Premature Infants in Neonatal Intensive Care Units.

BACKGROUND: The birth of a premature infant and her/his hospitalization can cause the parents to experience a variety of needs. Understanding the needs of parents by nurses can lead to provision of high quality care to premature infants. This study aimed to compare the parents' and nurses' viewpoints regarding parents' needs in the neonatal intensive care units (NICU). MATERIALS AND METHODS: In this descriptive cross-sectional study, 63 nurses, 120 mothers, and 120 fathers, who met the inclusion criteria, participated. Nurses were selected through a census method and parents through a simple convenience sampling method. Data were gathered using a researcher-made questionnaire and were analyzed using descriptive-analytic statistical methods in the Statistical Package for the Social Sciences software version 16. RESULTS: From the viewpoint of mothers, the need for assurance with a mean score of 87.4 was the most important and the need for support with a mean score of 71.37 was the least important need. From the perspective of fathers, the need for assurance with a mean score of 78.5 was the most important and the need for support with a mean score of 51.20 was the least important need. From the viewpoint of the nurses, the need for assurance with a mean score of 77.6 was the most important and the need for support with a mean score of 59.77 was the least important need. The mean scores of the needs of mothers in all subscales were higher than that of the fathers' and nurses' (P < 0.001). CONCLUSIONS: From the viewpoint of nurses, the scores of parents' needs were significantly less than that of the parents' for all subscales. It is suggested that appropriate education programs be provided for nurses regarding how they can understand parents' needs to provide high quality care.

A Comparative Study of the Effect of Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure on the Regional Brain Tissue Oximetry in Premature Newborns Weighing <1500 g.

BACKGROUND: Near-infrared spectroscopy (NIRS) provides the capability of monitoring oxygenation levels in cerebral microscopic vessels, enabling the operator to observe the spontaneous changes in the levels of hemoglobin concentration in tissue and interpret the resulting fluctuations. The current study tried to investigate whether brain's autoregulatory mechanisms in premature newborns have the potential to prevent the adverse effects caused by asynchronous changes of pressure in the rib cage. Therefore, NIRS method was applied to newborns that were alternatively shifted from nasal continuous positive airway pressure (nCPAP) to nasal intermittent positive pressure ventilation (NIPPV) and vice versa. METHODS: This study was done as a crossover randomized clinical trial on 30 very low-weight newborns under nCPAP, who had received surfactant as a result of respiratory distress syndrome diagnosis, from April 2015 to April 2016, in Isfahan Shahid Beheshti Educational Hospital. The newborns were 72 h old, experiencing continuous distending pressure (CDP) = 4-6 cmH2O with FiO2 = 30%-40%. The respiratory support would alternate from nCPAP to NIPPV and vice versa (with indicators of expiratory PAP (EPAP) = CDP and inspiratory PAP = EPAP + 4 cmH2O), and the cerebral regional oxygen saturation (CrSO2) was monitored using NIRS. RESULTS: The study results indicated that newborns significantly showed higher levels of CrSO2(84.93, P = 0.005) and oxygenation (94.63, P = 0.007) under nCPAP rather than NIPPV (82.43 and 93.43, respectively). The respiratory rate was also meaningfully slower when newborns were under nCPAP (P = 0.013). CONCLUSIONS: This study revealed that applying NIPPV may have an unfavorable effect on the premature newborn's brain tissue perfusion. However, more studies are needed to ensure solid outcomes.

The effect of neutral oligosaccharides on fecal microbiota in premature infants fed exclusively with breast milk: A randomized clinical trial.

OBJECTIVE: This study was designed to compare the efficacy and safety of enteral supplementation of a prebiotic mixture (SCGOS/LCFOS) on faecal microbiota in very premature infants who fed exclusively with human-milk. METHODS: This double-center randomized control trial was conducted from December 2012 to November 2013 in the tertiary Neonatal Intensive Care Units of the Isfahan University of Medical Sciences. Fifty preterm infants (birth weight ≤1500 g who were not fed with formula) were randomly allocated to have enteral (tube feeding) supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or receive no prebiotics. FINDINGS: The primary outcome (e.g., the effect of the prebiotic mixture on fecal microbiota pattern) was clearly different between the two groups. Despite greater coliforms colony counts in first stool cultures in the prebiotic group (Group P) (P = 0.67), coliforms were significantly lower in the third stool cultures in the Group P (P < 0.001). Furthermore, despite the much higher Lactobacillus colony counts, in the first stool cultures, in the control group (Group C) (P = 0.005); there was a trend toward significantly increased Lactobacillus colony counts in the Group P during the study, but the difference between Lactobacillus colony counts, in the third stool cultures, between two groups was no longer statistically significant (P = 0.11). Interestingly, the median length of hospital stay was significantly less in the Group P (16 [12.50-23.50] vs. 25 [19.50-33.00] days; P = 0.003). CONCLUSION: This suggests that it might have been "the complete removal of formula" which manifests a synergistic effect between nonhuman neutral oligosaccharides (prebiotics) and human oligosaccharides, which in turn, led to the rapid growth of beneficial Lactobacillus colonies in the gut of breast milk-fed preterm infants, while decreasing the number of pathogenic coliforms microorganisms. Therefore, further studies with larger sample sizes are recommended to investigate the issue.

A Comparison of the Effect of Nasal bi-level Positive Airway Pressure and Sigh-positive Airway Pressure on the Treatment of the Preterm Newborns Weighing Less than 1500 g Affiliated with Respiratory Distress Syndrome.

BACKGROUND: Nowadays, administering noninvasive positive airway pressure (PAP) is considered as the building block for the management of respiratory distress syndrome (RDS). Since nasal continuous PAP (n-CPAP) established its roots as an interventional approach to treat RDS, there have always been concerns related to the increased work of breathing in newborns treated with this intervention. Therefore, respiratory support systems such as nasal bi-level PAP (N-BiPAP) and sigh-PAP (SiPAP) have been developed during the last decade. In this study, two respiratory support systems which, unlike n-CPAP, are categorized as cycled noninvasive ventilation, are studied. METHODS: This study was a randomized clinical trial done on 74 newborns weighing 1500 g or less affiliated with RDS hospitalized in NICU at Al-Zahra Hospital from October 2012 to March 2014. Patients were randomly assigned to two respiratory support groups of N-BiPAP and SiPAP. Each group contained 37 newborns who were compared, according to their demographic characteristics, duration of noninvasive ventilation, the need to administer surfactant, apnea incidence, the need for mechanical ventilation, pneumothorax, intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), the duration of oxygen supplement administration, and chronic lung disease (CLD). RESULTS: The average duration of noninvasive respiratory support, and the average duration of the need for oxygen supplement had no significant difference between the groups. Moreover, apnea incidence, the need for mechanical ventilation, pneumothorax, IVH, PDA, CLD, the need for the second dose of surfactant, and the death rate showed no significant difference in two groups. CONCLUSIONS: In this study, SiPAP showed no significant clinical preference over N-BiPAP in the treatment of the newborns with RDS weighing <1500 g.

Analysis and comparison of the effects of N-BiPAP and Bubble-CPAP in treatment of preterm newborns with the weight of below 1500 grams affiliated with respiratory distress syndrome: A randomised clinical trial.

BACKGROUND: Nowadays, establishment of nCPAP and surfactant administration is considered to be the first level of intervention for newborns engaged in the process of Respiratory Distress Syndrome (RDS). In order to decrease the side effects of the nCPAP management placed in noninvasive-non-cycled respiratory support. Noninvasive-cycled respiratory support mechanism have been developed such as N-BiPAP. Therefore, we compared N-BiPAP with Bubble-CPAP in a clinical trial. MATERIALS AND METHODS: This research was done as an on newborns weighing less than 1500 grams affiliated with RDS. A3 The total number of newborns was 70. Newborns were divided into two groups with the sample size of 35 patients in each, according to odd and even document numbers. One group was treated with N-BiPAP and the other with Bubble-CPAP. Patients were compared according to the length of treatment with noninvasive respiratory support, length of oxygen intake, number of surfactant doses administered, need for invasive mechanical ventilation, apnea, patent ductus arteriosus (PDA), chronic lung disease, intraventricular hemorrhage, pneumothorax, and death. Data was recorded and compared. RESULTS: The average duration for noninvasive respiratory support and the average time of need to complementary oxygen was not significantly different in both groups (P value > 0.05). Need for invasive ventilation, also chronic lung disease, intraventricular hemorrhage (IVH), pneumothorax, need for the next dose of surfactant, and the death rate did also have no meaningful difference. (P value > 0.05). CONCLUSION: In this research N-BiPAP did not show any obvious clinical preference over the Bubble-CPAP in treatment of newborns weighing less than 1500 grams and affiliated with RDS.

The Effect of Neutral Oligosaccharides on Reducing the Incidence of Necrotizing Enterocolitis in Preterm infants: A Randomized Clinical Trial.

BACKGROUND: Necrotizing enterocolitis (NEC) is one of the most destructive diseases associated with conditions of neonatal prematurity. Supplementation with enteral prebiotics may reduce the incidence of NEC, especially in infants who fed exclusively with breast-milk. Therefore, we compared the efficacy and safety of enteral supplementation of a prebiotic mixture (short chain galacto-oligosaccharides/long chain fructo-oligosaccharides [SCGOS/LCFOS]) versus no intervention on incidence of NEC in preterm infants. METHODS: In a single-center randomized control trial 75 preterm infants (birth weight [BW] ≤1500 g, gestational age ≤34 weeks and were not fed with formula) on 30 ml/kg/day volume of breast-milk were randomly allocated to have enteral supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or not receive any prebiotic. The incidence of suspected NEC, feeding intolerance, time to full enteral feeds, duration of hospitalization were investigated. RESULTS: Differences in demographic characteristics were not statistically important. SCGOS/LCFOS mixture significantly reduced the incidence of suspected NEC, (1 [4.0%] vs. 11 [22.0%]; hazard ratio: 0.49 [95% confidence interval: 0.29-0.84]; P = 0.002), and time to full enteral feeds (11 [7-21] vs. 14 [8-36] days; P - 0.02]. Also duration of hospitalization was meaningfully shorter in the prebiotic group (16 [9-45] vs. 25 [11-80]; P - 0.004]. Prebiotic oligosaccharides were well tolerated by very low BW (VLBW) infants. CONCLUSIONS: Enteral supplementation with prebiotic significantly reduced the incidence of NEC in VLBW infants who were fed exclusively breast-milk. This finding suggests that it might have been the complete removal of formula which caused a synergistic effect between nonhuman neutral oligosaccharides (prebiotic) and human oligosaccharides.

Suprapubic Bladder Aspiration or Urethral Catheterization: Which is More Painful in Uncircumcised Male Newborns?

BACKGROUND: The aim was to compare the intensity of pain caused by suprapubic aspiration (SPA) and urethral catheterization for urine sampling in premature infants. METHODS: A prospective randomized controlled design with 80 premature infants in Alzahra University Hospital, Isfahan, Iran was conducted. Premature newborns who needed urine samples for microbiologic analysis were randomly assigned into two groups: SPA group and urethral catheterization group. Newborn faces and upper parts of the body were videotaped during the study and the pain was assessed during urine collection using Premature Infant Pain Profile (PIPP) score. Furthermore, crying time compared between groups. RESULTS: The mean crying time was significantly higher in SPA than urethral catheterization group (77 vs. 34.4 s) (P < 0.001). The PIPP score was significantly lower in urethral catheterization group (13.4) than SPA group (11.5) P < 0.001. The success rate of SPA was 53% compared with 71% success rate of urethral catheterization. CONCLUSIONS: SPA is more painful than urethral catheterization in premature male infants as assessed by PIPP score and is more likely leads to procedure failure.

A comparison between the effect of fluorescent lamps and quartz halogen incandescent filament lamps on the treatment of hyperbilirobinemia in newborns with the gestational age of 35 weeks or more.

BACKGROUND: Icter is the most prevalent disease in newborns. Although most of the newborns affiliated with this seem healthy in other aspects, there is always a fear for toxic complication of indirect hyperbilirobinemia in the central nervous system. Nowadays phototherapy is the method of decreasing (or avoidance of increase) of total serum bilirobin (TSB) and it is also used widely in neonatal health care centers according to the availably of equipment, but without any defined standard. In this study, two light sources, quarts halogen incandescent filament lamp (QHIFL) and fluorescent lamp (FL) are compared with each other to find out which method is more useful and efficient. METHODS: This study is a randomized controlled trial done on 25 newborns with gestational age of 35 weeks or more, with newborn's icter in the 1(st) week after birth, at Isfahan Behesti Hospital, February 2012 to March 2013. A group of these newborns was treated with FL and the other with QHIFL and they all were controlled and tested according to their level of TSB at the beginning of phototherapy, at 8(th), 12(th), and 24(th) h of treatment and at discharge. The data from the study was analyzed by IBM SPSS Statistics Version 21. RESULTS: According to the findings, the level of TSB before and 8 h after the intervention had no significant difference among the groups. However, at 16(th) and 24(th) h of treatment, the TSB level was lower in the FL group and this difference was meaningful (P = 0.002 and P = 0.013 respectively). Furthermore the duration of the treatment was significantly shorter in FL group meaningfully (P = 0.047). CONCLUSIONS: According to the findings of this study, the technology used in QHIFL cannot show the capabilities of the FLs. However, more studies are needed to confirm the findings of this study are universal.

A comparison of two interventions for HHHFNC in preterm infants weighing 1,000 to 1,500 g in the recovery period of newborn RDS.

BACKGROUND: Nasal cannula, beside administering low-flow therapy, showed the capability for the administration of continuous positive airway pressure (CPAP) through high-flow nasal cannula (HFNC). Meeting specific physical criteria of 100% relative humidity (RH) and temperature of 37(°)C are the basic interventional requirements to administer oxygen for the newborns through a nasal cannula. Recently, two systems, MR850 and PMH7000, received the Food and Drug Administration (FDA) approval to administer heated, humidified HFNC (HHHFNC). These systems are evaluated in this study based on their humidifying and heating capabilities. MATERIALS AND METHODS: This study was done as an RCT on newborns weighing 1,000 to 1,500 g recovering from respiratory distress syndrome (RDS) while nCPAP was administered at CDP = 4 cmH2O, Fio2 <30%. Patients were randomized to two groups of 35 receiving HHHFNC after treatment with nCPAP, with one group using MR850 humidifier and the other PMH7000. The patients were compared according to the duration of HHHFNC administration, repeated need for nCPAP respiratory support, the need for invasive ventilation, apnea, chronic lung disease (CLD), nasal trauma, RH, and temperature of the gases. RESULTS: The average time of support with HHHNFC did not show any significant difference in the two groups. There was no significant difference between the groups in the need for nCPAP, invasive ventilation, apnea, nasal trauma, and CLD. The difference in the levels of average temperature and humidity was significant (P value <0.001). CONCLUSION: Although the records of temperature and RH in the PMH7000 system was lower than the records from the MR850 system, no clinical priority was observed for respiratory support with HHHNFC in the two systems.

A comparison of surfactant administration through i-gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams.

BACKGROUND: Surfactant administration together with nasal Continuous Positive Airway Pressure (nCPAP) administration is considered to be the basis for Newborn's Respiratory Distress Syndrome (RDS) management. This study evaluated the method of directing the surfactant to the lungs in newborns affiliated with RDS through i-gel (i-gel surfactant administration/i-gelSA) compared to the standard care INSURE method, in a clinical trial. MATERIALS AND METHODS: This randomized control trial (RCT) was done on newborns weighing ≥2000 g, with RDS, while being supported with Bubble-CPAP. Newborns, which required FiO2 ≥0.3 under Continuous Distending Pressure (CDP) ≥5 cm H2O for more than 30 minutes to maintain SpO2 in the range of 89 - 95%, were given 100 mg/kg of Survanta. In the interventional group or the i-gelSA (i-gel Surfactant Administration) group, 35 newborns experienced surfactant administration with i-gel and 35 newborns in the control or INSURE group. The average a/APO2 before and after surfactant administration, repeated need for surfactant administration, average nCPAP duration, need for invasive mechanical ventilation, pneumothorax, and the average duration of hospitalization in the Neonatal Intensive Care Unit (NICU) were compared. RESULTS: Although the average a/APO2 showed no significant difference before the procedure; in the i-gelSA group, this average was meaningfully higher after the administration of the surfactant (P = 0.001). The other factors showed no significant difference. CONCLUSION: According to the results of this study, the surfactant administration using i-gel was more successful in oxygenation improvement than the INSURE method, and the i-gel method could even be promoted to the standard care position. However, more research is needed in this area.