The effect of behavioral therapy based counseling with anxious mothers on their infants' colic: a randomized controlled clinical trial.

BACKGROUND: Given the possible effect of maternal anxiety on the severity of colic pain in infants, this study aimed to investigate the effects of behavioral therapy counseling on infantile colic (primary outcome), maternal anxiety, and mother-infant attachment (secondary outcomes) in anxious mothers with colicky infants. METHOD: This randomized controlled clinical trial was conducted on 46 anxious mothers of 2-6-weeks-old exclusively breastfed colicky infants who had a score of 112 and above according to the Postpartum Specific Anxiety Scale (PSAS), reffered to the pediatric clinics of Al-Zahra, Taleghani and Children Hospitals of Tabriz, Iran. The participants were randomly assigned to the intervention (n = 23) and control (n = 23) groups using randomized block design. Mothers in the intervention group attended 8 systematic desensitization counseling sessions (2-3 sessions per week). Those in the control group received routine care. The researcher completed the Postpartum Specific Anxiety Scale (PSAS), Mother-Infant Attachment Questionnaire (MIAQ), and Infant Colic Scale (ICS) by interviewing the participants before and two weeks after the intervention. RESULTS: There was no significant difference between the intervention and control groups in the socio-demographic profile of participants. After the intervention, the mean postpartum anxiety score of women in the intervention group was significantly lower than that of those in the control group (Mean Difference (MD) = 22.5, 95% Confidence Interval (CI) = 2.3 to 42.7; p = 0.029). The mean infant colic score of the infants of mothers in the intervention group was insignificantly lower than that of those in the control group (MD = -2.9, 95% CI = -8.3 to 2.4; p = 0.271). In addition, no significant difference was observed between the two groups in terms of their mean mother-infant attachment scores (MD = -0.04, 95% CI = -3.1 to 0.3; p = 0.976). CONCLUSION: Behavioral therapy counseling effectively reduced postpartum anxiety in women with colicky infants; however, this reduction did not lead to a significant decrease in the infants' colic pain. Therefore, health care providers are recommended to use this counseling method in combination with other effective counseling approaches to promote mental health of these mothers. TRIAL REGISTRATION: IRCT Registration Number: IRCT20111219008459N14, registered on 08/10/2020. https://irct.ir/user/trial/45949/view.

Evaluation of melatonin efficacy in prevention of bronchopulmonary dysplasia in preterm newborn infants.

BACKGROUND: Excessive production of reactive oxygen species play an important role in the pathogenesis of bronchopulmonary dysplasia (BPD). Melatonin is an effective antioxidant and free radical scavenger. The aim of this study was to evaluate the efficacy of melatonin in the prevention of BPD in preterm infants with respiratory distress syndrome. METHODS: In a randomized clinical trial, 80 preterm newborn infants with respiratory distress syndrome and gestation age of 27-32 weeks were allocated randomly in two groups. Group A consisted of 40 neonates who received surfactant with the INSURE technique. Patients in group B received melatonin 5mg/kg /day per gastric tube for 3 days in addition to the surfactant. The primary outcome was on the occurrence of BPD. The secondary outcome was considered other complications of prematurity, duration of hospital stay and mortality. RESULTS: The mean gestational age and birth weight of studied patients were 31.3±3.8 weeks and 1189±84 grams, respectively. Thirty-five (43.8%) patients were girls and 45 (56.2%) were boys. BPD was diagnosed in 24 (60%) neonates of group A and 18 (45%) patients in group B, p=0.02. The duration of hospital stay, need for mechanical ventilation and mortality rate were significantly lower in patients in group B (p=0.02, 0.003, 0.009 respectively). CONCLUSIONS: Our study results showed that BPD, mortality and hospital stay reduced with melatonin treatment in preterm infants. However, future studies with a larger number of patients are needed to confirm these beneficial effects.

The efficacy of intratracheal administration of surfactant and budesonide combination in the prevention of bronchopulmonary dysplasia.

BACKGROUND: Bronchopulmonary dysplasia (BPD) remains a major problem in preterm infants that occurs in up to 50% of preterm infants. The inflammation plays an important role in its pathogenesis. This study was conducted to evaluate the efficacy intratracheal budesonide administration in combination with surfactant in the prevention of BPD in preterm infants. MATERIALS AND METHODS: In a randomized controlled clinical trial, 128 preterm infants with gestation age <30 weeks and birth weight <1250 g who had respiratory distress syndrome (RDS) and need surfactant replacement therapy were studied. They randomly allocated into two groups, surfactant group (n = 64) and surfactant + budesonide group (n = 64). Patients were followed till discharge for the primary outcome which was BPD. RESULTS: The mean gestation age and birth weight of studied neonates were 28.3 ± 1.6 weeks and 1072 ± 180 g, respectively. BPD was occurred in 20 (31.3%) neonates in surfactant + budesonide group and 38 (59.4%) patients in surfactant group, P = 0.02. Respiratory support was needed in two groups similarly, but the mean duration of respiratory support was significantly longer in surfactant group in comparison with surfactant + budesonide group (mechanical ventilation 2.8 ± 0.6 vs. 0.8 ± 0.1 days, P = 0.006, nasal continuous positive airway pressure 5.2 ± 3.0 vs. 4.0 ± 3.5 days, P = 0.04 and high flow nasal cannula 7.7 ± 0.9 vs. 4.1 ± 0.5 days, P = 0.001). CONCLUSION: Based on our findings, the use of budesonide in addition to surfactant for rescue therapy of RDS significantly decreases the incidence of BPD and duration of respiratory support. Future studies are recommended with a large number of patients before routine administration of surfactant and budesonide combination.

Evaluating the effects of different doses of ursodeoxycholic acid on neonatal jaundice.

BACKGROUND: Icterus tends to be one of the most prevalent causes of neonatal hospitalization. The present study aimed to evaluate the effects of the different doses of ursodeoxycholic acid (UDCA) on neonatal jaundice. METHOD: In this study, 120 newborns who were hospitalized for phototherapy were randomly assigned. Group A received phototherapy and UDCA 5 mg/kg/dose every 12 hours orally, group B patients were treated with phototherapy and UDCA 7.5 mg/kg/dose every 12 hours orally. Group C received phototherapy with a placebo. All patients were evaluated for bilirubin levels, the duration of phototherapy, and the length of hospital stay. RESULTS: The mean bilirubin level at hospital admission was 19.88 ± 2.33 mg/dl in group A, 19.33 ± 2.51 mg/ dl in group B, and 19.76 ± 2.64 mg/dl in group C (p= 0.58). The groups receiving phototherapy with UDCA showed a significant decrease in the bilirubin level. Bilirubin level decreased to 10.04 ± 1.11mg/dl in group A, 8.82 ± 1.11 mg/dl in group B, and 12.04 ± 2.05 mg/dl in group C (p= 0.000). Furthermore, the mean duration of phototherapy, as well as the average length of hospital stay, were significantly lower in group B as compared to the other groups (p= 0.000). CONCLUSION: The findings of this study indicated that the administration of UDCA in addition to phototherapy could effectively decrease the length of hospital stay and bilirubin levels in neonatal hyperbilirubinemia. However, further studies with a larger sample size are required before one can recommend the routine use of UDCA for the treatment of neonatal jaundice.

Comparing the Efficacy of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation in Early Management of Respiratory Distress Syndrome in Preterm Infants.

OBJECTIVES: There is a tendency to use noninvasive ventilation (NIV) as a substitute for mechanical ventilation in preterm infants who need respiratory support. Two important modes of NIV include nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV). We sought to compare the efficacy of NCPAP and NIPPV as early respiratory support in preterm infants with respiratory distress syndrome in reducing the need for intubation, surfactant administration, and mechanical ventilation. METHODS: We conducted a randomized clinical trial. Sixty-one preterm infants with a gestational age of 28-32 weeks and a birth weight < 1500 g were randomly allocated to early NCPAP (n = 31) or NIPPV (n = 30) groups. The primary outcome was the need for intubation and mechanical ventilation in first 72 hours of life and the secondary outcome was oxygen dependency beyond day 28 post-birth. RESULTS: Surfactant replacement therapy was done in 15 neonates (50.0%) in the NIPPV group and 19 neonates (61.3%) in the NCPAP group, odds ratio (OR) = 1.58 (95% confidence interval (CI): 0.57-4.37; p = 0.370). Intubation and mechanical ventilation in the first 72 hours of life were needed in five cases (16.7%) in the NIPPV group and two cases (6.5%) in the NCPAP group, OR = 2.90 (95% CI: 0.51-16.27; p = 0.250). The mean duration of hospitalization was 26.2±17.4 days in the NIPPV group and 38.4±19.2 days in the NCPAP group, p = 0.009. Bronchopulmonary dysplasia (BPD) occurred in two (6.7%) neonates in the NIPPV group and eight (25.8%) neonates in the NCPAP group, p = 0.080. CONCLUSIONS: NIPPV and NCPAP are similarly effective as initial respiratory support in preterm infants in reducing the need for mechanical ventilation and occurrence of BPD. The duration of hospitalization was significantly reduced using NIPPV in our study. KEYWORDS: Nasal Continuous Positive Airway Pressure; Preterm Infants; Mechanical Ventilation; Bronchopulmonary Dysplasia; Respiratory Distress Syndrome, Newborn.

The effects of flexed (fetal tucking) and extended (free body) postures on the daily sleep quantity of hospitalized premature infants: A randomized clinical trial.

BACKGROUND: Proper sleep is essential for the development of premature infants. Infants, during hospitalization, might suffer from inappropriate postures and insufficient sleep hours. To compare the daily sleep quantities of premature infants in flexed (facilitated fetal tucking) posture and extended (free body) posture. This study is a randomized clinical trial which was conducted in neonatal ward of Al-Zahra Teaching Hospital of Tabriz, Iran, 2015. Thirty-two premature infants with the age range of 33-36 weeks were selected for the study. MATERIALS AND METHODS: Every infant was studied for 4 days in a sequential format. Every infant was studied for 4 days and in a 12-h period every day (8 a.m-8 p.m). Each day, an infant was randomly put in one of the four statuses, namely, free body posture in the supine position, free body posture in the lateral position, facilitated fetal tucking in the supine position and facilitated fetal tucking in the lateral position. Films were recorded in the 12-h period (8 a.m-8 p.m). SPSS Software (version 13) was used for data analysis. RESULTS: The results showed that about the main effect of posture on sleep variable, there was a statistically significant difference (P = 0.003). In addition, about the main effect of position on sleep variable; there was a statistically significant difference (P = 0.002). Meanwhile, there was no significant interaction effect between the posture and position for the daily sleep duration (P = 0.746). Daily sleep duration of the infants in flexed (facilitated fetal tucking) posture and lateral position is longer than that of the infants in extended (free body) posture and supine position. CONCLUSION: Daily sleep duration in the infants experiencing flexed posture and lateral position at rest is longer. Moreover, it decreases wakefulness time of the premature infants.

Vascular endothelial growth factor and insulin-like growth factor-1 in preterm infants with retinopathy of prematurity.

INTRODUCTION: Retinopathy of prematurity (ROP) can lead to severe visual impairment. This study was conducted to determine the levels of biochemical mediators (i. e. vascular endothelial growth f actor [ VEGF] and insulin- like growth factor-1 [IGF-1]) in the blood of premature infants with proliferative ROP. METHODS: Blood samples from 71 preterm infants born at or before 32 weeks of gestation were obtained 6-8 weeks after birth. These infants were classified into two groups according to their eye examination results. The control group consisted of 41 infants who had no evidence of ROP, and the study group consisted of 30 infants with proliferative ROP at stage III or higher. Blood VEGF and IGF-1 levels were measured using enzyme-linked immunosorbent assay. RESULTS: The mean gestational ages of the infants at birth were 28.4 ± 1.6 and 28.8 ± 1.6 weeks in the study and control groups, respectively (p = 0.259). The mean postmenstrual age of the infants at the time of blood sampling was 34.9 ± 1.2 weeks in the study group and 34.6 ± 1.3 weeks in the control group (p = 0.339). The mean blood IGF-1 (18.48 ± 11.79 µg/L and 16.75 ± 13.74 µg/L in the study and control groups, respectively; p = 0.580) and VEGF (267.35 ± 103.43 pg/mL and 237.52 ± 130.92 pg/mL in the study and control groups, respectively; p = 0.305) levels of the infants were not significantly different between the two groups. CONCLUSION: At 6-8 weeks after birth, blood IGF-1 and VEGF levels were not found to be significantly different between premature infants with proliferative ROP and those without.

Serum selenium levels of the very low birth weight premature newborn infants with bronchopulmonary dysplasia.

BACKGROUND: The selenium (Se) is an essential trace element that has a critical role in synthesis and activity of a number of selenoproteins with protective properties against free radical damage. This study was conducted to detect the serum Se concentration in very low birth weight (VLBW) preterm infants and its association with bronchopulmonary dysplasia (BPD). MATERIALS AND METHODS: Cord blood Se concentration was determined in 54 neonates with gestation age 30 week or less. Another sample was obtained from these infants at day 28 of birth and serum Se levels were measured by atomic absorption spectrophotometer. All neonates were followed for oxygen dependency at 28 day after birth and 36 week postmenstrual age. RESULTS: The mean cord blood Se concentration in studied neonates was 64.78 ± 20.73 µgL(-1). Serum Se concentration was 60.33 ± 26.62 µgL(-1) at age 28-day. No significant correlation was observed for serum Se concentration at birth and at one month after birth (r = -0.04, p = 0.72). BPD was diagnosed in 25 neonates (46%). The mean serum Se concentration at one month was 57.16 ± 29.68 µgL(-1) in patients with BPD (25 cases) and 63.27 ± 23.6 µgL(-1) in 29 patients without BPD (p = 0.40). CONCLUSION: In our study, serum Se concentration at 28 day of birth was lower than cord blood levels in preterm neonates, but we have not found significant difference among patients who had BPD or not with respect to serum Se concentrations at this age.

Insulin-like growth factor binding protein-3 in preterm infants with retinopathy of prematurity.

BACKGROUND: Retinopathy of prematurity (ROP) is the main cause of visual impairment in preterm newborn infants. OBJECTIVE: This study was conducted to determine whether insulin-like growth factor binding protein -3 (IGFBP-3) is associated with proliferative ROP and has a role in pathogenesis of the disease in premature infants. MATERIALS AND METHODS: A total of 71 preterm infants born at or before 32 weeks of gestation participated in this study. Studied patients consisted of 41 neonates without vaso-proliferative findings of ROP as the control group and 30 preterm infants with evidence of severe ROP in follow up eye examination as the case group. Blood samples obtained from these infants 6-8 weeks after birth and blood levels of IGFBP-3 were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean gestation age and birth weight of the studied patients were 28.2 ± 1.6 weeks and 1120.7 ± 197 gram in the case group and 28.4 ± 1.6 weeks and 1189.4 ± 454 gram in the control group (P=0.25 and P=0.44 respectively). The infants in the case group had significantly lower Apgar score at first and 5 min after birth. Insulin-like growth factor binding protein -3 (IGFBP-3) was significantly lower in the patients with proliferative ROP than the patients without ROP [592.5 ± 472.9 vs. 995.5 ± 422.2 ng/ml (P=0.009)]. Using a cut-off point 770.45 ng/ml for the plasma IGFBP-3, we obtained a sensitivity of 65.9% and a specificity of 66.7% in the preterm infants with vasoproliferative ROP. CONCLUSION: Our data demonstrated that the blood levels IGFBP-3 was significantly lower in the patients with ROP and it is suspected that IGFBP-3 deficiency in the premature infants may have a pathogenetic role in proliferative ROP.

Umbilical vascular catheter associated portal vein thrombosis detected by ultrasound.

OBJECTIVE: To determine catheter-associated thrombosis by color Doppler ultrasound and to detect duration of catheter placement as a risk factor for thrombosis. METHODS: All newborn infants with umbilical vascular catheterization for more than 6 h duration were included in this study. Color Doppler ultrasound examination was performed within 24-48 h of catheter insertion, 48-72 h after its withdrawal and weekly until hospital discharge or clot resolution. RESULTS: Portal vein thrombosis (PVT) was determined in five cases (3.04%) of 164 infants received umbilical vascular catheterization. The mean duration of catheter placement in patients with PVT was 3.4 ± 1.94 days, which was not significantly different from infants without thrombosis (3.5 ± 2.03). Thrombosis was completely recanalized and resolved after 3-6 weeks in three survived neonates. There was history of exchange transfusion for hyperbilirubinemia via umbilical vein in two neonates with PVT. CONCLUSIONS: Catheter-associated portal venous thrombosis was uncommon in our study. The duration of catheter placement was not longer in patients with portal vein thrombosis than those without thrombosis.

Exchange transfusion in severe hyperbilirubinemia: an experience in northwest Iran.

Our goal was to determine the indications for exchange transfusion (ECT) and the rates of ECT-related adverse events in neonatal hyperbilirubinemia. We reviewed retrospectively the medical charts of all newborns that had undergone ECT over three years from January 2006 to December 2008. Causes of jaundice, demographic data of the patients, and details of ECT and ECT-related adverse events were recorded. A total of 176 ECT procedures were performed in 150 neonates in the three-year study period. The mean total serum bilirubin before ECT was 29.59 +/- 6.88 mg/dl. Those infants requiring more than one ECT had higher total serum bilirubin than neonates with single ECT, but the difference was not significant (35.66 +/- 12.21 vs. 29.12 +/- 6.30 mg/dl, p = 0.09). The most common cause of ECT was ABO incompatibility (49.3%), Rh disease (7.3%) and idiopathic (28%). Among the adverse events related to ECT, thrombocytopenia (36.4%), hypocalcemia (25.5%), apnea (20%), and infection (10.9%) were noted commonly. No case of ECT-related mortality was observed. All of the adverse events resolved completely before discharge. ABO isoimmunization was the most common cause of ECT in this study. The majority of adverse events associated with ECT are asymptomatic and reversible.

Complications among premature neonates treated with beractant and poractant alfa.

OBJECTIVE: To compare the complications among preterm infants treated with two different natural surfactants. METHODS: In a randomized clinical trial, 150 preterm infants with Respiratory distress syndrome (RDS) treated with exogenous surfactant, were enrolled in the study. Group A consisted of 79 neonates that received poractant (curosurf). Seventy one newborn infants in group B were treated with beractant (Survanta). RESULTS: The mean gestational age for group A and B were 29.40+/-2.90 wk and 29.50+/-2.73 wk (P=0.82), respectively. The demographic and clinical variables were similar in both groups. The mean duration of intubation (as a primary outcome) was significantly shorter in infants treated with poractant (3.13+/-1.80 vs 4.06+/-2.7 days p=0.05). The mean duration of need for oxygen and hospitalization of patients in group A and B were 17.73+/-22.25 vs 19.14+/-17.85 days (p=0.67) and 24.89+/-26.41 vs 29.14+/-23.54 days (p= 0.32), respectively. There was no significant difference between groups with respect to mortality and morbidity, including pulmonary hemorrhage, intraventricular hemorrhage (IVH), patent ductus arteriosus, sepsis, and bronchopulmonary dysplasia (secondary outcome). CONCLUSIONS: In this study, infants who received poractant had shorter duration of intubation than infants treated with beractant, without any difference in the duration of oxygen therapy or hospitalization. There was no significant superiority of poractant over beractant.

Goldenhar syndrome in an infant of diabetic mother.

BACKGROUND: Goldenhar syndrome (oculoauriculovertebral dysplasia) is a rare congenital anomaly with unknown etiology and consists of non accidental association of hemifacial microsomia, auricular anomalies, epibulbar dermoid and vertebral anomalies. Although some malformations are more frequent in infants of diabetic mothers, developmental defects of first and second branchial arch is not a common finding in these patients. CASE PRESENTATION: We report a female case of Goldenhar syndrome in a newborn infant of a diabetic mother (IDM). Follow up of this patient after 6 months showed normal neurodevelopment and no evidence of hearing loss. She had developed epibulbar dermoid tumor in her right eye. CONCLUSION: It is necessary to evaluate IDM for presence of anomalies implying oculoauriculo-vertebral dysplasia.

The effect of clofibrate with phototherapy in late pre-term newborns with non-hemolytic jaundice.

BACKGROUND: Despite an understanding of the enzymatic pathways leading to bilirubin production and degradation, very few pharmacologic interventions are utilized and the mainstay of treatment remains phototherapy. AIMS: To evaluate the efficacy of clofibrate in reducing total serum bilirubin levels in late pre-term neonates with non-hemolytic jaundice. DESIGN AND SETTING: Double-blind, placebo-controlled, randomized trial; tertiary level neonatal unit. MATERIALS AND METHODS: A randomized controlled study was carried out in the neonatal ward of Children's Hospital, Tabriz, Iran, over a 1-year period. Sixty-eight healthy late pre-term infants readmitted with non-hemolytic hyperbilirubinemia were randomized to receive phototherapy and clofibrate (n= 35) or phototherapy and placebo (n= 33). STATISTICAL ANALYSIS USED: Chi-square test and independent sample 't' test. RESULTS: There were no significant differences in the weight, gender, modes of delivery and age of neonates between the two groups. Similarly the mean total serum bilirubin (TSB) level at the time of admission was not significantly different between the two groups [mean+/- SD: 19.72 +/- 1.79 (95% confidence interval: 19.12-20.54 mg/dL) vs. 20.05 +/- 2.82 (95% confidence interval, 19.54-22.04 mg/dL), P= 0.57]. The mean TSB 48 hours after phototherapy [mean+/- SD: 8.06+/- 1.34 (95% confidence interval: 7.94-10.18 mg/dL) vs.10.94 +/- 2.87 (95% confidence interval: 9.92-12.16 mg/dL), P= 0.02] and the mean duration of phototherapy [mean+/- SD: 64.32 +/- 12.48 (95% confidence interval: 60-81.6 hours) vs. 87.84 +/- 29.76 (95% confidence interval: 79.2-108 hours), P< 0.001] were significantly lower in the clofibrate-treated group. CONCLUSIONS: Clofibrate is an effective adjunctive drug in neonatal hyperbilirubinemia, which results in decreased TSB level and reduced duration of phototherapy in late pre-term newborns.