Antibiotic Therapy for Very Low Birth Weigh Newborns in NICU.

BACKGROUND: Prolonged empiric antibiotics therapy in neonates results in several adverse consequences including widespread antibiotic resistance, late onset sepsis (LOS), necrotizing enterocolitis (NEC), prolonged hospital course (HC) and increase in mortality rates. OBJECTIVES: To assess the risk factors and the outcome of prolonged empiric antibiotic therapy in very low birth weight (VLBW) newborns. MATERIALS AND METHODS: Prospective study in VLBW neonates admitted to NICU and survived > 2 W, from July 2011 - June 2012. All relevant perinatal and postnatal data including duration of antibiotics therapy (Group I < 2W vs Group II > 2W) and outcome up to the time of discharge or death were documented and compared. RESULTS: Out of 145 newborns included in the study, 62 were in group I, and 83 in Group II. Average duration of antibiotic therapy was 14 days (range 3 - 62 days); duration in Group I and Group II was 10 ± 2.3 vs 25.5 ± 10.5 days. Hospital stay was 22.3 ± 11.5 vs 44.3 ± 14.7 days, respectively. Multiple regression analysis revealed following risk factors as significant for prolonged empiric antibiotic therapy: VLBW especially < 1000 g, (P < 0.001), maternal Illness (P = 0.003), chorioamnionitis (P = 0.048), multiple pregnancy (P = 0.03), non-invasive ventilation (P < 0.001) and mechanical ventilation (P < 0.001). Seventy (48.3%) infants developed LOS; 5 with NEC > stage II, 12 (8.3%) newborns died. Infant mortality alone and with LOS/NEC was higher in group II as compared to group I (P < 0.002 and < 0.001 respectively). CONCLUSIONS: Prolonged empiric antibiotic therapy caused increasing rates of LOS, NEC, HC and infant mortality.

Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used. METHODS: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds. RESULTS: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU). CONCLUSION: According to results of this study, antibiotics' prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.

Women's knowledge and attitude towards mode of delivery and frequency of cesarean section on mother's request in six public and private hospitals in Tehran, Iran, 2012.

AIM: The rate of cesarean section (CS) has been reported to be as high as 40% among Iranian women in the year 2009. The aim of this study was to determine the rate of cesarean delivery on mother's request (CDMR) and to determine maternal attitude and knowledge about various modes of delivery in private and public (university) hospitals in Tehran. MATERIAL AND METHODS: All primiparous mothers delivering in six selected hospitals between April 2010 and March 2011 were included. Trained investigators handed a predesigned questionnaire to mothers 1 day after delivery to be filled out in the presence of the investigator. RESULTS: From 600 deliveries, 501 (83.5%) were CS and 99 (16.5%) were normal vaginal delivery. The CS rates in university hospitals versus private hospitals were 78.5% and 91.9%, respectively. In total, mothers' knowledge scores were poor, intermediate, and good in 55.6%, 37.9%, and 6.5% of cases, respectively, and no significant difference in knowledge was observed between mothers attending private or public hospitals. The overall rate of CDMR was 20.8%; and the most frequent reason was fear of pain. Women with CDMR were at higher marital age, education, insurance coverage, and socioeconomic status compared with the women with vaginal delivery. CONCLUSION: Prompt action is needed to reduce the unacceptably high rate of unwarranted cesarean deliveries. Improving women's knowledge about the risks and benefits of different modes of delivery can lead to a positive maternal attitude towards vaginal delivery.

Screening of congenital CMV infection in saliva of neonates by PCR: report of a pilot screening study in Iran.

BACKGROUND: Cytomegalovirus (CMV) is a leading cause of congenital infection in neonates. Most infants with congenital CMV infection are asymptomatic at birth and not diagnosed on routine clinical examination. To identify these at-risk infants early in life, polymerase chain reaction (PCR) assays are done to screen large populations of newborn infants. OBJECTIVE: We carried out a pilot study to estimate the prevalence of CMV in saliva from newborns by DNA PCR assay. METHODS: This study was performed from January 2012 to March 2012 at a maternity hospital in the south of Tehran. All newborns aged between 1 to 14 days born at this hospital were enrolled. Saliva specimens from newborns were collected by swabbing the inside of the baby's mouth and stored at -70 degrees C until PCR processing for virus detection. RESULTS: Six-hundred and twenty infants between 1 to 14 days of age were enrolled during the study period of two months. The PCR assay was positive for CMV in 2 newborns [0.3%]. Both of these infants were asymptomatic for congenital CMV at birth and also when followed up at three months and six months of age. CONCLUSIONS: Our findings reveal that because of a low yield of positive results, screening for congenital CMV infection would not be cost-effective in Iranian neonates.

Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella (MMR) vaccination in children.

BACKGROUND: In Iran, the measles, mumps and rubella vaccine (MMR) is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. METHODS: A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay (ELISA) in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. RESULTS: Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. CONCLUSION: IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella.

Effects of miglustat on stabilization of neurological disorder in niemann-pick disease type C: Iranian pediatric case series.

Niemann-Pick disease type C is a rare neurodegenerative disorder with autosomal recessive inheritance that can be broadly categorized into different forms dependent on age at disease onset: pre-/perinatal, early infantile, late infantile, juvenile, and adolescent/adult. This study was conducted to define the age at onset, clinical manifestations, neuroimaging findings and response to treatment in 21 patients diagnosed with Niemann-Pick disease type C and managed in the neurology departments of hospitals in Tehran, Iran. The effects of miglustat on patient ambulation, fine and gross motor function, swallowing, hearing, speech, seizures, psychomotor development, and ocular movements were evaluated for up to 26 months of treatment. Ambulation, fine and gross motor movements, swallowing, speech, and supranuclear gaze palsy were generally stabilized during therapy, and psychomotor delay appeared to be improved in early- and late-infantile onset patients. However, miglustat had no effect on organomegaly or other systemic manifestations of the disease. Miglustat was well tolerated.

Assessment of a new algorithm in the management of acute respiratory tract infections in children.

OBJECTIVES: To assess the practicability of a new algorithm in decreasing the rate of incorrect diagnoses and inappropriate antibiotic usage in pediatric Acute Respiratory Tract Infection (ARTI). MATERIALS AND METHODS: Children between 1 month to15 years brought to outpatient clinics of a children's hospital with acute respiratory symptoms were managed according to the steps recommended in the algorithm. RESULTS: Upper Respiratory Tract Infection, Lower Respiratory Tract Infection, and undifferentiated ARTI accounted for 82%, 14.5%, and 3.5% of 1 209 cases, respectively. Antibiotics were prescribed in 33%; for: Common cold, 4.1%; Sinusitis, 85.7%; Otitis media, 96.9%; Pharyngotonsillitis, 63.3%; Croup, 6.5%; Bronchitis, 15.6%; Pertussis-like syndrome, 82.1%; Bronchiolitis, 4.1%; and Pneumonia, 50%. CONCLUSION: Implementation of the ARTIs algorithm is practicable and can help to reduce diagnostic errors and rate of antibiotic prescription in children with ARTIs.

ELISA Cut-off Point for the Diagnosis of Human Brucellosis; a Comparison with Serum Agglutination Test.

BACKGROUND: Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test (SAT) is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay (ELISA) can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT. METHODS: Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. RESULTS: The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut off-point of ELISA-IgG to diagnose acute brucellosis. At this cut-off, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively. CONCLUSION: The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis.

Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome.

BACKGROUND: This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in newborns hospitalized in a Neonatal Intensive Care Unit (NICU) in Tehran, Iran. METHODS: A prospective cohort study was carried out in the NICU of Mahdieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. RESULTS: There were 81 neonates enrolled. VAP occurred in 14 (17.3%), at a rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E. coli (21.4%), Klebsiella (21.4%), and Pseudomonas (14.1%). The only VAP predictor was sputum [odds ratio (OR) = 5.11, P = 0.02]. Mortality rate for VAP was 2/14 (14.3%). Duration of mechanical ventilation [hazard ratio (HR) = 0.96, P = 0.01], birth weight (HR = 0.81, P < 0.001), and purulent tracheal aspirate (HR = 0.25, P < 0.006) were independent predictors of overall survival. CONCLUSIONS: VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols.

Determination of integron frequency by a polymerase chain reaction-restriction fragment length polymorphism method in multidrug-resistant Escherichia coli, which causes urinary tract infections.

The purpose of this study was to determine the presence of integrons in Escherichia coli, which cause urinary tract infections, and to define the association between integrons and antimicrobial susceptibility. Susceptibility of 200 isolates from urine samples of patients suffering from urinary tract infections to 13 antibiotics was determined by the Kirby-Bauer disk diffusion method. The existence of class1 and 2 integrons in resistant isolates was assessed by polymerase chain reaction-restriction fragment length polymorphism and sequencing. Antibiotic resistance patterns were observed as follows: amoxicillin 78%, tetracycline 76.1%, co-trimoxazole 67.7%, cephalotin 60%, nalidixic acid 57.4%, chloramphenicol 49%, gentamicin 46.4%, ceftazidim 38.1%, ciprofloxacin 36.2%, nitrofurantoin 33.5%, amikacin 32.1%, norfloxacin 36.1%, and imipenem 27.1%. Of 200 isolates, 155 (77.5%) were multidrug resistant (MDR). The existence of integrons was confirmed in 50.3% of isolates. Three class 1 integron types, aadA2 being the most frequently found, and four class 2 integron types are described. Significant association between resistance to gentamicin, co-trimoxazole, cephalotin, ceftazidim, imipenem, chloramphenicol, and nalidixic acid with the existence of integrons was observed. Multidrug resistance suggests that the strategy for treatment of patients with E.coli infections needs to be revised. Furthermore, it was shown that integrons may be partly responsible for multidrug resistance. Imipenem and norfloxacin were the most effective antibiotics against isolates.

The use of polymerase chain reaction assay versus cell culture in detecting neonatal chlamydial conjunctivitis.

One of the most common bacterial infections that causes ophthalmia neonatorum is Chlamydia trachomatis, (C. trachomatis). Very few studies have been performed in Iran using both cell culture and polymerase chain reaction (PCR) methods to determine the prevalence of C. trachomatis as an etiological agent of ophthalmia neonatorum. This study aimed to evaluate the prevalence of neonatal chlamydial conjunctivitis (NCC) as diagnosed by both methods in two hospitals in Tehran, Iran. From March 2008 to May 2009, out of 2253 neonates, 241 (10.7%) with clinical findings of conjunctivitis were included in this study. A total of 241 conjunctival swabs were tested by cell culture (as the gold standard test), PCR, and Giemsa staining. Cell cultures were positive for C. trachomatis in 31 (12.9%) neonates, C. trachomatis was positive in 40 (16.6%) neonates by PCR and 18 (7.5%) by Giemsa staining. The sensitivity of PCR was 100%, whereas Giemsa staining sensitivity was 558.1%. High sensitivity (100%) and specificity (95.7%) of PCR as compared to culture makes it a proper diagnostic method for the detection of C. trachomatis.

Serologic evidence of pertussis infection in vaccinated Iranian children.

BACKGROUND: It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. METHODS: In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P<0.05 was considered significant. RESULTS: 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off (derived from mean+2SD) was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. CONCLUSION: Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies (≥2 SD), positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary.

Survey of needle-stick injuries in paediatric health personnel of 5 university hospitals in Tehran.

OBJECTIVE: To study the prevalence and correlates of needle-stick injury in the health personnel of the Paediatric Department of five university-affiliated hospitals in Tehran, from April till June 2009. METHODS: Cross-sectional questionnaire survey. Physicians undergoing paediatric training and nurses working in the paediatric departments filled up a pre-designed questionnaire. Relevant variables were compared between doctors and nurses. RESULTS: Three-hundred fifty-five health personnel were enrolled. Of these 49.3% had incurred needle stick injury at least once, 36.7% doctors and 54.9% nurses (p=0.002). Nurses fared better than the doctors as regards knowledge about hazards of improper needle disposal. Correct answers from doctors and nurses respectively were: 45.6% vs. 59.3% about needle separation and 41.9% vs. 81.2% about recapping, (p=0.02 and <0.001). Doctors 11.1% and Nurses 37.7% believed injections to be better than oral medication for children, (p<0.001), however, 68.9% of doctors and 46.6% of nurses believed that parents preferred injections to oral medicines for their children, (p<0.001). Only 26.6% knew about auto-disable syringes. Vaccinated against Hepatitis B was present in 92.7%. Doctors 58.7% and 55.3% nurses knew HBV to be the most common needle transmitted infection, (p=0.56). CONCLUSION: Needle-stick injuries are common among Paediatric health care personnel and their knowledge about prevention strategies is suboptimal. Most, health personnel are immunized against Hepatitis B.

Exposure to secondhand smoke in infants: declining trends from 2001 to 2008?

OBJECTIVE: To define the trend in young children's exposure to parental secondhand smoke. METHODS: Secondary analysis of data was done on families of infants between the ages of 6 and 24 months that had been enrolled for 2 cross-sectional studies in 2001 and 2008. RESULTS: Data from 648 families were analyzed. Overall, 29.8% of children had been exposed to parental secondhand smoke; 32% in 2001 and 27.4% in 2008, (P value >.05). In all cases, the source of exposure was the father; in 2008, 4 families reported both parents as being habitual smokers. Ratio of indoor to outdoor smokers was 2.92 in 2001 and 0.93 in 2008. CONCLUSION: The decline in the percentage of infants exposed to parental smoking is nonsignificant; parental indoor smoking has decreased significantly but remains at unacceptably high levels. Authorities responsible for the health of young children need to revise interventional policies.

Association of serum soluble triggering receptor expressed on myeloid cells levels in malignant febrile neutropenic patients with bacteremia and fungemia.

OBJECTIVE: Infections are the major cause of morbidity and mortality in febrile neutropenic patients with malignancy. Rapid diagnostic tests are needed for prompt diagnosis and early treatment which is crucial for optimal management. We assessed the utility of soluble triggering receptor expressed on myeloid cells (sTREM-1) in the diagnosis of bacteremia and fungemia in febrile neutropenic patients. METHODS: Sixty-five febrile neutropenic children with malignancy hospitalized in Mofid Children's Hospital during a period of one year from January 2007 were recruited for this cross sectional study (mean age 66.2± 37 months; 35 females and 30 males). Thirty patients (46.2%) had acute lymphoblastic leukemia, 2 (3.1%) acute myeloid leukemia, one (1.5%) lymphoma and 32 (49.2%) were under treatment for solid tumors. Simultaneous blood samples were collected for measurement of serum sTREM-1 levels and for blood cultures which were grown in BACTEC media. Gold standard for the presence of infection was a positive BACTEC culture as a more sensitive method compared to current blood culture techniques. FINDINGS: Blood cultures with BACTEC system were positive in 13(20%) patients (12 bacterial and one fungal culture). The mean serum sTREM-1 level in BACTEC positive patients was 948.2±592.9 pg/ml but in BACTEC negative cases it was 76.3±118.8 pg/ml (P<0.001). The optimal cut-off point of sTREM-1 for detecting patients with positive result of BACTEC was 525 pg/ml with sensitivity and specificity of 84.6% and 100%, respectively. CONCLUSION: Our study revealed a significant association between serum sTREM-1 level and bacteremia and fungemia in febrile neutropenic patients suffering malignancy with acceptable sensitivity and specificity.

Pulmonary alveolar proteinosis in children: a case series.

Pulmonary alveolar proteinosis, (PAP) is a rare disease of unknown etiology, characterized by accumulation of intraalveolar proteinaceous material which is rich in lipid and positive on periodic acid-Schiff stain. Two clinically different pediatric types have been defined as congenital PAP which is fulminant and fatal, and a late-onset PAP which is similar to the adult form and less severe. Eight children with late-onset PAP were hospitalized from 1998 to 2005 in Mofid Children Hospital. Characteristics of these patients and the methods of diagnosis and treatment are presented in this case series.

An assessment of the necessity of lumbar puncture in children with seizure and fever.

OBJECTIVE: It is frequently thought that lumbar puncture (LP), is a mandatory procedure in all children who have fever and a seizure; because a convulsion may be the sole clinical manifestations of bacterial meningitis. To assess whether meningitis could be recognized using readily available clinical information. METHODS: This study was done during a 4 yr period from 2002-2006. A total of 254 previously healthy children aged 6 months to 5 years, were brought consecutively to the paediatric department of a teaching university hospital after their first fever-associated-seizure; lumbar puncture (LP) was performed in all cases. Children with seizure and fever and meningitis served as cases and those with fever and seizure, but no meningitis, served as control. Factors compared in the two groups were: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use. RESULTS: Twelve, (4.7%), cases were diagnosed as meningitis. Risk factors significantly associated with meningitis were: age < 12 months, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use, (p < 0.05). All children with meningitis had at least one of the risk factors mentioned above. CONCLUSION: Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizure and fever; thus there is no need for routine lumbar puncture in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or who have received prior antibiotics.

Smoking practices and risk awareness in parents regarding passive smoke exposure of their preschool children: a cross-sectional study in Tehran.

BACKGROUND: Young children living with parents who smoke are exposed to unacceptable health hazards. AIM: To determine patterns of parental smoking, the level of parental awareness about hazards of secondhand smoke, and the effect of risk awareness on smoking behavior. SETTING: Health centers affiliated with two teaching hospitals in Tehran. DESIGN: Cross-sectional. MATERIALS AND METHODS: Data was collected from parents of preschool children visiting the health centers, through face-to-face interview, during a period of 18 months. STATISTICAL ANALYSIS: Data was analyzed by multiple logistic regression, and analysis of variance was done for comparison of means. RESULTS: In a total of 647 families, prevalence of parental smoking was 35.7%, (231 families). In 97.8% of smoking families, only the fathers smoked; and in 5 (2.2%) families, both parents were regular smokers. Prevalence of smoking was higher in poor families as compared with families who were well-off (39% vs. 25%; P = 0.025), and also in families with lower educational level. There was no significant difference in risk awareness between smokers and nonsmokers (P > .05). CONCLUSION: Low socioeconomic status and low education were identified as risk factors for children's exposure to secondhand smoke; parental risk awareness had no apparent effect on the smoking behavior. Unlike western societies, fathers were the sole habitual smokers in most families. Since factors that influence smoking behavior vary in different cultures, interventional strategies that aim to protect children from the hazards of tobacco smoke need to target diverse issues in different ethnic backgrounds.

Infant feeding and hospitalization during the first six months of life.

OBJECTIVE: To compare the frequency of hospitalization during the first six months of life between breast-fed and bottle-fed infants. METHOD: A descriptive cross-sectional study was conducted over twelve months, in hospital-based outpatient clinics. Mother-infant pairs, seen at the clinics during the study period, were enrolled. Infants were between the ages of 6-24 months and had been brought for routine check-ups, vaccinations or common childhood ailments. Subjects were recruited from babies with no congenital anomalies or chronic illnesses. Study team recorded necessary information about feeding practices, previous illnesses and hospitalizations on a structured questionnaire. Hospitalization rates in 3 groups of infants with different feeding methods i.e. predominant breastfeeding, partial breast-feeding, and bottle-feeding were compared. Results were analyzed using SPSS software, ANOVA was used for comparison of means between groups, and a p-value <0.05 was regarded as significant. RESULTS: A total of 606 mother-infant dyads were enrolled, of which 73% infants were on predominant breastfeeding at 6 months of age. The rate of all-cause hospitalization before six months of age was: 6.3%, 22.2% and 27.2% in infants with predominant breast-feeding, partial breast-feeding and bottle-feeding, respectively, (p < 0.001). Figures for admission due to infectious cause were 6%, 17.6% and 25.6%, respectively, (p < 0.001). Adjusted Odds ratio between bottle-fed and breast-fed babies was 5.3 for all-cause hospitalization, and 6.1 for hospitalization due to infectious illnesses. CONCLUSION: Our findings show that protective effect of breast-feeding is not limited to developing countries; it extends to young infants living in urbanized environments equipped with adequate sanitation and clean water supply.

Lumbar puncture in neonates under and over 72 hours of age.

OBJECTIVE: To identify the criteria for performing a spinal tap in neonates with suspected sepsis and compare the findings in infants under and over the age of 72 hours. STUDY DESIGN: Analytical. PLACE AND DURATION: Neonatal Ward of Taleghani Medical Centre, Shaheed Beheshti University of Medical Sciences, Evin,Tehran. Study period was of one year, from March 2003 to February 2004. PATIENTS AND METHODS: All newborns subjected to a lumbar puncture during the first 24 hours of admission were enrolled in the study. Results of cerebrospinal fluid analysis were scrutinized. RESULTS: There were 380 neonates in the study. Majority i.e. 248 infants were aged<72 hours. Meningitis was diagnosed in 22 cases, (5.8%). There was no significant difference in the incidence of meningitis between neonates under and over 72 hours of age, (6.9% vs. 3.8%, p-value>0.5). Comparison of risk factors, clinical manifestations, and routine laboratory investigations revealed no significant difference in babies with or without meningitis. CONCLUSION: The findings of this series do not support a selective approach for performing a lumbar puncture in a possibly septic newborn. A lumbar puncture is recommended in all neonates with suspected sepsis regardless of age, risk factors, or specific neurological manifestations.