Serum level of vitamin D in preterm infants and its association with premature-related respiratory complications: a case-control study.

BACKGROUND AND AIM: Prematurity and related problems, especially respiratory distress, are one of the main challenges for neonatal medicine. The aim of this study was to compare vitamin D levels in preterm infants with, and those without respiratory distress. METHODS: This case-control study was conducted in Ghaem and Emam Reza Hospitals in Mashhad (Iran) from 2015 to 2016. In this study, we examined 160 preterm infants weighing less than 2000 grams and born at less than 34 weeks' gestation. Serum vitamin D levels were measured in preterm infants without- and those with respiratory distress, and their mothers. Neonatal characteristics, including age, sex, birth weight, gestational age, Apgar score and needs for oxygen, resuscitation, ventilation and surfactant were documented. The data were analyzed using SPSS version 16.0. RESULTS: Means serum level of maternal vitamin D in control and case groups were 16.66±14.29 ng/dl and 21.23±15.19 ng/dl, respectively (p=0.029). In addition, mean serum level of neonatal vitamin D in control and case groups were 11.69±8.66 ng/dl 17.9±12.55 ng/dl, respectively (p=0.001). Vitamin D levels in premature neonates without respiratory distress and their mothers were significantly different from other preterm neonates with respiratory distress (p=0.029). There was a direct correlation with neonatal and maternal vitamin D levels (r=0.713, p=0.001). The duration of hospitalization (p=0.001), gestational age (p=0.073), birth weight (p=0.001), one- and (p=0.001) five-minute (p=0.001) Apgar scores and head circumference (p=0.002) had significant relation with vitamin D levels in neonates. Death (12.5%) and pneumothorax (7.5%) were the main complications among cases with respiratory distress. CONCLUSION: According to the results of present research, neonatal vitamin D levels have a significant association with respiratory distress syndrome and maternal vitamin D levels.

Breast milk concentration of rubidium in lactating mothers by instrumental neutron activation analysis method.

OBJECTIVE: Relatively little is known about the trace elements content of human milk from different countries. This has not been fully investigated especially among Iranian women. This study aimed to assess the concentration of Rubidium (Rb) as a poisonous trace element in transitional breast milk of lactating mothers living in Mashhad. METHODS: Forty nursing mothers in early lactation 3 days to 15 days postpartum, free from any medical disorder and/or medication were randomly selected. We have applied Instrumental Neutron Activation Analysis (INAA) to assess the long-lived isotope trace element Rb in transitional milk of these economically moderate 18-39 year old Iranian women. FINDINGS: The average concentration level of Rb was 32.176 ppm dry weight (min 8.660, max 107.210 ppm). No significant correlation was observed between Rb concentration and maternal weight and age (P=0.06, P=0.05 respectively) and newborns' weight, age and sex (P=0.07, P=0.2, P=0.2 respectively). CONCLUSION: Although the Rubidium concentration found in this study is among the highest reported in the literature, it could not be compared to other studies because of differences in analytical performance, state of lactation, and unavailable reference ranges, so this finding needs further investigations.

The investigation of effects of blood exchange transfusion on selenium in newborn infants by instrumental neutron activation analysis method.

OBJECTIVE: The evidence for the effects of blood exchange transfusion on selenium (Se) in newborn infants is unknown. This study was conducted to determine the possible effects of blood exchange transfusion on Se by comparing the Se blood concentrations before and after exchange transfusion in jaundiced neonates. METHODS: A total of 30 jaundiced term neonates who underwent blood exchange transfusion (EXT) for first time because of idiopathic unconjugated hyperbilirubinemia, were recruited. The Se level of 30 blood bank donors' samples used for EXT were measured and 30 pairs of uncontaminated umbilical cord blood samples were investigated for Se before and after exchange transfusion. The samples were analyzed by instrumental neutron activation analysis method. Serum bilirubin concentrations were measured by venous blood samples before EXT. FINDINGS: The average of Se concentration before EXT was higher than that after EXT (629.78±283.82 SD ppb versus 454.83±213.75 SD ppb) (P<0.05). There was significant correlation between the blood concentration of Se before and after EXT and also between the blood level of Se before EXT and total serum bilirubin level (P<0.05). There was no significant correlation between the blood concentration of Se before EXT and babies' gender and weight (P>0.05). The average Se level in samples obtained from transfused blood products was 507.90±223.56 SD ppb. CONCLUSION: Blood exchange transfusion caused a 28% decrease of the blood Se level because the blood donors had lower blood Se levels than the newborns. Furthermore, there was a significant correlation between the blood level of Se before EXT and the total serum bilirubin level.

Successful treatment of neonatal chylothorax with octreotide.

Chylothorax is a relatively uncommon, but a common form of pleural effusion in the neonates. It may be either congenital or acquired. The efficacy of octreotide therapy for chylothorax is controversial. Herein the authors report successful suppression of chylothorax by octreotide in a newborn who had undergone thoracostomy tube.

Effects of early human recombinant erythropoietin therapy on the transfusion in healthy preterm infants.

OBJECTIVE: Early recombinant erythropoietin therapy and iron therapy would decrease the need for red blood cells transfusions and prevents anemia of prematurity. METHODS: Fifty-eight preterm infants in newborn services at Ghaem Medical Center randomly were assigned, among them 18 patients were excluded. A total of 40 preterm infants with gestational age 28-34 weeks, birth weight 1000-1750 g followed the study: 20 infants in treatment group and 20 infants in control group were randomized to treatment (rhu EPO, 500u per kg, per week, 2 times weekly, subcutaneous) and control (no treatment). Therapy was initiated 4 days after birth and continued throughout the 4 weeks. All infants on enteral feeds received supplements: iron 3 mg/kg/d, vitamins and folat. Complete blood cells and reticulocyte counts were measured weekly. Transfusions and phlebotomy data were recorded. Statistical significance was determined by chi-square test, student t test and Mann-Whitney. A P value of < 0.05 was considered statistically significant. RESULTS: The reticulocyte counts were higher in treated infants during the study (p: 0.009). Final hematocrits were higher in treated infants (p: 0.02).The volume of packed red blood cells transfusions mililiter per infant significantly reduced (p: 0.05), the average number of transfusion per infant was also lower for treated infant than control [2 (10 % )vs 8 (40%) respectively]. No adverse effects of EPO or supplemental iron occurred. CONCLUSION: The combination of early rhu EPO and iron as administered in the present study stimulated erythropoiesis and decreased red blood cells transfusion in premature infants who were 1000-1750 g at birth. The enrollments of the larger and healthier preterm infants, who are at lower risk for transfusion, are limitation of the present study.

Effects of early human recombinant erythropoietin therapy on the transfusion in healthy preterm infants.

OBJECTIVE: Early recombinant erythropoietin therapy and iron therapy would decrease the need for red blood cells transfusions and prevents anemia of prematurity. METHODS: Fifty-eight preterm infants in newborn services at Ghaem Medical Center randomly were assigned, among them 18 patients were excluded. A total of 40 preterm infants with gestational age 28-34 weeks, birth weight 1000-1750 g followed the study: 20 infants in treatment group and 20 infants in control group were randomized to treatment (rhu EPO, 500u per kg, per week, 2 times weekly, subcutaneous) and control (no treatment). Therapy was initiated 4 days after birth and continued throughout the 4 weeks. All infants on enteral feeds received supplements: iron 3 mg/kg/d, vitamins and folat. Complete blood cells and reticulocyte counts were measured weekly. Transfusions and phlebotomy data were recorded. Statistical significance was determined by chi-square test, student t test and Mann-Whitney. A P value of < 0.05 was considered statistically significant. RESULTS: The reticulocyte counts were higher in treated infants during the study (p: 0.009). Final hematocrits were higher in treated infants (p: 0.02).The volume of packed red blood cells transfusions mililiter per infant significantly reduced (p: 0.05), the average number of transfusion per infant was also lower for treated infant than control [2 (10 % )vs 8 (40%) respectively]. No adverse effects of EPO or supplemental iron occurred. CONCLUSION: The combination of early rhu EPO and iron as administered in the present study stimulated erythropoiesis and decreased red blood cells transfusion in premature infants who were 1000-1750 g at birth. The enrollments of the larger and healthier preterm infants, who are at lower risk for transfusion, are limitation of the present study.