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Background: Recently, blood monocyte concentration has been introduced as an inventive biomarker for necrotizing enterocolitis (NEC) in low birth weight neonate; therefore, we aimed to examine and compare blood monocyte counts in preterm neonates with and without NEC. Methods: A case-control study was conducted on 160 preterm neonates in Tehran during 2017. In this study, medical records and laboratory findings of 80 neonates with NEC (case) and 80 neonates (control), who were randomly chosen from among neonates who had survived NEC, were reviewed and CBC outcomes were compared between the groups. Results: We compared 80 cases and 80 controls. The mean gestational age in the NEC and control group was 30.78±2.33 and 31.41±2.16 weeks, respectively. The birth weights in the NEC and control group were 1500±488 and 1562±360 g, respectively. The mean age for developing NEC was 14.14±13.9 days. The absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) did not differ statistically significantly between the two groups. The mean absolute white blood cells (WBC) in the NEC and control group were 11368±7957 and 8268±7505, respectively; absolute WBC was significantly different between the two groups (P=0.001). The mean absolute monocyte count (AMC) in the NEC and control group were 262±193 and 518±691, respectively; the difference in absolute WBC was significant between the two groups (P=0.002). Receiver operating characteristic of AMC values showed a diagnostic accuracy of 0.693 (95% CI: 0.612–0.773) for NEC and 0.738 (95% CI: 0.627–0.850) for stage II and III NEC. Conclusion: The result of this study suggest that the concentration of blood monocyte could be an indicator for NEC in the preterm neonate. However, this result should be confirmed by other studies.

Recent studies on the pathophysiology of COVID-19 are indicating that the Angiotensin convertase enzyme 2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) can act as a major component in the fusion of SARS-Cov-2 with target cells. It has also been observed that the expression of ACE-2 and TMPRSS2 can be altered in malignancies. Shedding light on this matter could be crucial since the COVID-19 pandemic interfered with many gastrointestinal cancer screening programs. Herein we discuss the possibility of severe forms of COVID-19 in patients with gastrointestinal cancers due to the gastrointestinal entry route of SARS-CoV-2 into the human body. The disruption of cancer screening programs caused by the current COVID-19 pandemic could therefore have massive negative health impact on patients affected by gastrointestinal malignancies.

Background: In this study, we aimed to evaluate the accuracy of echocardiography compared to plain radiography in determining the appropriate line tip position of peripherally-inserted central catheters (PICC). Also, we aimed to evaluate the relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and related complications with PICC line tip position. Methods: In this prospective observational study, which was performed in the neonatal intensive care units of teaching hospitals affiliated with Iran University of Medical Sciences in 2019, 50 out of 96 neonates were non-randomly selected based on inclusion criteria. The radiographic and echocardiographic tests were simultaneously performed, and the data were analyzed. Results: The findings of this study showed that there was an agreement between radiography and echocardiography in determining the PICC line tip position in 43 neonates (86%). The sensitivity and specificity of echocardiography in determining the ectopic position of the catheter were 81% and 77%, respectively. In 32 neonates (64%), a second radiograph prevented the following line manipulation using echocardiography. In addition, there was no significant relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and PICC line complications. Conclusions: The results of the present study showed that echocardiography was a useful tool for determining the position of the catheter’s tip in LBW neonates. It also minimizes radiation exposure on subsequent radiographs and obviates the need for additional radiographs following catheter manipulation by echocardiography.

Background: Standard treatment of persistent pulmonary hypertension in neonates (PPHN) is inhaled nitric oxide (iNO), which is not available in Iran. Consequently, other drugs such as milrinone are prescribed. So far, no study has investigated the effect of inhaled milrinone on the management of PPHN.Our study was designed for better management of PPHN in the absence of iNO.Methods: In this randomized clinical trial, neonates with PPHN admitted Neonatal intensive care unit of Hazrat Ali Asghar and Akbarabadi hospitals were treated with intravenous dopamine infusion and randomly divided into two groups receiving injectable and inhaled milrinone. Neonates were evaluated by Doppler echocardiography, clinical status, and oxygen demand. Patients were also evaluated for clinical symptoms and mortality during follow-up. Results: A total of 31 infants with median age of 2 days (IQR: 4) were studied. There was a significant decrease in peak and mean pulmonary arterial pressure in both inhalation and infusion group following milrinone administration, with no statistical difference. (P=0.584 and 0.147, respectively). There was no significant difference among the frequency of tricuspid regurgitation and systolic blood pressure before and after treatment among two groups. Diastolic blood pressure was significantly lower in infusion group after treatment (P=0.020), however, the amount of decrease was not statistically significant among two groups (P=0.928). Overall, 83.9% achieved full recovery, of which 75% were among infusion groups while 93.3% were among inhalation group. (P=0.186)Conclusion: Inhaled milrinone can have similar effects with injected milrinone as an adjunct in the management of PPHN. Also, the results indicate similar safety for both intravenous and inhaled prescriptions. . Trial registration: IRCT code of this RCT trial is iIRCT20220130053890N1 and its Ethical verification code is IR.IUMS.FMD.REC.1400.493.

Background: ABO/Rh incompatibilities are common causes of hemolytic disease of newborn. Alloimmunization due to minor RBC antigens may also cause severe hemolysis and hyperbilirubinemia necessitating exchange transfusion in the early neonatal period. Case Presentation: Here we report a rare case (first such report to our knowledge in Iran) of severe hemolytic disease of the newborn due to anti-Rh17 antibody (an antibody to the RhCc/Ee antigen protein) in a newborn with maternal blood group B Rh D--. Conclusion: Presenting this case would improve the insight and knowledge about managing severe hemolytic anemia due to minor group alloantibodies postnatally, and highlight the importance of prenatal surveillance and diagnosis for the optimal management of alloimmune hemolytic disease.

Intraventricular hemorrhage (IVH) often occurs in preterm infants and is an important cause of brain damage in the infants. Although its incidence has decreased, IVH remains a significant complication in the survival of preterm infants. One of the predisposing factors is thyroid function. The aim of the present study was to evaluate the effects of thyroid hormones T4 and thyroid-stimulating hormone (TSH) on risk of IVH in Iranian preterm infants. We designed a cross-sectional study, and the population includes fifty preterm infants admitted in the neonatal intensive care unit (NICU) ward of Ali Asghar Hospital, Tehran, Iran, during the period of 2017 to 2018. Cranial sonography at the 5th and 30th day after birth was performed to evaluate the IVH and thyroid function tests were conducted on blood samples using radioimmunoassay. Results of IVH prevalence and grading indicated that 5th day IVH occurs in 38% and 30th day IVH occurs in 28% of infants. There is no statistically significant correlation between T4 and TSH with 5th day IVH but there is a significant statistical relationship between T4 and TSH levels and IVH on the 30th day after birth. Thyroid function hormones could be used as markers to predict the risk of IVH in preterm infants. Larger sample size can help to obtain more validated results.

Background: Endotracheal intubation is a common procedure in the neonatal intensive care unit (NICU). Rapid and accurate confirmation of the endotracheal tube (ETT) position is critical . Routinely CXR is used for evaluation of ETT position that has some disadvantages . So there has been a considerable interest to find alternative modality with minimal complication and acceptable accuracy. The purpose of our study is the evaluation of ultrasound efficacy in confirmation of ETT position in neonates comparison to CXR.Methods: This cross-sectional study was conducted on 66 intubated neonates in NICU of Ali -Asghar children Hospital, between January 2018 and January 2019. To determine the ETT position, CXR and ultrasound were requested at the same time. Each neonate had a bedside ultrasound (US) with a high-frequency linear transducer. Accuracy, sensitivity, specificity, negative predicted value (NPV), positive predicted value (PPV) and Kappa agreement coefficient was used to compare the US and CXR results. Results: Sixty-six intubated neonates included in this study had a mean gestational age of 34.98 ±3.7 weeks and mean birth weight of 2284.7 ± 915g. US images were taken a mean of 3 ±0.6 h after CXR. The ETT was visualized by the US in all newborns examined.US revealed a sensitivity of 88% (95% CI, 68.78% to 97.45%), specificity of 84 % (95% CI, 63.92% 95.46%), PPV of 84.62% (95% CI, 68.89% to 93.18%), NPV of 87.50 % (95% CI, 70.49% to 95.35%), diagnostic accuracy of 86%(95% CI, 73.26% to 94.18%), positive likelihood ratio of 5.50 (95% CI 2.21 to 13.66), and Negative Likelihood Ratio of 0.14 (95% CI 0.05 to 0.46) compared to chest radiography. Overall, the Kappa value showed very good agreement in confirming the correct position of the tracheal tube placement (Kappa coefficient 0.72, p-value Conclusion: The findings of this study demonstrate ultrasound has acceptable accuracy for confirmation of ETT position in neonates and is a safer and faster method in comparison to CXR .

Background: What has received special attention in recent months is the use of a combination of clinical findings, laboratory markers, and, in addition, the findings of lung Computed Tomography (CT) scan in the design and delivery of risk scoring systems for Coronavirus Disease 2019 (COVID -19) patients. The present study aimed to determine main lung CT-related correlates of disease severity (Intensive Care Units (ICU) requiring) as well as death in COVID -19 patients.Methods: This cross-sectional study was performed on 515 consecutive patients with definitive diagnosis of COVID-19 admitted to one of the COVID -19 referral hospitals in Tehran. All patients' information was collected through a review of their archives. All patients were evaluated by CT scan of the lungs.Results: The mean follow-up of patients from the time of admission was 10.85±6.11 days between 1 and 30 days. During this period, a total of 29.1% were admitted to the ICU. Also, the mortality rate of patients was equal to 28.2%. According to multivariable logistic regression model with the presence of death-related correlates, crazy paving pattern, diffuse distribution of lesions, CT Severity Score (CTSS) score >12, the presence of plural effusion or emphysema were the main determinants of COVID -19 related death and should be considered for presenting new scoring system for predicting death following COVID -19 disease. In similar model, CTSS score >12 along with the presence of plural effusion, emphysema, or pulmonary hypertension were the main determinants of requiring ICU admission. Conclusion: The CT score higher than 12 along with observing the pattern of diffuse distribution of lesions especially accompanied with emphysema, pleural effusion or pulmonary hypertension can predict patient mortality or will determine the need for hospitalization in the ICU.

Background: Endotracheal intubation is a common procedure in the neonatal intensive care unit (NICU). Rapid and accurate confirmation of the endotracheal tube (ETT) position is critical . Routinely CXR is used for evaluation of ETT position that has some disadvantages . So there has been a considerable interest to find alternative modality with minimal complication and acceptable accuracy. Objectives: the purpose of our study is the evaluation of ultrasound efficacy in confirmation of ETT position in neonates comparison to CXR.Patients and Methods: This cross-sectional study was conducted on 66 intubated neonates in NICU of Ali -Asghar children Hospital, between January 2018 and January 2019. To determine the ETT position, within 2-4 hours after CXR, each neonate had a bedside ultrasound (US) with a high-frequency linear transducer. Accuracy, sensitivity, specificity, negative predicted value (NPV), positive predicted value (PPV) and Kappa agreement coefficient was used to compare the US and CXR results. Results: Sixty-six intubated neonates included in this study had a mean gestational age of 34.98 ±3.7 weeks and mean birth weight of 2284.7 ± 915g. US images were taken a mean of 3 ±0.6 h after CXR. The ETT was visualized by the US in all newborns examined.US revealed a sensitivity of 88% (95% CI, 68.78% to 97.45%), specificity of 84 % (95% CI, 63.92% 95.46%), PPV of 84.62% (95% CI, 68.89% to 93.18%), NPV of 87.50 % (95% CI, 70.49% to 95.35%), diagnostic accuracy of 86%(95% CI, 73.26% to 94.18%), positive likelihood ratio of 5.50 (95% CI 2.21 to 13.66), and Negative Likelihood Ratio of 0.14 (95% CI 0.05 to 0.46) compared to chest radiography. Overall, the Kappa value showed very good agreement in confirming the correct position of the tracheal tube placement (Kappa coefficient 0.72, p-value Conclusion: The findings of this study demonstrate ultrasound has acceptable accuracy for confirmation of ETT position in neonates and is a safer and faster method in comparison to CXR .

Background: Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs. Objectives: This study aimed to investigate the risk factors of hospital-acquired infection in NICUs. Methods: A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis. Results: In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii. Conclusions: Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.

Background: Feeding intolerance is a common complication in preterm neonates and is responsible for prolonged hospitalization. This study aimed at assessing the effects of high-dose oral erythromycin on feeding intolerance in preterm infants. Methods: A randomized, double blinded, placebo-controlled trial was performed during 2014 and 2015 (Tehran-Iran). Preterm neonates aged >14 days, who met the feeding intolerance criteria were selected for the study and their medical records were randomly assigned into 2 groups by simple randomization. Infants in group A received 10 mg/kg oral erythromycin every 6 hours for 2 days, followed by 4 mg/kg oral erythromycin every 6 hours for 5 days; and infants in group B received placebo with the same route. The number of days until reaching complete oral feeding, day of discharge from NICU, and complications related to intervention were recorded and compared between the 2 groups. Independent samples t test, Mann-Whitney, Fischer exact test, and Chi square were used to analyze the relationships between variables. P-value less than 0.05 was considered statistically significant. Results: A total of 20 infants in group A received erythromycin and 20 infants in group B received placebo. Erythromycin could not alter the mean volume of feeding, duration of parental feeding, length of hospitalization, and frequency of feeding discontinuity (p>0.05); however, mean days to reach complete feeding in group A was significantly shorter than in group B (9.80 vs. 16.80 days; p=0.001). Conclusion: High-dose erythromycin as a rescue measure with no potential adverse effect is beneficial in reducing the time taken to achieve full enteral feeding. However, more extensive investigations are needed to determine the best administration dosage.

Background: Mercury is a one of the pollutant that can cross the placenta. Contamination by mercury in mothers and their neonates is associated with many problems. Objectives: This study aimed to compare mercury levels of cord blood in term and preterm neonates in Akbarabadi Hospital, Tehran, Iran, 2014. Methods: In this analytical cross-sectional study, we evaluated 50 term and 50 preterm neonates who were born in Akbarabadi Hospital in 2014. Necessary information including mother’s age, location, mother’s job, use of amalgam, use of fish, use of blood products and level of mercury were collected. Data were entered into SPSS V.16 and analyzed. Results: Mean age of mothers was 30.1 (SD = 6.4) years. Location in 86 (86%) were Tehran and in 14 (14%) were out of Tehran. Mean of mercury in neonatal cord blood was 2.7 (SD = 1.3) µg/L. There was significant difference between this mean in term and preterm neonates (P value = 0.009), while mean of mercury level in term neonates was 2.3 (SD = 0.7) µg/L and in preterms was 3 (SD = 1.7) µg/L. Mean of using fish in term neonates was1.2 (SD = 1.3) and in preterms was 1.6 (SD = 2.5). We could not find any significant difference between mercury level and using amalgam, fish and blood products in term and preterm neonates (P value > 0.05). Conclusions: Mercury level of cord blood in our study was higher compared to other studies, although it is not in the level of toxicity. Also we found that mercury level in preterm neonates is significantly higher than term neonates, therefore evaluating factors affecting mercury levels in neonates is essential.

Neonatal sepsis is a life-threatening disorder among infants, which is associated with high morbidity and mortality. In recent years, although the management of newborns has improved, early diagnosis and treatment of neonatal early-onset sepsis (NEOS) are the major challenges for neonatologists in Neonatal intensive care units (NICUs). We assessed the diagnostic value of interleukins-35 (IL-35) in diagnosis of NEOS. A prospective process evaluation study was carried out in the NICU of Akbar-Abadi and Ali-Asghar Hospitals affiliated to Iran University of Medical Sciences from 2017 to 2018. Eighty hospitalized neonates with clinical suspicion of sepsis in the first 72 h of life entered the study by convenience or accidental sampling. Routine hematology tests regarding sepsis diagnosis were performed after admission. All subjects were assigned into two groups: newborns with proven sepsis and newborns with suspected sepsis. IL-35 levels in septic and unlikely infected hospitalized newborns were measured using Elisa Kit (ZellBio GmbH. Cat. No; ZB-10042C-H9648, Human Interleukin 35), and the results were compared. The mean IL-35 in serum samples from septic neonates was significantly higher than this variable in samples from unlikely infected newborns (13.41 ± 2.4 vs. 9.02 ± 2.6 pg/ml; p

To evaluate the severity of respiratory failure among newborns with respiratory distress syndrome (RDS), oxygenation index (OI) has been implemented. In the present study, we assessed the accuracy of oxygen saturation index (OSI) in determining the severity of respiratory failure.A cross-sectional study was carried out in the NICUs of two Iranian Hospitals (Tehran, Iran) in 2018. Preterm neonates with RDS entered the study. Immediately after admission, the severity of RDS was determined based on RDS scoring system. Then, 2 CC of arterial blood was withdrawn and sent to laboratory determining blood gases. Simultaneously, the level of peripheral capillary oxygen saturation (SpOIn the study, 95 neonates were considered. Based on ROC curves, the appropriate cut off with AUC = 0.99 for severe respiratory failure was OSI8. The sensitivity, specificity, negative predicted value, and positive predicted value for the OSI Cut off8 were 100, 98, 0.97 and 100%, respectively. The overall accuracy and Kappa agreement between OSI and OI was 0.96 and 0.98%, respectively.Our results showed that OSI with high sensitivity, specificity values could predict the severity of respiratory failure in preterm neonates with RDS.

Background: Urine calprotectin significantly rises in acute kidney injury (AKI) in adult and pediatrics. The aim of the present study was to investigate the accuracy of urine calprotectin as a diagnostic marker for (AKI) in neonates. Methods In this cross sectional study, we assessed urine calprotectin in 100 neonates, in which 80 of them had AKI and 20 were healthy. Random urine calprotectin measured by ELISA and then compared between two groups. We included neonates who had received at least 48 hour intra venous fluid and met our inclusion and exclusion criteria. . Receiver-operating characteristic (ROC) curve used to set a cut of point for urine calprotectin to predict AKI. The overall accuracy and Kappa coefficient was used for assess the agreement between two methods.. P value below 0.05 considered significant. Results: Urine calprotectin levels were not significantly higher in neonates with AKI than healthy ones (146.2 vs 142.4, p=0.1). The results showed an optimal cutoff value of 123.5 mg/dl for urine calprotectin with area under the curve of 0•515 with sensitivity, specificity, positive predictive value and negative predictive value of 77.5%,40%,83.7% and 30.7%, respectively. The overall accuracy was 70% and the Kappa agreement coefficient was 0.15 (P=0.11.). Conclusion: Although urine calprotectin level can predict the AKI, it is not accurate measure comparing the gold standard.

Background: As there are different views on the effects of aminophylline on neonatal renal function, we intended to observe the effects of aminophylline on renal dysfunction in neonates with prenatal asphyxia.Methods: This randomized trial was conducted in the Obstetrics and Gynecology Hospital, Tehran, Iran, from June 2016 to May 2017, in neonates with moderate to severe asphyxia during birth. Fifty-six neonates were divided randomly into two groups. The intervention group received one dose of 5mg/kg slow intravenous aminophylline injection and the placebo group received 2 mL/kg of intravenous 10% solution of dextrose saline during the first hour of life. They were monitored and compared for renal functional indices, electrolytes, and complications of asphyxia during the three days of life.Results: The mean of Cr (37.9 ± 8.8 vs 38.5 ± 9.4 and 20.8 ± 4.8 vs 30.1 ± 5.2 μmol/L), GFR (21.55 ± 4.7 vs 20.25 ± 4.4 and 30.8 ± 7.1 vs 20.1 ± 6.5 mL/minute/1.73 m2 ), Na (135.1 ± 12.4 vs134.5 ± 11.2 and 128.9 ± 11.5 vs 134.2 ± 10.9 mEq/L), and urine output (98.2 ± 25 vs 96.8 ± 23 and 148.7 ± 35 vs 108.8 ± 20 cc) were in the aminophylline treated and placebo group on the 1st and 3rd days, respectively. The mean difference of Cr (-9.3 (-8.9; -9.7) μmol/L); (P= 0.02), GFR (10.7 (10.1; 11.3) mL/minute/1.73 m2 ) (P= 0.009), Na (-5.3 (-5.9; -4.7) mEq/L) (P= 0.002), and urine volume (39.9 (24.9; 54.9) cc) (P= 0.001) presented statistically significant differences on the third day between the intervention and placebo group.Conclusion: Aminophylline was effective in preventing renal dysfunction in neonates with asphyxia. Neonates who received aminophylline indicated a significant improvement in GFR and urine output on the first day of life.

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3– and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age. RESUMO OBJETIVOS: Medimos o nível de gases de pH em bebês prematuros, no nascimento dos neonatos, e examinamos a relação entre a ecografia cerebral no terceiro e no sétimo dia após o nascimento. Um estudo de casos e controles realizados na Unidade de Cuidados Intensivos Neonatais (UCIN) do Hospital Shahid Akbar Abadi durante os anos de 2016-2017, Irã. MÉTODOS: Todos os recém-nascidos prematuros que deram entrada na UCIN foram inscritos no estudo atual. Ao nascer, foi retirada uma amostra de gás em sangue, do sangue do cordão umbilical dos bebês. No terceiro e sétimo dia após o nascimento, um radiologista realizou uma ecografia do cérebro de cada neonato. O cordão umbilical foi avaliado para detectar gases no sangue em 72 neonatos (em sua maioria do sexo masculino). RESULTADOS: Sessenta e seis recém-nascidos tinham ecografia normal e 16.7% (12 casos) tinham anomalias. 75% das 8 crianças com hemorragia intravenosa eram meninas, que foram significativamente diferentes das do grupo não hemodinâmico (62.5% homens) (P.0.049). Contudo, o tipo de parto, o peso médio, a altura, o perímetro cefálico, a circunferência do tórax e a pontuação de Apgar não foram diferentes entre os grupos. O pH médio, HCO3 e PCO2 nas amostras de gás no sangue do cordão umbilical não foram significativamente diferentes entre dois grupos com ou sem hemorragia intraventricular (Hiv). Apesar de não estar relacionado com o gênero e o tipo de parto em recém-nascidos. Conclusão: os gases sanguíneos não ajudam a determinar o aparecimento de Hiv nos bebês. Contudo, está associado com a imaturidade e idade fetal.

Background: The role of urinary cystatin C to early predict acute kidney injury (AKI) in children and neonates remains uncertain. The present study aimed to assess and compare the level of urinary cystatin C in neonates with and those without AKI. Methods: This cross-sectional study was performed on 55 available neonates who were involved by AKI and admitted to the neonatal department at Ali-Asghar hospital in Tehran in 2016. 97 neonates with jaundice and normal serum creatinine level were randomly selected as the control group. In both groups and on admission, the urine levels of cystatin C and creatinine were measured. Results: The average urinary level of cystatin C was 162.87 ± 56.50 mmol/mole creatinine in the group with AKI and 68.06 ± 57.16 mmol/mole creatinine in the control group that was significantly higher in former group (p < 0.001). The measurement of cystatin C level in urine could predict kidney injury with a sensitivity of 98.2%, a specificity of 39.2%, a positive predictive value of 47.8%, a negative predictive value of 97.4%, and an accuracy of 60.5%. Assessment of the area under the receiver operating characteristic (ROC) analysis showed that measuring urinary cystatin C level could effectively discriminate kidney injury from normal kidney condition in neonates (AUC = 0.868, 95CI: 0.811 – 0.925, P < 0.001). The best cutoff value of urinary cystatin C level to predict kidney injury was shown to be 41.5 mmol/mole creatinine yielding a sensitivity of 98.2% and a specificity of 46.4%. Conclusion: Measurement of cystatin C in urine is an early sensitive method to diagnose neonatal kidney injury.

Background: The present study aimed to assess the efficacy of omega-3 in treating ROP in premature infants. Methods: This randomized double-blinded controlled trial was performed on 160 premature infants with gestational age lower than 32 weeks and birth weight < 1500 grams who were at risk of ROP development (Tehran, Iran-2013). Children were randomly assigned to two groups. The intervention group received 300 mg omega-3 daily and the control group received sterile water as the placebo. The severity of ROP was defined according to the International Classification of ROP. Results: The frequency of ROP was 7.5% in the group received omega-3 and 20.0% in the placebo group with a significant difference (p = 0.021). Regarding the severity of ROP in the intervention group, ROP grade I was found in two patients and ROP grade II in four patients; while ROP grade I, II, and III were revealed in 6, 6, and 4 patients in placebo group indicating a significant difference between the two groups (p = 0.001). Using the multivariate logistic regression modeling with the presence of gender, gestational age, and birth weight, the use of omega-3 was associated with reduced risk for ROP (p = 0.045). Conclusion: The use of omega-3 supplement can be an appropriate treatment option for the treatment of ROP in premature infants.

Premature infant is an infant who was born before the end of 37th weeks of pregnancy. Approximately 9.6% of infants are premature and they can be at risk for hospitalization. This study has done for evaluation of awareness and knowledge of parents about problems of premature infants in Neonatal Intensive Care Unit (NICU). This was a descriptive study with 160 parents whose premature infants were admitted to NICU (Tehran-Iran, 2009-2011). Data were collected by a questionnaire for evaluation of awareness and knowledge of parents about problems of prematurity, and then analyzed by using descriptive analytic statistical methods and SPSS software. Based on the results, there was a significant relation between age and the total score of questionnaire (P = 0.022, R = 0.18). Mothers had higher awareness and knowledge than fathers (P < 0.05). The most awareness in parents was about doing of hygienic principle when they entered to NICU and about the importance of regularly and continuous attendance in ward. Awareness and knowledge of parents about problems of their premature infant were related to their age and being a mother or father. Parents had little knowledge about some NICU principles and premature infant’s needs and care.

Intraventricularhemorrhage (IVH) is one of thecommon morbidities among preterm neonates. In thepresentstudy, we set out to evaluate the efficacy of two prophylactic modalities (ibuprofen and indomethacin prophylaxis) for prevention of IVH in our local setting. A prospective study was carried out in Akbar-Abadi Hospital, Tehran-Iran (2013-2014). Ninety-six preterm neonates who cared in closed incubator entered the study. Neonates randomly assigned into 3 groups; control, oral indomethacin (0.2 mg/kg indomethacin daily for 3 days) and oral ibuprofen (10,5,5 mg/kg ibuprofen every 24 hours during 3) administration. For all subjects brain sonography examination was performed in 3rd day, first, 2nd week of life and when infants reached to 36 and 42 weeks of postmenstrual age. The IVH prevalence and the effectiveness of the drugs among groups were statistically assessed. Of all 93 subjects; 14 cases had IVH (15.1%). IVH was significantly more frequent in the controls than in other groups (P=0.049). Prophylactic treatment could significantly decrease the incidence of grade 3 or 4 IVH in experimental groups (P=0.008). There were no significant differences between the three experimental groups with respect to theincidence of GI bleeding, Oliguria, renal dysfunction or NEC (P>0.05). This study demonstrates that low-dose prophylactic indomethacin and ibuprofen are equally associated with a reduction of IVH without any significant side effects like renal dysfunction, GI bleeding or NEC.

The use of earmuffs can protect preterm infants against negative effects of high noise levels in the neonatal intensive care unit. This study was aimed at assessing the effectiveness of the earmuffs on the physiologic and behavioral responses in preterm infants.A crossed over controlled trial was conducted at Aliasghar Hospital (Tehran, Iran) in 2014. Thirty-six preterm infants cared in closed incubators, 18 cases wore a pair of silicon earmuffs in the first day and the others were worn it at the second day. During 2 consecutive days, all subjects were observed as their own controls (without earmuffs). Physiologic (body temperature, heart rate, respiratory rate, systolic, diastolic pressures, arterial Oxygen Saturation) and behavioral responses (according to the Anderson behavioral state scoring system) were assessed every 2 h for 8 h long during daytime for two consecutive days.The application of earmuffs could decrease the rate of the heart and respiratory while could increase the amount of oxygen saturation (p 0.05). The results also showed that the preterm infants with earmuffs had lower ABSS score and a better light sleep compared to those without earmuffs (2.38 ± 0.47 versus 4.8 ± 0.97, p 0.05).The results indicated that using the earmuffs reduces the level of noise in NICUs following by improving the preterm neonates' physiological stability and behavioral states of ABSS.

Background Ghrelin is a pleiotropic hormone that regulates feeding and energy balance and stimulates growth hormone release. Ghrelin also exerts developmental and organizational effects during prenatal life. Objectives The aim of this study was to determine ghrelin levels in cord blood of small for gestational age (SGA) infants and its association with GH (growth hormone) and IGF-1 levels (insulin-like growth factor-1). Methods Cord blood sample was obtained from 31 SGA and 25 appropriate for gestational age (AGA) infants. Acylated ghrelin, GH, and IGF-1 levels were measured by enzyme-linked immunosorbent assay. Results No significant differences were observed in ghrelin and GH concentrations between SGA and AGA infants. However, IGF-1 levels were significantly lower in SGA infants. Cord blood ghrelin was negatively correlated with the infants’ birth weight (r = -0.33, P = 0.013); on the other hand, IGF-1 level was positively correlated with birth weight (r = 0.43, P = 0.002). Conclusions IGF-1 has the most significant effect on intrauterine growth. Acylated ghrelin is detectable in cord blood and correlated with birth weight, suggesting a role in intrauterine development, but its level is not affected by intrauterine growth retardation.