Effect of white plastic cover around the phototherapy unit on hyperbilirubinemia in full term neonates

Jaundice is a common problem in neonatal period. Phototherapy is the most common treatment for neonatal jaundice. The purpose of this study was to determine the effect of adding white plastic cover around the phototherapy unit on hyperbilirubinemia in full term neonates with jaundice. In this randomized controlled trial, over 12 months [October 2009 - September 2010], 182 term neonates with uncomplicated jaundice, admitted to neonatal unit of Imam Reza Hospital [AS] in Kermanshah province of Iran, were selected. They were randomized in two groups. Control group received conventional phototherapy without cover around the apparatus and covered group received conventional phototherapy with plastic cover around the unit. After enrolment, total serum bilirubin was measured every 12 hours. Phototherapy was continued until the total serum bilirubin decreased to or less than 12.5 mg/dl. There were no significant differences between the two groups for gestational age, birth weight, postnatal age, weight [at admission], serum level of hemoglobin, hematocrit and reticulocyte count. Total serum bilirubin in covered group, during the first 48 hours of treatment, declined significantly than in control group [P. value=0.003]. The cover around the phototherapy unit not only did not increase the side effects of phototherapy, but also had a positive impact in reducing duration of jaundice [P. value <0.0001] and duration of hospitalization [P. value <0.0001]. The study results showed that using white plastic cover around the phototherapy unit can increase the therapeutic effect of phototherapy

[Comparison of intermittent versus continuous phototherapy and position change effect on treatment of term newborns with jaundice]

Hyperbilirubinemia is a common problem of neonatal period and phototherapy serves as the effective method in treatment. Despite its worldwide application, there are many unanswered questions regarding enhancement of its efficacy. The aim of present study was the comparison of intermittent versus continuous phototherapy and position change effect on treatment of term newborns with jaundice A clinical randomized controlled trial was performed during a 17 months at NICU of Imam Reza's hospital in Kermanshah. Eighteen jaundiced neonates were selected according to inclusion and exclusion criteria. The neonates were randomized into three groups receiving different regimens of phototherapy. Group I was treated with continuous single phototherapy in supine position during phototherapy. Group II received intermittent single phototherapy without change position, and group ?II received continuous single phototherapy with changing position. Total and direct serum bilirubin levels were measured every 12 hours after starting phototherapy. Phototherapy was continued until the serum bilirubin level declined to less than 13mg/dl. The data was analyzed using t-test and ANOVA tests. There was no statiscally significant difference between sex, birth weight and other variables within three groups. The mean duration of phototherapy was 47.5h in group I, 51.6h in group II and 39.3h in group III. There was no significant difference for the duration of phototherapy between the three groups [p=0.18]. We can conclude that an intermittent single phototherapy was as effective as continuous single phototherapy in treatment of neonatal hyperbilirubinemia in the term newborns

[Evaluation of cleft lip and palate frequency and related risk factors in infants born in Kermanshah hospitals [2001-2008]]

Cleft lip and palate are the most common congenital anomalies in the head and neck region, which are affected by environmental and genetic factors. The prevalence of these anomalies varies in different countries. There is no scientific report from the west of Iran. The aim of the present study was to determine its prevalence and related risk factors in infants born in Kermanshah hospitals during 2001-2008. In this descriptive study, 62823 infants born during 2001-2008 in Motazedi and Imam Reza hospitals in Kermanshah [a city in the west of Iran] were reviewed. A total of 98 cases with oral clefts were recorded. Data were analyzed by ANOVA and Chi-square test using SPSS12 statistical software. Out of 62823 infants 98 cases had oral clefts [1.5 for 1000 birth], 59.8% of which were males; 38.8% had cleft lip and palate; 31.6% had cleft lip and 29.6% had cleft palate. A total of 51.3% of parents had familial marriage; 14.7% of mothers reported use of medications; 40% of mothers had A[+] blood group; 37.2% of the newborns were the first baby of the family and 93.8% of mothers had not taken vitamin supplements. The mean age of mothers were 27 years and the highest number of clefts belonged to 21-30 year-old mothers. The prevalence of oral clefts and their types in Kermanshah are consistent with world reports but lower than the calculated average for Iran

[ effect of intravenous immunoglobulin on admission duration and mortality rate related to sepsis in preterm neonates]

The infection in the neonatal period is a significant cause of mortality in the preterm neonates. The transfer of the immunoglobulin from mother to fetus occurs mainly after 32 to 34 weeks of gestation. Therefore, preterm neonates are relatively immune compromised. The aim of the study was to evaluate the impact of intravenous immunoglobulin on mortality rates reduction in preterm neonates. A randomized clinical trial conducted from Jan2008 to July 2009 in Imam Reza hospital of Kermanshah - Iran. The population was 40 preterm neonates with gestational age less than 34 weeks admitted in the NICU with probable sepsis [clinical sepsis + Lab test]. They have been divided into two case and control groups with 20 subjects in each group. The case group received 500 mg/kg intravenous immunoglobulin during first 24 hours of admission in addition to routine treatments, which were the same in both group. Before and 6 hours after administration of intravenous immunoglobulin serum level of IgG was measured in treatment group. Then data were analyzed with SPSS software and Fisher's exact test and Chi [2] test were analyzed. Mortality rate was higher in control than treatment group, but it was no statistically significant. There were not significant differences in variables including the need for ventilation, exchange transfusion, admission duration and positive blood culture. Serum IgG levels significantly increased after administration of immunoglobulin in treatment group [p=0.001]. Using intravenous immunoglobulin in the treatment of sepsis increased serum level of IgG but did not effect on mortality rate and admission duration in preterm neonates

[ effect of clofibrate and phototherapy on physiological jaundice in term newborns]

Clofibrate is an effective anti lipid agent that induces glucuronyltransferase could increase bilirubin conjugation. The aim of this study was to evaluate effect of clofibrate on neonatal physiologic jaundice. Randomized clinical trial sampling method used and 60 healthy term neonates which were admitted in Imam Reza Hospital of Kermanshah-Iran because of indirect hyperbilirubinemia enrolled into the study. 30 neonates [case group] were treated with single oral dose of clofibrate [100/mg] plus phototherapy and 30 neonates [control group] received only phototherapy. Serum total and direct bilirubin levels were measured at admission, 12 hours later, and then every 24 hours until 96 hours. There were no significant difference between two groups regarding to gender, age, weight and total serum bilirubin level at the admission. Mean values for total bilirubin of serum in case group 12, 24 and 48 hours after admission were significantly lower than control group [P<0.001]. The mean of needed time for phototherapy in case group was significantly less than the control group [P<0.00l]. It seems that clofibrate plus phototherapy is effective for treatment of neonatal physiologic jaundice in healthy term newborns, although further studies are necessary for evaluation of clofibrate safety as a routine treatments

[ survey of complaints against physicians reviewed at Kermanshah Medical Council 2001-2005]

Medical complaints affect a large number of the physicians. Apart from them being a waste of time, money and energy, lawsuits can be source of great stress for the physician. So far, no survey of medical complaints has been conducted in Kermanshah. This study examines complaints processed through Kermanshah Medical Council between 2001 and 2005. In this descriptive study, a convenient sampling was carried out: using the files available at Kermanshah Medical Council in the period of 2001 to 2005. From a total of 544 cases reviewed, 462 were included in the study. Data was gathered through a check list based on objectives and in accordance with the council's regulations, including demographic characteristics of patients and physician, type of disease, reason to see physician, intervention, choice of physician, type of disease, reason to see physician, intervention, choice of physician, treatment, reason for complaint, length of process and the verdict. The data were then analyzed using descriptive statistic. Overall, 462 complaints were examined, 95% of cases involved a physician with gynecologists, orthopedists, dentists and general surgeons making up 19%, 14.7%, 13.1% and 11.1% of the total respectively. Complaints regarding the outcome of an operation represented 65.2% of the total. Side effects [36.9%], death [24%], malpractice [13.8%] and disability [12.3%] came out as the most common reasons for complaining. The average length of process was 150/68 + 206/1. In 58.2% of the cases, the defendant had been acquitted. There was an upward trend for the number of complaints filed in the past few years. While negligence on the part of the physician remained a main cause, in many cases there was lack of conclusive evidence for complaining, reflecting the fact that people were not informed of the possible side effects that a condition and its treatment might bring about. On the other hand, this shows that medical records are by no means comprehensive

[ effect of calcium and phosphorus supplements on bone mass and serum alkaline phosphatase in premature infants]

Osteopenia is common problem in premature infants. Low-birth weight babies do not receive adequate amounts of calcium and phosphorus through breast feeding. This study examines the effect of calcium and phosphorus supplements on osteopenia in premature infants. This clinical trial included 42 premature infants hospitalized at Razi hospital in Kermanshah. All the babies had a birth weight of less than 1800 grams. They were assigned into two groups of control and case. While babies in the control group received only breast milk, calcium [80mg/kg/day] and phosphorus [40mg/kg/day] were added to the breast milk for the infants in the other group. All the infants received a daily supplement of 400 iu vitamin D. Anthropometric measurements, serum calcium, phosphorus, and alkaline phosphatase concentration were examined once at the beginning of the study and then every two weeks until week 6. At the end of the period, wrist x- ray was administered for all the infants. Data were then analyzed using t-student and chi square. Radiographic criteria did not indicate any signs of osteopenia. Yet a significantly higher serum alkaline phosphatase concentration was revealed through biochemical analysis in control group [p=0.001]. Anthropometric measurements showed improvements in height, weight and head circumference for the two groups. Treatment with calcium and phosphorus supplements was associated with a decrease in serum alkaline phosphatase concentration which is an indication of osteopenia. However the treatment did not reduce incidence of osteopenia in premature infants