Prevalence and factors associated with exclusive breastfeeding at 6 months of life in Tehran: a population-based study

Exclusive breastfeeding is the best form of nutrition for infants in the first 6 months of life. The aim of this study was to determine the prevalence of exclusive breastfeeding in Tehran, Islamic Republic of Iran in the first 6 months of life, and the factors that influence it. In a population-based, cross-sectional study 538 mothers with children aged 6-24 months completed an interview questionnaire. Only 46.5% of mothers exclusively breastfed their infant in the first 6 months of life. In multivariate analysis formula supplementation in the hospital [OR = 0.41, 95% CI: 0.17-0.95] and mother receiving conflicting infant feeding advice [OR = 0.53, 95% CI: 0.37- 0.78] had a negative effect on exclusive breastfeeding. Mother's intention to exclusively breastfeed [OR = 5.85, 95% CI: 2.88-11.9] and infant having first breast contact 6-30 minutes after delivery [OR = 2.35, 95% CI: 1.17-4.72] had positive effects on exclusive breastfeeding

Risk factors in neonatal anaerobic infections

Anaerobic bacteria are well known causes of sepsis in adults but there are few studies regarding their role in neonatal sepsis. In an attempt to define the incidence of neonatal anaerobic infections a prospective study was performed during one year period. A total number of 400 neonates under sepsis study were entered this investigation. Anaerobic as well as aerobic cultures were sent. The patients were subjected to comparison in two groups: anaerobic culture positive and anaerobic culture negative and this comparison were analyzed statistically. There were 7 neonates with positive anaerobic culture and 35 neonates with positive aerobic culture. A significant statistical relationship was found between anaerobic infections and abdominal distention and pneumonia. It is recommended for those neonates with abdominal distention and pneumonia refractory to antibiotic treatment to be started on antibiotics with anaerobic coverage

Prevalence of Factors involved in intracranial hemorrhage of premature neonates less than 34 weeks' gestation

Intracranial hemorrhage is one of the major causes of neonatal mortality and morbidity. It is the most severe cranial problem in that period. Those who survive would be affected by hydrocephalus, encephalomalacia, and finally brain atrophy. With accurate knowledge of risk factors, hemorrhage may be diagnosed earlier and the complications managed earlier. This study was performed in Neonatal Intensive Care Unit of Imam Khomeini Hospital. All the neonates less than 34 weeks of gestation were undergone intracranial sonography from Feb 2005 to Feb 2006. Sonography was performed via anterior fontanel with proper probe according to neonatal age. 113 neonates less than 34 weeks of gestation have been studied. Mean gestational age was 32 weeks. Mean neonatal weight were 1566 +/- 734 grams. Intracranial hemorrhage was evident in 21% of them; 16.8% was grade 1, 0.9% grade 2, 2.7% grade 3, 0.9% grade 4. The mean weight of neonates with hemorrhage was 1504.11 grams. Intracranial hemorrhage had correlation with respiratory acidosis and pneumothorax. The latter was also correlated with hemorrhage grade. Supposing the safety and non-invasiveness of intacranial sonography, we suggest performing sonography in all premature neonates with low birth weight, and also in those neonates with pneumothorax and respiratory acidosis

Prevalence of anaerobic and aerobic bacteria in early onset neonatal sepsis

To determine prospectively the prevalence of anaerobic and aerobic infection in early onset [during 72 hours of age] neonatal sepsis, in Tehran Vali-e-Asr Hospital. Among all the live birth, neonates suspecting of having septicemia were investigated for isolation of microorganisms. Culture bottle containing enriched tryptic soy broth was used for standard blood culture system to detect aerobes and an ANAEROBIC/F bottle was inoculated using BACTEC 9120 continuous monitoring blood culture system to determine the growth of anaerobic bacteria. Among 1724 live births, 402 consecutive neonates suspecting of having septicemia were investigated for isolation of micro organism. A total of 27 episodes of early onset neonatal sepsis occurred with an incidence of 15.66 [11.6 aerobe + 4.0 anaerobe] per 1000 live births. Aerobic bacteria were the major etiological agents, accounting for 20 cases. 7 [26%] cases had positive blood cultures with anaerobic bacteria. Propionibacterium and Peptostreptococccus [amongst anaerobic] and coagulase-negative staphylococci and staphylococcus aureus [amongst aerobic] were the most commonly isolated organisms. Comparison of clinical findings and demographic characteristics between aerobic and anaerobic infection did not have a significant statistical difference. Our impression is that while anaerobic bacteremia in the newborn infants can occasionally cause severe morbidity and mortality, majority of cases experience a self limited illness with transient bacteremia

[Evaluation of the cause and predisposing factors in neonatal mortality by using international coding diseases version 10 in Valiasr Hospital]

According to the fact that the reduction of Neonatal Mortality Rate is correspondent to improvements in health and hygienic status of the society, understanding the major neonatal mortality causes will help the society to plan better prenatal and neonatal care systems. On this retrospective study, the major causes of the mortality of the dead neonates were extracted from files of Vali-Asr hospital according to the International Coding of Disease Ver 10 [ICD[10]]. Data were analyzed in proportion to gestational age, birth weight, gender and neonatal age. Mortality rate was higher during the first week of life [78%]. Generally five main causes of death were; prematurity, respiratory distress syndrome, intra cerebral hemorrhage, multiple congenital anomalies and air leak syndromes. It was also revealed that the causes of death of low birth weight neonates were similar to those of premature neonates [respiratory distress syndrome, prematurity, intra cerebral hemorrhage, septicemia and air leak syndromes]. Similarly there was no difference between the causes the of death in mature neonates and appropriate for growth age neonates. The main causes of death in these two groups were; congenital disease, infections [septicemia and Pneumonia], asphyxia, diffuse intra vascular coagulation, intra cerebral hemorrhage, meconium aspiration and complications of pregnancy. Data analysis indicated significant relationships between death and gestational age, neonatal age and birth weight [P=0.001] but it was not related to gender. With due attention to the easy application of ICD 10 for determining the major and underlying causes of death of neonates and the fact that autopsy is not routinely applicable in neonatology wards, routine using of ICD 10 for classifying the causes of death in death certificates is highly recommended

[Frequency and severity of retinopathy of prematurity: singleton versus multiple-births]

To determine the frequency and severity of retinopathy of prematurity [ROP] among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran-Iran. We reviewed the records of 99 consecutive neonates from multiple-gestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP during 2002-2004. The frequency, severity and risk factors of ROP were determined. The results were compared with a group of singletons who did not differ from the multiple-birth group regarding birth weight, gestational age, oxygen therapy, respiratory distress syndrome, transfusion, sepsis, phototherapy and gender. ROP was present in 12.1% of multiple-birth neonates compared to 15.1% in singletons [P=0.53]. Threshold ROP was present in 6.1% of multiple-birth neonates and 7.1% of singletons [P=0.62]. ROP was detected in 60% of quadruplets vs 9.6% of twins and triplets with threshold disease in 40% of quadruplets compared to 4.2% in twins and triplets. Logistic regression analysis revealed no statistically significant differences in frequency and severity of ROP among subgroups of multiple-gestation pregnancies [P= 0.79]. The higher frequency of ROP among multiple-birth neonates is due to lower birth weight and gestational age but there is no significant difference between multiple-births and singletons in terms of frequency and stages of ROP. Screening for ROP in multiple pregnancy births may be conducted according to the same standard protocols as for singletons

Incidence and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran

To identify the incidence rate and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran, 900 neonates were randomly selected. Body temperature was measured repeatedly at different time points after birth. More than 50% became hypothermic soon after birth. Multiple regression analysis showed that low birth weight, low gestational age, low environmental temperature, low Apgar score, multiple pregnancy and receiving cardiopulmonary resuscitation were significantly associated with hypothermia. These findings suggested that there is an urgent need to sensitize and educate all levels of staff dealing with neonates in our country

Hypothermia at birth and its associated complications in newborns: a follow-up study

Hypothermia is one of the main causes of neonatal mortality in developing countries. The aim of this prospective study was to determine the relationship between hypothermia at birth and the risk of mortality or morbidity among neonates born in Imam Hospital in Tehran, Iran. During a one-year period, body temperature was taken from all newborns using a low-reading rectal thermometer, immediately after their admission into the Neonatal ward of the above hospital. A temperature less than 36.5 C was considered as hypothermia. A questionnaire was filled for each subject. Using logistic regression the risk of development of respiratory distress in the first six hours of birth, hypoglycemia, metabolic acidosis, hyperbilirubinemia, scleroderma, pulmonary hemorrhage, Disseminated Intravascular Coagulopathy [DIC] in the first three days of birth were assessed and compared with the hypothermic and normothermic newborn infants. Nine hundred and forty neonates were enrolled into the study. A significant relationship was found between hypothermia and respiratory distress in the first six hours of birth and death, as well as with jaundice, hypoglycemia and metabolic acidosis in the first three days of birth [P=0.0001]. Logistic regression showed that, regardless of weight and gestational age, hypothermia at birth alone could increase the risk of neonatal death [OR=3.64, CI=1.85-7.18], Respiratory distress [OR=2.12, CI=1.53-2.93], metabolic acidosis [OR=2.83, CI=1.74-4.59] and jaundice [OR=2.01, CI=1.45-2.79]. Neonatal hypothermia at birth increases mortality as well as significant morbidity and hospitalization period

Effects of antenatal steroids on the incidence and severity of respiratory distress syndrome in an Iranian hospital

Antenatal corticosteroids are still not routinely used in the Islamic Republic of Iran to promote lung maturity in premature neonates. In a retrospective review of records at Imam Hospital, Tehran, we compared 140 premature neonates born in 2000 whose mothers received dexamethasone antenatally with 142 born in 1995 whose mothers did not receive treatment. There were no significant differences between the groups in mothers' age; neonates' birth weight, gestational age or sex; route of delivery and multiple gestation; underlying maternal disease; or adverse events in labour. The incidence of respiratory distress syndrome was significantly lower in the dexamethasone-treated group [18.6% versus 35.9%]. Mortality [5.7% versus 14.8%] and use of the neonatal intensive care unit [12.9% versus 21.1%] were also significantly lower among those who had received treatment

Neonatal hypothermia in Tehran, Iran: incidence, severity and death rate

In 1958, Silverman demonstrated that maintenance of body temperature reduces mortality in low birth weight infants. From the early 1990s it was already recognized that adequate environmental warmth was essential in the case of newborns. However, neonatal hypothermia continues to be a significant issue in developing countries.In order to describe the incidence and severity of hypothermia after delivery and to determine the possibility of related mortality risk among neonates in a tertiary nursery, we measured the body temperature on admission of 898 consecutive inborn infants after birth by a low-reading thermometer. Body temperature less than 36.5°C was designated as 'hypothermia'. In such cases the infants were re-warmed according to WHO recommendations. Their body temperature was checked and recorded every hour and their final outcome was noted.The overall incidence of hypothermia was 53.2%. 456 [i.e., 50.2% of] infants had mild hypothermia [35>T>36.5] while 22 [2.5%] of them had moderate to severe hypothermia [T<35°C]. The incidence and severity of hypothermia was found to be significantly associated with birth weight [p= 0.000] and gestational age [p= 0.000]. The duration of re-warming was also correlated with birth weight [p= 0.000]. Logistic regression analysis showed that the mortality rate of hypothermic neonates is 3.64 times that of the normotherms. The risk of death was higher in the moderate to severe hypothermic groups than in the mild hypothermic infants.In our study, the incidence of hypothermia was found to be high with both the incidence and severity to be significantly associated with birth weight and gestational age. The risk of death was recognized to be higher in the hypothermic new borns than non-hypothermic ones