Pregnancy complications and neonatal outcomes in multiple pregnancies: a comparison between assisted reproductive techniques and spontaneous conception

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies [ART] to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student's t test, chi square and logistic regression [p<0.05]. There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups [p<0.001]. The ART group had significantly higher preterm labor and premature rupture of membranes [PROM] whereas pregnanc-induced hypertension [PIH] was higher in the spontaneous group [p=0.01]. Newborn intensive care unit [NICU] admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome [RDS], NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART

Risk factors for neonatal mortality among very low birth weight neonates

The objective of this study is to determine risk factors causing increase in very low birth way [VLBW] neonatal mortality. The medical files of all neonates weighing <1500 gram, born in Vali-e-Asr hospital [2001-2004] were studied. Two groups of neonates [living and dead] were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age [P=0.02], low birth weight, lower than 1000 gram [P=0.001], Apgar score <6 at 5[th] minutes [P=0.001], resuscitation at birth [P=0.001], respiratory distress syndrome [P=0.001] need for mechanical ventilation [P=0.001], neurological complications [P=0.001] and intraventricular hemorrhage [P=0.001]. Regression analysis indicated that each 250 gram weight increase up to 1250 gram had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 gram should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 gram. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage

[Study of characteristics, risk factors and outcome for ventilator associated pneumonia in neonatal intensive care unit patient]

Ventilator Associated Pneumonia [VAP], developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit [NICU], over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP.105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death. Thirty eight patients were enrolled [58% were boys and 42% were girls].42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni [43%]. On multiple regression analysis, duration of mechanical ventilation was associated with VAP [P=0.00]. Patients with VAP had greater need for mechanical ventilation [18.7 vs 6 median days], longer NICU length of stay [39 vs 21.5 median days] and higher total median hospital costs [79.5 vs 52 million rials] than those without VAP. The mortality rate was not different between two groups. In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn't increase mortality in patients.

[ effects of temperature and birth weight on the transition rate of hypothermia in hospitalized neonates using Markov models]

Hypothermia is an important determinant of survival in newborns, especially among low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine the factors affecting transition from hypothermic state in neonates. The study consisted of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonates' rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multistate Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model. Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute, respectively. Weight had a significant effect on transition from hypothermia to normal condition [95% CI: 0.1364-0.4165, P<0.001]. Environmental temperature significantly affected the transition from hypothermia to normal stage [95% CI: 0.0439-0.4963, P<0.001]. The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28°C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental temperature in an optimum level could help neonates to pass through the hypothermia stages faster

Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran

Asphyxia is a medical condition in which placental or pulmonary gas exchange is impaired or they cease all together, typically producing a combination of progressive hypoxemia and hypercapnea. In addition to regional differences in its etiology; it is important to know its risk factors. This is a case-control study, all neonates born from May 2002 to September 2005 in Vali-e-Asr Hospital were studied. 9488 newborns were born of which 6091 of the live patients were hospitalized in NICU. 546 newborns were studied as case and control group. 260 neonates [48%] were female and 286 neonates [52%] were male. Among the neonates who were admitted, 182 of them were diagnosed with asphyxia and twice of them [364 newborns] were selected as a control group. The variables consist of; gestational age, type of delivery, birth weight, prenatal care, pregnancy and peripartum complications and neonatal disorders. Our studies showed that 35 [19.2%] patients had mild asphyxia, 107 [58.8%] had moderate asphyxia and 40 [22%] were diagnosed as severe asphyxia. Mean maternal age was 34.23 +/- 4.29yr; [range: 23-38 yr]; and mean of parity was 2 +/- 1.2; [range: 1-8]. Risk factors in our study included emergent Caesarian Section, preterm labor [<37w], low birth weight [<2500g], 5 minute Apgar [less than 6], need for resuscitation, nuchal cord, impaired Biophysical Profile, neonatal anemia, and maternal infertility. All risk factors listed above play a role in asphyxia. The majority of these factors are avoidable by means of good perinatal care

Comparison of two regimens of RhG-CSF in neutropenic neonatal septicemia: a randomized clinical trial

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals [Tehran, Iran]. The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10 micro g/kg/s.c. to neonates in group A and as 10 micro g/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups [P>0.05]. The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups [P>0.05]. The results of this study showed that administration of a single dose of RhG-CSF [10 micro g/kg] was effective in treating neonatal septicemic neutropenia

randomized controlled clinical trial of olive oil added to human breast milk for weight gaining in very low birth weight infants

Evaluating the effect of vegetable oil, as a supplement to breast milk in increase the weight gaining of VLBW neonates. In this single blind; Randomized clinical trials, in NICU of Vali-asr Hospital, Tehran University of Medical Sciences, 2005-2006;A total of 48 VLBW neonates referred and admitted to NICU, who did not have any major GI [especially NEC], respiratory or cardiac diseases; participated randomly in two groups: intervention and control.Vegetable oil was added to the milk of 25 neonates [0.5 cc per 30cc of milk] and the other 25neonates with similar conditions that were selected as a control group, did not get any type of supplementary nutrition. Daily feeding volume in both groups was 150-200 cc for each kilogram of body weight. Weight gaining in interventional groups was considerably more than control group. [p<0.04].There were also significant statistical differences in hospitalization period between the two groups, 28.9 days in interventional and 20.33 days in control group, [p<0.03].However, no significant side effects were observed. There is no report regarding contraindication linking the use of vegetable oil intended for appropriate weight gaining or reducing hospitalization period to neonatal chronic diseases

Association between maternal and neonatal blood pressure

This study aims to describe the blood pressure profile of newborns of preeclampsia mothers in Vali-e-Asr hospital during 2003-2004. In this cross-sectional descriptive analytical study 200 mothers and their newborns were studied. Blood pressure of all newborns was checked by oscillometric method on the first day after birth and recorded in a questionnaire along with information pertaining to the mother, obtained by interview or through medical file retrieval. The newborns of mothers with high systolic [>140 mmHg] and diastolic [>90 mmHg] blood pressure had mean systolic [65.40 mmHg] and diastolic [42.85 mmHg] blood pressures higher than that in neonates of normotensive mothers[P <0.006]. Mean systolic and diastolic blood pressure of neonates whose mothers were preeclampsia [68.2/42.11 mmHg or chronically hypertensive [68.59/ 41.50 mmHg-] were significantly higher than neonates of normotensive mothers [P<0.0001 and P<0.002, respectively].Newborns of smokers had significantly higher blood pressures too [P<0.02]. Mother's blood pressure can affect neonatal blood pressure. Chronic hypertension, pre-eclampsia, and cigarette smoking in mothers can adversely alter neonatal blood pressure. These maternal conditions should be screened and managed as soon as possible

Retinopathy of prematurity: Single versus multiple-birth pregnancies

To compare the frequency and severity of retinopathy of prematurity [ROP] among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran-Iran. In this retrospective study, records of 99 consecutive neonates from multiplegestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP from 2002 to 2004 were reviewed. The frequency, severity and risk factors for ROP were determined and compared to a group of singletons who were matched in terms of gender, birth weight [BW], gestational age [GA], oxygen therapy, respiratory distress syndrome, blood transfusion, sepsis and phototherapy. ROP was present in 12.1% of multiple-birth neonates as compared to 15.1% of singletons [P=0.53]. Threshold ROP was present in 6.1% of multiple-birth neonates versus 7.1% of singletons [P=0.62]. ROP was detected in 60% of quadruplets versus 9.6% of twins and triplets; threshold disease was observed in 40% of quadruplets as compared to 4.2% of twins and triplets [P<0.03]. However, considering the effect of BW and GA, logistic regression analysis revealed no statistically significant difference in the frequency and severity of ROP among subgroups of multiple-gestation pregnancies. There was no significant difference between multiple-birth neonates and matched singletons in terms of frequency and severity of ROP. Any apparent higher rate may be due to independent risk factors such as low birth weight and gestational age rather than multiple pregnancies per se. Screening for ROP in multiple gestation births may be conducted according to standard protocols applied for singletons

Outcome of newborns conceived through artificial reproductive techniques in Tehran Iran

Today there is a rise in the number of newborns conceived by artificial reproductive techniques [ART]. Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Prematurity, low birth weight [LBW], very low birth weight [VLBW], twins and triplets, small for gestational age [SGA], need for resuscitation at birth, respiratory distress syndrome [RDS] and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception [p<0.05]. Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age [LGA], congenital pneumonia, necrotizing entrocolitis [NEC], respiratory air leakage syndromes [ALS], hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome [MAS], isseminated intravascular coagulopathy [DIC], cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth

[Malassezia flora of neonates hospitalized in hospitals affiliated to tehran university of medical Sciences]

Malassezia yeasts are normal flora of humans and warm-blooded animals. These lipophilic yeasts are associated with skin diseases in neonates such as pityriasis versicolor, neonatal postulitis and seborrheic or atopic dermatitis. Moreover in the recent years, these yeasts are increasingly isolated form fatal catheter-related fungemia in premature neonates. Concerning the role of Malassezia species in neonatal diseases and variation in their pathogenesis and sensitivity to antifungal drugs, we investigated the distribution of Malassezia species and related predisposing factors in neonates. 261 skin samples from scalp, chest and ear were collected from neonates in both Children Medical Center and Vali-Asr Hospitals using cellotape method and sterile wet swab. All samples were also inoculated in plates containing Leeming-Notman medium and Malassezia colonies were then sub-cultured on modified-Dixon and SCC media. Malassezia species were identified according to their macroscopic and microscopic morphological features and their physiological properties including tween assimilation test, catalase reaction and splitting of sculine. In this study 36% of samples were collected from Vali-Asr Hospital and the rest from Children Medical Center. The average age of the examined individuals was 11.7 days. 58.7% of neonates were boys and 41.3% were girls. Based on culture results, 68.9% of examined neonates had Malassezia flora. Besides, significant differences in frequency of isolated Malassezia were not seen between either two examined hospitals nor NICU and neonatal wards. M. furfur was the most common isolated species followed in frequency by M. globosa. In addition, M. obtusa and M. slooffia were recovered only once from trunk and head samples, respectively. In contrast to Malassezia flora in adults which is M.globosa, we isolated M. furfur as the dominant flora in neonates. This high prevalence of colonization may put hospitalized neonates in great danger of nosocomial Malassezia infections. Considering high mortality of Malassezia fungemia in neonates, skin should be cleaned effectively from Malassezia flora prior to administration of intra venous lipid or catheters

Hypothermia in Iranian newborns. Incidence, risk factors and related complications

To determine the incidence rate and factors associated with hypothermia in Iranian newborns and to discover the effect of hypothermia on neonatal morbidity and mortality. We selected a random sample of 1952 neonates using a multistage sampling technique from February 2004 to February 2005 in University Teaching Hospitals in Iran. We measured repeatedly at different time points the rectal temperature of these newborns. At each time of measurement, those with rectal temperature <36OC were considered as hypothermic. The obtained results showed that approximately one third of newborns became hypothermic immediately after birth. In addition, the regression analysis revealed that low birth weights, prematures, low apgar scores, infants of multiple pregnancies and those who received cardiopulmonary resuscitation had higher risk for being hypothermic. It was also found that hypothermia increases the risk of metabolic acidosis, jaundice, respiratory distress, hypoglycemia, pulmonary hemorrhage and death, regardless of the newborn's weight and gestational age. There is an urgent need to train mothers and all levels of neonatal care staff to control this health problem in our country