[Correlation between retinopathy of prematurity and clinical risk index for babies score]

Several risk factors like prematurity, hyperoxia, hyperglycemia, duration of mechanical ventilation and supplemental oxygen use have been attributed to the occurrence of retinopathy of prematurity [ROP] in low birth weight infants. Clinical Risk Index for Babies [CRIB] score have been used to assess the severity of the newborn's disease and neonatal mortality. The relation between the CRIB score and the incidence of retinopathy of prematurity is less assessed. This study was carried out to determine the relation between the CRIB score and retinopathy of prematurity in preterm infants. In a cross-sectional study all preterm infants admitted to NICU at Amirkola Children's Hospital, Northern Iran, from March 2009 to November 2012, with a birth weight less than 1500 grams and gestational age less than 28 weeks and other premature infants with birth weight 1500 to 2000 grams and gestational age 29 to 34 weeks with an unstable clinical condition, were included. The CRIB score was recorded in firs 12 hours of admission to the NICLJ. Ophthalmologic examination was done by a retinologist unaware of CRIB score. ROP classification was done according to the international classification of ROP. The CRIB score compared with presence or non-presence of ROP and its stage, progression or regression of disease. A P-value less than 005 are considered significant. One hundred and eighty [70%] neonates out of 256 neonates developed ROP. In 124 [68.88%] neonates it resolved spontaneously on serial ophthalmologic examination, but fifty-six [3 1.11%] neonates were required treatment for ROP which 42 [75%] received Avastin and 14 [25%] neonates treated with Laser. The Mean +/- SD for CRIB score in ROP group was 4.79 +/- 2.74 and in a group without ROP it was 3.78 +/- 2.00 [P0.004]. No correlation was found between the severity of ROP and CRIB score [P0.152]. The CRIB score can predict the occurrence of ROP, but can't predict its severity and progression or regression

[Assessment of bilirubin to albumin ratio as a criterion for exchange transfusion in severe neonatal hyperbilirubinemia]

Total Serum Bilirubin level [TSB] has been the gold standard indicator for exchange transfusion [ET] in the neonates for many years. This study was designed to assess the bilirubin/albumin [B/A] ratio as an indicator for ET in comparison with TSB. In the NICU and newborn services at Amirkola Children's Hospital [ACH] in the north of Iran, 90 neonates in 3 groups were selected. The first group was 30 neonates who required exchange transfusion [ET], because of severe hyperbilirubinemia [HB] based on the TSB according to the ACH protocol .The second group was 30 neonates, treated with phototherapy due to pathologic HB and the Other 30 neonates had only physiologic neonatal jaundice. Blood samples were checked for serum bilirubin, albumin and B/A ratio in addition to the routine lab tests for HB. Sensitivity, specificity, negative predictive value, positive predictive value, and relative risk were assessed for B/A ratio as a determinant to do ET. The mean +/- SD of B/A ratio was 6.0847 +/- 0.9870 in blood exchange group, 4.1680 +/- 0.5480 in phototherapy group and 1.7677 +/- 0.5061 in healthy neonate group. "Cut off level" of B/A ratio calculated to do ET was 4.50.The B/A ratio of 4.5 has a "positive predictive value" of 75% and a "negative predictive value" of 100%. A B/A ratio equal to 4.5 among newborns Who required exchange transfusion has a high value as a criterion to do ET, although further study is required to recommend it alone in clinical practice. So we recommend doing B/A ratio in accompaniment with TSB as an adjunctive test

Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis

Correlation between umbilical cord pH and apgar score in high-risk pregnancy

The Apgar score as a proven useful tool fro rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad Hospital, which is affiliated to Babol University of Medical Sciences. Apgar score at 1 and 5 minutes after birth was taken and an umbilical cord blood gas analysis was done immediately after birth in both groups. Mothers came with a labor pain and were divided into high-risk and low risk if they have had any perinatal risk factors. Other data like gestational age, birth weight, need for resuscitation and admission to the newborn ward or neonatal intensive care unit was gathered by a questionnaire for comparison between the two groups. P-value less than 0.05 was considered being significant. The gestational age and birth weight were the same in high-risk and low risk mothers. Mean umbilical artery blood pH in high-risk mothers was significantly lower than in low risk mothers [P =0.004]. Mean apgar scores at 1 and 5 minutes were significantly lower in high-risk mothers than in low risk mothers [P<0.05]. According to the Kendal correlation coefficient there was no significant correlation between Apgar score at 1 and 5 minutes and umbilical cord pH in low risk group [r=0.212, P=0.1]. But in high-risk group there was significant correlation between Apgar score at 1[st] and 5[th] minute and the umbilical cord ph [r=0.01, P=0.036 and r=0.176, P=0.146, respectively]. Combination of Apgar score and umbilical cord pH measurement in high-risk pregnant mother could better detect jeopardized baby

Procalcitonin as a marker of neonatal sepsis

Early diagnosis of neonatal sepsis and appropriate treatment decreases the mortality and morbidity of these infants. The aim of this study was to assess the role of pro_calcitonin [PCT] as a marker in the early diagnosis, treatment and follow-up of neonatal sepsis. Thirty-eight neonates with clinical [n=8], suspected [n=19] and proven sepsis [n=11] were evaluated. The PCT levels were measured by immunoluminoassay before and on day 5 of treatment. PTC levels of 0.5-2 ng/ml, 2.1-10 ng/ml and >10 ng/ml were considered as weakly positive, positive, and strongly positive, respectively. The sepsis screen tests and cultures of blood or other sterile body fluids in these three groups of infants were recorded. The levels of PCT in proven sepsis group were higher than that in other groups. Strongly positive PTC level was seen in none of 8 cases of clinical sepsis, 4 of 19 suspected and in 10 of 11 cases with proven sepsis. PCT levels were dramatically decreased in three groups on day 5 of treatment. The results show that the serum procalcitonin levels seem to be significantly increased in proven sepsis and decrease dramatically in all types of sepsis after appropriate treatment

[Enterally recombinant erythropoietin stimulates erythropoiesis in preterm infants]

Erythropoietin [Epo] is an essential hormone for erythropoiesis. Parenterral recombinant erythropoietin [rEpo] is effective for prevention of anemia of prematurity [AOP]. The aim of this study was to determine the effect of enteral rEpo on erythropoiesis in preterm infants. This is a randomized clinical trial [RCT] study performed on preterm infants [?1800gr birth weight and ?34 weeks gestational age [GA]]. Two groups of infants were randomly included in the study by sequential admissions. One group [n=7] received Epo [CIMBA. Cuba] 1200U/kg per week [3 days a week] plus ferrous sulfate [3-6 mg/kg/day]. The control group [n=7] received only ferrous solfate. Hemoglobin [HB], Hematocrit [Hct] reticulocyte count, serum Epo and ferritin level were measured at baseline, after 10 days and on discharge. Collected data were tested by T-test and repeated measurement and analyzed by SPSS software. Mean [SD] GA of control group [n=7] were 30.3 [0.9] weeks and Epo group [n=7] were 30.7 [2.56] [P=0.7]. The mean [SD] body weight of control group was 1392 [196] gr and Epo group 1328 [267] gr. Reticulocytes count at the end of study in Epo group was significantly more than in control groups [2.99 [1.45] vs 1.36 [0.96]] [P<0.009]. Serum mean erythropoietin level in Epo group was significantly more than in control group [18 [11] vs 8.7 [4]] [P=0.006]. Mean serum ferritin level in Epo group was lower than in control group although statically not significant [238 [78.59] vs 340 [166.51]] [P=0.4]. There was no significant difference in Hb and Hct between the two groups [P=0.3]. Oral administration of rEpo increased significantly serum Epo and reticulocytes count [stimulated erythropoiesis] but did not increase Hb and Hct in preterm infants

[Epidemiology, clinical and laboratory characteristics of pneumonia in hospitalized children, at amirkola children Hospital from 2003 to 2005]

Pneumonia causes about three million deaths a year in young children; nearly all of them are in developing countries. Most of pneumonias are caused by microorganisms but a number of non-infectious agents could be the etiologic agent. The aim of this study was to determine the epidemiological, clinical and laboratory characteristics of pediatric patients admitted to Amirkola Children's Hospital, Babol/Iran because of pneumonia. This cross-sectional study was done on pediatric patients, aged 1 month to 12 years who were hospitalized with a final diagnosis of pneumonia. From 2003 to 2005 a total of 404 cases with a diagnosis of pneumonia were recorded. The diagnosis was based on physical examination, result of chest radiography and laboratory findings. The epidemiologic, clinical and laboratory characteristics were recorded and analyzed by SPSS 10 software. Sex distribution showed male 58.6%, female 41.4%. The mean age of boys was significantly less than girls [P=0.02]. Admissions more than once because of pneumonia were seen in 10% of the patients. The most common clinical signs and symptoms were positive pulmonary auscultation, cough and increased respiratory rate. ESR and CRP were elevated in 66% and 65.8% respectively. The blood culture was positive in 3.5% of cases and the predominant bacteria isolated was Haemophilus influenzae type b. The mortality rate of pneumonia in this study was 1.2%. Although cases of positive culture for bacterial infection in our study population seem to be low, the predominance of Haemophilus influenzae type b in comparison to the similar studies in developed countries necessitates the vaccination of target population against this microorganism

effect of human recombinant erythropoietin on prevention of anemia of prematurity

Premature infants often develop significant anemia that requires blood transfusion, this carries significant risks. This study was carried out to determine the effect of recombinant human erythropoietin [r-HuEPO] on prevention of anemia of prematurity. From April 2001 to March 2002, 24 neonates in newborn services at Amirkola children's hospital randomly were assigned to erythropoietin group and control [no treatment] group. Inclusion criteria were birth weight of

Comparison of the rate of exclusively breast-feeding rate between pacifier suckers and non-sucker infants

Pacifier as a non-nutritive and comforting object instead of mother's breast is used widespread in civilised societies. The most possible risks of this habit are increased incidence of oral thrush; dental deformities, recurrent acute otitis media and dental caries, but there are still some reports on its beneficial effects. We carried out this study to compare the rate of exclusive breast-feeding during the first six months of life between the pacifier sucker and non-sucker infants. The study was designed as a case-control study on infants who came to outpatient clinic in a primary health care center, affiliated to Babol University of medical sciences during 2003-4. Inclusion criteria were: infants aged 6-12 months, born at term via normal vaginal delivery with a normal birth weight. We divided them into pacifier suckers as case group [n=100] and non-suckers as control group [n=120] by frequency matching. Pacifier suckers were given by their mothers a pacifier to suck as a soothing object before 2 month of life. Outcome characteristics including exclusive breast-feeding, rate of early weaning and substitution of mother milk with a non-mother milk in infants who were pacifier suckers were compared with those of the infants who were not used to suck a pacifier. A p-value less than 0.05 was considered being significant. Success rate of exclusive breast-feeding in pacifier suckers was 30% [n=30], in non-suckers 64% [n=77], [CI: 2.3-7.3; OR=1.24; P<0.001]. The rate of early cessation of breast-feeding among pacifier suckers was 16% and non-suckers 0.01% [p<0.001]. To promote successful breast-feeding and to reduce early cessation of breast-feeding, the use of pacifiers should be avoided or restricted

Prevalence of Shigella species and their antimicrobial resistance patterns at Amirkola children hospital, North of Iran

In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains and pattern of antimicrobial resistance. Shigellosis is one of the most important examples in this group of intestinal infections. In order to establish such parameters in our city this study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhea admitted to the Amirkola children's hospital, North of Iran. The study included all patients with acute diarrhea, 6 months to 12 years of age, who were admitted to the Amirkola children's hospital during March 2001 to March 2004. Incidence, phenotypic characteristics and antimicrobial resistance patterns of Shigella strains, isolated from hospitalized children with acute diarrhea, were studied We received 260 positive cultures for Shigella out of 1850 stool samples during 3 years [14.05%]. Shigella specimens presented a high resistance rate to trimethoprim-sulfamethoxazole [73.84%] and ampicillin [73.84%], and low resistance rate to Ciprofluxacine [2.69%] and cefotaxim [2.69%]. S. flexneri [70%] was most frequently isolated, followed by S. Sonnei [30%]. No cases of S. boydii and S. dysenteriae were found. Our results provide data on antimicrobial resistance to choose a proper antibiotic for Shigellosis in our community. According to our findings cefotaxime for pediatric patients and quinolone derivatives for adult patients are the proper drug choices. Systematic monitoring is needed to identify changes in prevalence and antimicrobial resistance pattern

effect of topical application of human milk, ethyl alcohol 96% and silver sulfadiazine on umbilical cord separation time in newborn infants

Several agents have been used for neonatal umbilical cord care, but we did not find any study evaluating the effect of human milk on umbilical cord separation time. The purpose of this study was to compare the effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants. This study was undertaken place at a primary-level newborn nursery at a university teaching hospital and a private hospital. Of 373 singleton near- to full-term newborns enrolled in the study, 312 completed the study. Newborns from birth were randomized to either: 1] mother's milk group, 2] alcohol group, 3] silver sulfadiazine group, and 4] control [no treatment] group. Mother's milk for group 1, ethyl alcohol for group 2, and silver sulfadiazine ointment for group 3 were applied to the umbilical stump three hours after birth and continued every eight hours until two days after umbilical cord separation. The time to umbilical cord separation and any discomfort such as infection, hemorrhage, and granuloma formation were reported by mothers. Nothing was applied to the umbilical stump of the control group and they received dry cord care only. It was observed a significant difference in the mean cord separation time among the four group. No significant complications were observed in any group. Breast milk could be substituted for other topical agents for umbilical cord care, but a multicenter study is required in order to advise it for routine umbilical cord care