Prophylactic Effect of Clofibrate on Hyperbilirubinemia in Very Low Birth Weight Twins.

Aims: To determine the prophylactic effects of clofibrate on hyperbilirubinemia in very low birth weight twins. Study Design: A randomized double blind clinical trial Place and Duration of Study: Department of Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, between Oct 2010- Sep 2011. Methodology: Forty neonates with very low birth weight (20 pairs of twins) having same blood group and sex were elected. Infants with congenital anomalies, metabolic diseases, hemolytic disease, and infections were excluded. Case group received a single dose of clofibrate 100 mg/kg and control group received sterile water. Both clofibrate and sterile water were administrated through orogastric tube and were the same volume. Serum bilirubin levels were measured before administration, 24, 48, 72 and 96 hours after the administration. Data was analyzed using repeated measure ANOVA. Results: Total serum bilirubin after clofibrate administration was lower than control group (F= 6.48, P=0.02); however, the duration of phototherapy and hospitalization were not significantly different between the two groups (P=0.39 and 0.91 respectively). No side effects of drug were observed based on the physical exam and liver function tests. Conclusion: These findings suggest that clofibrate maintained total serum bilirubin lower in very low birth weight neonates but without effect on duration of phototherapy and hospitalization.

Assessment of pain management in pediatric emergency department in Mashhad-Iran

Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long -lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department [ED] in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics [AAP] recommendations about pain. Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED. According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options

Does umbilical cord bilirubin level have predictive value in pathologic neonatal hyperbilirubinemia?

The increase in the use of breast feeding and the decrease in mothers' hospitalization in the past few years have caused an increase in the infant bilirubin level, so it is necessary to introduce methods which can identify infants with higher risks of hyperbiliru binemia. The aim of this study is to determine the predictive value of measuring the umbilical cord bilirubin for pathologic hyperbilirubinemia, that is the bilirubin more than 15mg /dl. This prospective study was performed from November 2009 to December 2010 on the umbilical cord serum of 274 newborns who were born in Iran-Mashhad Razavi Hospital. The neonates' Apgar scores were above 7, weights more than 2.5 kg and gestational ages above 37 weeks. Once again their bilirubin level was measured via skin during the third to fifth day. Using the Smirnov test, one-sample Kolmogorov test, t-test, and Man Whitney test, we analyzed the data. P< 0.05 was considered significant. Out of 274 newborns, 178 cases were followed up. Ninety-three infants of the monitored cases had hyperbilirubinemia [total bilirubin >/= 15 mg/dl or group A, 85 of the infants did not have pathologic hyperbilirubinmia [total bilirubin < 15 mg/dl or group B]. The average umbilical cord bilirubin for group A was 2.32 +/- 0.78 mg/dl, and for group B was 1.98 +/- 0.72 mg/dl; so statistically, there is a significant difference. At the cut-off point of 2 mg/dl for umbilical cord bilirubin, sensitivity was obtained to be 68.86% and the specificity was obtained to be 61.18%. If the amount of bilirubin in the umbilical cord is more than 2 mg/dl, it can be considered as a contributing factor among other risk factors in the prediction of the infant's pathologic hyperbilirubinemia

Maternal serum magnesium level and low birth weight neonate

The aim of study was to compare the serum level of magnesium in mothers having low birth weight with those having normal birth weight neonates. In a case-control study, women who delivered low birth weight neonate [cases], compared with normal birth weight [controls] in serum concentration of magnesium. Blood samples collected within 24 h after delivery. Concentration of magnesium assessed by standard atomic absorption spectro-photometry. Multiple linear regression analysis was performed to control of potential confounding variables. A total of 116 mothers [67 cases and 49 control] were studied. Mothers in two groups did not differ in age, body mass index, and socioeconomic or demographic factors. Maternal magnesium concentration did not differ between two groups 0.86 +/- 0.11 m. mol/l versus 0.94 +/- 0.22 m.mol/l respectively [P = 0.09]. There is no significant difference between serum magnesium levels of low birth weight infants' mother and normal weight infants' mother

Selenium level of umbilical cord blood: is it related to respiratory distress syndrome?

The aim of study was to compare umbilical cord blood selenium levels in respiratory distress syndrome [RDS] and non RDS preterm babies. Umbilical cord blood selenium levels of all preterm newborn born during a 6-month period were enrolled in the study. They were divided into two groups: RDS and non RDS. Selenium level was assessed by using electro-thermal atomic absorption spectrometry and serum concentration of selenium was compared between the two groups. During the study 150 preterm babies were studied. Mean umbilical cord blood selenium levels were 98.5 micro g/L. Among 150 preterm babies 27 [18%] had RDS and 82% no RDS. Mean umbilical cord blood selenium level in RDS and non RDS groups were 96.5 and, 96.6 micro g/L respectively [P=0.64]. There were no significant differences between the two groups with regard to umbilical cord blood selenium levels. In this study there was no significant relationship between selenium umbilical cord blood level and respiratory distress syndrome in preterm neonates

Advantages of kangaroo mother care in less than 2000 grams low birth weight neonates

The aim of study was to compare the effect of Kangaroo mother care [KMC] and conventional methods of care [CMC] in low birth weight babies less than 2000 grams. One hundred babies with birth weight less than 2000 grams and without clinical problem were randomized in two groups; the intervention group [N=50] who received Kangaroo mother care and the control group [N=50] with conventional care. Two groups were compared in daily weight gaining, self confidence of mother, duration of hospitalization, clinical cyanosis and nosocomial infection. Collected data was analyzed by SPSS 11.5. Irct ID: IRCT201101091162N16. The KMC babies had better daily weight gaining average [18.3 +/- 7.57 gm vs. 4.8 =/- 16.57 gm [P<0.001]] CMC: and also, self confidence of mother in KMC group was significantly higher than CMC group [p<0.001]. A significantly longer duration of hospitalization observed in CMC group [17.18 +/- 12.07 day vs. 16.24 +/- 10.04 day [P<0.001]]. There was no significant difference between the two groups for clinical cyanosis and nosocomial infection [both P>0.05]. In this study Kangaroo mother care had better effect on daily weight gaining, mother confidence and shorter duration of hospitalization

Prevalence and risk factors of hypospadias in a private hospital in Northeast Iran

The aim of this study was to determine prevalence and risk factors of hypospadias in newborn infants of a private hospital in Mashhad city located in northeast Iran. All live birth deliveries in maternity hospital were enrolled from Oct 2006 to Sep 2008. All hypospadias cases were compared with the next male live births for possible risk factors. This study included only solitary hypospadias cases, those associated with other anomalies were excluded. Both parents were asked to fill out the same written questionnaires seperately. Data was analyzed by using SPSS. During two years 6149 babies were born in our hospital; 25 cases [0.4%, 4 inl000 live births] of hypospadias were identified. Hypospadias occurred in 0.76% of male deliveries. Most cases of hypospadias were born in summer and winter was the season which least number. Positive family history [P=0.04] was regarded as a potential risk factor that was present in 44% of cases in hypospadias group. Iron supplement consumption in first trimester of pregnancy in control group was significantly more than in hypospadias group [P=0.001] and also usage of folic acid in control group before and in first trimester of pregnancy was taken more by mother in control group than in hypospadias group [P=0.049 and P=0.001 respectively]. Prevalence in this population was intermediate [4 in 1000 live births]. Summer was the most epidemiology factor for occurring of hypospadias probably due to conception in cold season. Iron and folic acid supplementation may have preventive effect in hypospadias

Study of the bacterial agents in nosocomial and acquired infections based on the blood culture in neonatal intensive care unit of a hospital, north east of Iran

To study the distribution of bacterial agents in bloodstream infections among hospitalized patients in the neonatal intensive care unit [NICU]. From March 2003 to February 2004, 1341 blood samples were taken from hospitalized infants in NICU of Imam Reza Hospital in Mashhad north east of Iran. In this study, 6 ml of blood was extracted from the patients having septicemia, which was then added to the bottle containing the blood culture broth. The bottles were labeled and incubated at 35 degrees celcius for maximum of 7 days. The result shows that out of the 202 patients with positive blood cultures 109 had gram positive organisms while 93 had gram negative organisms. In those with gram-positive bacteria, 73 cases were acquired infection and 36 cases were nosocomial infection. These results for gram negative bacteria showed that 51 cases were due to acquired infection and 42 cases due to nosocomial infection. In determining the relation between the rate of death and the type of infection, we found that out of 202 patients 83 [41%] died. Of these cases 48 [39%] were due to acquired infection and 35 [45%] were due to nosocomial infection. We conclude that nosocomial bloodstream infection is an important target for the most aggressive strategies for prevention and control