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.

Efficacy of zinc sulfate in reducing unconjugated hyperbilirubinemia in neonates

Hyperbilirubinemia is a common disease and unconjugatedhyperbilirubinemia has been seen mainly in neonates. Severe form ofunconjugated hyperbilirubinemia may cause kernicterus and even death.Conventional treatment for severe unconjugated hyperbilirubinemiaconsists of phototherapy and exchange transfusion that have severalknown disadvantages; specially exchange transfusion is associated witha significant morbidity and even mortality. These harmful effects indicatethe need to develop alternative pharmacological treatment strategies forunconjugated hyperbilirubinemia. One of these pharmacological agents iszinc salts. Zinc has been shown to lower the bilirubin levels by inhibitionof the enterohepatic cycling of unconjugated bilirubin. Oral zinc has beenshown to reduce serum unconjugated bilirubin in animals, adolescentsand low birth weight neonates. However, studies in healthy term neonatesgiven oral zinc showed no reduction in hyperbilirubinemia based ondaily measurement. In order to improve the accuracy, hyperbilirubinemiamay be determined based on measurements every hour. More studies areneeded to know the effect of zinc in neonatal jaundice

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

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

Hyperbilirubinemia and neonatal infection

Hyperbilirubinemia is a relatively common disorder among infants in Iran. Bacterial infection and jaundice may be associated with higher morbidity. Previous studies have reported that jaundice may be one of the signs of infection. The aim of this study was to determine the incidence rate, presentation time, severity of jaundice, signs and complications of infection within neonatal hyperbilirubinemia. This cross sectional study was conducted between 2003 and 2011, at Ghaem Hospital, Mashhad- Iran. We prospectively evaluated 1763 jaundiced newborns. We finally found 434 neonates who were categorized into two groups.131 neonates as case group [Blood or/and Urine culture positive or sign of pneumonia] and 303 neonates with idiopathic jaundice as control group. Demographic data including prenatal, intrapartum, postnatal events and risk factors were collected by questionnaire. Biochemical markers including bilirubin level, urine and blood cultures were determined at the request of the clinicians. Jaundice presentation time, age on admission, serum bilirubin value and hospitalization period were reported significantly higher among case group in comparison with control group [p<0.0001]. Urinary tract infection [UTI], sepsis and pneumonia were detected in 102 [8%], 22 [1.7%] and 7 [0.03%] cases, respectively. We concluded that bacterial infection was a significant cause of unexplained Hyperbilirubinemia among jaundice newborns [10%]. Therefore, we advise performing screening test for UTI as part of the evaluation in asymptomatic jaundice infants presenting after five days of life and sepsis workup should be request in symptomatic infant especially in the first week of life

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

Survival of a neonate after nine days without feeding: a case report

A male neonate from a 23 year-old mother by cesarean section without complication in labor or delivery had vomiting from birth for 9 days and lost 400 grams of body weight. He had severe dehydration upon admission to our hospital. After treating his dehydration and assessment of his problem by laboratory tests and radiography we found that he had esophageal atresia without hypoglycemia. We repaired his atresia and he is normal now 10 months post-treatment

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

Comparison of clinical and sonographic prevalence of developmental dysplasia of the hip

Developmental dysplasia of the hip [DDK] is one of the most widely discussed abnormalities in neonates. The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to over diagnosis, which might cause over treatment. Variations in the incidence of developmental dysplasia of the hip are well known. During six months study since September 2006 all 1300 neonates [2600 hips] were born in our hospital examined clinically and sonographically [587 hips] in the first 48 hours of life. Sonography was performed according to Grafs method, which considers mild hip sonographic abnormalities as type II a. Type IIb Graf were considered pathologic. Sonography screening of 587 hips detected 36 instances of deviation from normal indicating a sonographic DDH incidence of 12.5%. However, only 8 neonates remained abnormal and required treatment, indicating a true DDH incidence of 6 per 1000 live birth. Risk of diagnosis clinically and sonographicaly were 2.5 and 4.5 percent respectively and was significant [P<0.00001, x[2]=l 170]. In order to avoid over diagnosis in first days examination, repeated clinical and sonographic examination is required

Ophthalmic, hearing, speaking and school readiness outcomes in low birth weight and normal birth weight primary school children in Mashhad-Iran

Low Birth weight infants are at risk of many problems. Therefore their outcome must evaluate in different ages especially in school age. In this study we determined prevalence of ophthalmic, hearing, speaking and school readiness problems in children who were born low birth weight and compared them with normal birth weight children. In a cross-sectional and retrospective study, all Primary School children referred to special educational organization center for screening before entrance to school were elected in Mashhad, Iran. In this study 2400 children enrolled to study and were checked for ophthalmic, hearing, speaking and school readiness problems by valid instrument. Data were analyzed by SPSS 11.5. This study showed that 8.3% of our population had birth weight less than 2500 gram. Visual impairment in LBW [Low Birth Weight] and NBW [Normal Birth Weight] was 8.29% vs. 5.74% and there was statistically significant difference between them [P=0.015]. Hearing problem in LBW and NBW was 2.1% vs. 1.3 and it was not statistically significant. Speaking problem in LBW and NBW was 2.6% vs. 2.2% and it was not statistically significant. School readiness problem in LBW and NBW was 12.4% vs. 5.8% and it was statistically significant [P<0.001]. According to the results, neurological problems in our society is more than other society and pay attention to this problem is critical. We believe that in our country, it is necessary to provide a program to routinely evaluate LBW children

Prevalence of visual impairment in low birth weight and normal birth weight school age children

Studies demonstrated that 5-10% of preschool children have visual impairment. By age seven, up to 13% of children will have some defect in visual acuity. Both prematurity and low birth weight have been associated with an increased incidence of ophthalmic disorders. In this study we determined prevalence of visual impairment in low birth weight and normal birth weight school age children in Mashhad. This is a cross sectional study. The target population consisted of all children referred to educational organizations for screening before entering school in Mashhad, Iran. 2400 children enrolled in the study and were evaluated for amblyopia, refractive errors, color vision disturbance and optic nerve problems. Data were analyzed by SPSS. Prevalence of ophthalmic problems in all children was 5.43% and in low birth weight and normal birth weight 8.29% and 5.74% respectively. Incidence of ophthalmic problems was significantly [P=0.029] higher in low birth weight children than in normal birth weight children. The most common ophthalmic disease in both low birth weight and normal birth weight children was refractive errors 81.5% vs. 68.8% [P<0.05]. Prevalence of myopia, amblyopia and color vision disturbance was also higher in low birth weight than in normal birth weight children. Low birth weight children are at greater risk of the visual impairment that may occur at an early age and result in long term morbidity. Visual outcome of low birth weight neonates should be evaluated routinely

Comparison of maternal and umbilical cord blood selenium levels in term and preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Selenium is an essential trace element and has a main role in cellular antioxidant defense system. In very preterm babies, low selenium is associated with an increased risk of complications such as chronic neonatal lung disease and retinopathy of prematurity. This study was designed to determine and compare maternal and umbilical cord blood selenium levels in term and preterm infants.</p><p><b>METHODS</b>From February 2008 to April 2008, 30 term (gestational age>37 weeks) and 30 preterm infants (gestational age<34 weeks) and their mothers were enrolled. Selenium concentrations in umbilical cord and maternal venous blood were measured by atomic absorption spectrometry.</p><p><b>RESULTS</b>The mean selenium concentration in term infants was higher than in preterm infants (124.80+/-13.72 microg/L vs 100.30+/-11.72 microg/L, P=0.0001). The mean selenium concentration in mothers of term and preterm infants was not significantly different (117.03+/-17.15 microg/L vs 110.56+/-17.49 microg/L, P=0.15). Cord selenium concentrations were strongly correlated with gestational age and birth weight (r=0.66, p<0.0001 and r=0.59, p<0.0001, respectively) when the data of all infants were analyzed together. None of the 60 women had a serum selenium level below the laboratory lower limit of normal (70.0 microg/L). Maternal selenium levels were correlated with cord selenium levels in their infants (r=0.40, p<0.001) when data of all newborn infants and mothers were considered together.</p><p><b>CONCLUSIONS</b>Mothers have a relatively good selenium status and serum selenium is not a significant predictor of preterm delivery in Isfahan. The cord selenium concentration in term infants is significantly higher than in preterm infants, but the cord selenium concentrations in both groups are in a suggested normal range.</p>

effect of topical application of breast milk on the umbilical cord separation in neonates

The umbilical cord is one of the most important sites for bacterial colonization after birth. Different regimens have been used for umbilical neonatal cord care, some of which have established bad effects for neonates and may even delay its separation. This study is conducted to compare the effect of topical application of breast milk and dry cord care on cord separation time in neonates. In a randomized clinical trial, 150 neonates with 38-42 weeks of gestational age, singleton and without congenital anomaly were randomly selected an assigned into two groups: Mother's milk for group 1, and dry cord care for group 2. All mothers in two groups received an instructed face-toface cord care education within 3 hours of birth. Group 1 applied breast milk to the umbilical stump 3 hours after birth and continued every 12 hours until 2 days after umbilical cord separation. Nothing was applied to the umbilical stump of the dry cord care group. Relevant data were analyzed in SPSS using two-way ANOVA, Chi-Square, Student's t-test, Fisher's exact test, Mann-Whitney U test, and General Linear Model. According to the results, statistical differences were observed in the cord separation time across the two groups; in the breast milk group, the cord separation time [152.42 +/- 48.804] was shorter than the corresponding time [175.57 +/- 59.57] in the dry cord care group. The results indicated that topical application of breast milk for umbilical cord care leads to reduced cord separation time

Prevalanace and risk factors of preterm labor in Imam Reza Hospital [1381-1382]

Preterm delivery is the leading cause for infants mortality and morbidity after congenital anomalies. Because of its significance, it was decided to Carry out this Survey. 600 pregnant woman were assessed that 300 of them were patients with Preterm delivery and 300 of them were women with term delivery. The information gathered through interview and patient's medical record. Finally the resudts were Compared by chi square and T test statistical tests. The prevalance of preterm deliverv in Imam Reza hospital during this period [82/3/31- 81/10/1] was 16.4%.This evaluation showed a significant statistical difference between the preterm delivery and below factors mothers employment, mother's age, number of pregnancies, history of preterm delivery in patient and in her first degree relatives, history of trauma, surgery and psychological Stress during pregnancy, vaginal bleeding and ruptur and placenta previa, uterine anomalies, multiple pregnancies, cesarean section. There was no significant statistical difference between the preterm delivery and below factors: place of residence [city- village] the patient socioeconomic status, mother's height, smoking, addiction, prenatal care, patient's medical history, history of abortion and fetal death. Since many of predisposing factors for preterm labor are inevitable, once facing these factors, the process of preterm labor should be prevented, [by tocolytics] and in the case of inability to prevent labor mother should be transfered to a center where NICU is available