[Effect of different doses of clofibrate on neonatal jaundice]

Present study was performed to assess effect of diferent dose of clofibrate on neonatal jaundice. In a controlled randomized clinical trial, 132 neonates who admitted in the neonatal ward of Beasat hospital of Hamedan city with diagnosis of non-hemolytic indirect hyperbilirubinemia during a 9 months period [winter 87 till spring 88] were classified completely random in 3 groups: In the first group [control] only phototherapy was done as therapeutic management, in the second group [sample group 1], low dose oral clofibrate [25 mg/kg] and phototherapy was prescribed, and in third group [sample group 2] moderate dose oral clofibrate [50 mg/kg] and phototherapy was prescribed. In all 3 groups, total and indirect bilirubin level was measured at the beginning of therapy and then 12, 24, 36 and 48 hours after therapeutic management. All neonates were visited in outpatient clinic 2 days after discharge. Data was analyzed with SPSS software version 17. There was no significant difference in age, sex, and mean total bilirubin of referred patients of studied groups [P>0.05]. 12, 24 and 36 hours after starting therapy, mean total bilirubin was significantly lower in sample group 1 and 2 than control group [P<0.05], but no significant difference was seen between two sample groups 1 and 2 [P >0.05]. Mean total bilirubin was significantly lower in group 1 and 2 than control group [P= 0.004 and P = 0.001 respectively], but no significant difference was seen between sample group 1 and 2 [P= 0.524]. Mean admission duration and phototherapy duration was significantly lower than control [P<0.05], but there was no significant difference between sample group 1 and 2 [P<0.05]. There was not any report about side effects of clofibrate consumption. Because there was no difference prescribing low or moderate dose of oral clofibrate in lowering bilirubin level and also decreasing phototherapy and admission duration it is suggested to use lower doses of drug for preventing possible complications

Neonatal seizures: etiology and frequency

The aim of the present study was to evaluate the etiology and frequency of neonatal seizure in hospitalized neonates. In this descriptive, cross-sectional study, we evaluated 1295 neonates with seizures admitted to neonatal and NICU wards in our center. Data was collected on age, sex, birth weight, serum levels of calcium, glucose, and sodium, CT scan findings, history of maternal opium abuse, blood and cerebrospinal fluid culture, and analyzed using SPSS 13. Of a total of 1295 patients, 34 [2.62%] had seizure. Mean age was 14.03 +/- 10.05 days [range, 1 to 29 days]; twenty-five [73.5%] neonates were boys and 9 [26.5%] were girls. Of 34 neonates with neonatal seizures, 12 [35.3%], 11 [32.4%], 9 [26.5%], 7 [20.6%], and 3 [8.8%] had hypocalcemia, asphyxia, hypoglycemia, intracranial hemorrhage, and hypernatremia, respectively. Maternal addiction, meningitis, and sepsis were found in 3 [8.8%], 1 [2.9%] and 1 [2.9%] of neonates, respectively. The incidence rate of neonatal seizure in the neonates in our NICU and neonatal ward was 2.62%. Common causes of seizure in this study included hypocalcemia, asphyxia, hypoglycemia, intracranial hemorrhage, and hypernatremia. Maternal addiction, meningitis and sepsis had the lowest prevalence

[Effect of neonatal position on oxygen saturation in Hospitalized premature infants with respiratory distress syndrome]

Rspiratory distress syndrome is one of the most important of mortality and morbidity in premature newborns. The aim of this study was to determine the effect of body position on oxygen saturation in hospitalized premature infants with respiratory distress syndrome [RDS]. In an interventional analytic study, 69 premature infants with RDS were evaluated. Patients had a mean gestational age [ +/- SD] of 31.4 [ +/- 2.41] weeks [range: 28-35 weeks] with a mean birth weight [ +/- SD] of 1446.6 [ +/- 218.90] gram [range: 850-2400 gram]. Infants were studied both supine and prone positions. Each posture was maintained for 3 hours. Oxygen saturation was monitored by trans-cutaneous paIsoxymeter and mean of oxygen saturation was measured for 3 hours. All patients were premature, oxygen pendent and had RDS. Mean [ +/- SD] of oxygen saturation during 3 hours in prone and supine positions were 92.54% [ +/- 2.24%] and 91.78% [ +/- 2.35%] respectively [p=0.001]. Also mean [ +/- SD] of oxygen saturation at the end of each 3-hours period prone and supine positions were 91.30% [ +/- 2.42%] and 90.30% [ +/- 3.15%] respectively [p=0.006]. These findings suggest that, in premature infants with RDS oxygen saturation was significantly higher in the prone compard with the supine posture

[Low birth weight causes survey in neonates]

Neonatal mortality rate is one of the main health problems which is affected by prenatal status, maternal, fetal and perinatal conditions. Low birth weight [LBW] is one of the main causes of neonatal and infantile mortality. The aim of this study is an evaluation of the LBW causes in neonates. This descriptive cross sectional study was done on 1500 neonates, born in Fatemieh Hospital, Hamedan, 2004. Data such as birth weight, sex, maternal age, gestational age, birth interval, history of abortion, prenatal care, maternal occupation, level of education, systemic and underlying diseases, history of infections and smoking were extracted from medical records. Data were statistically analyzed by SPSS ver.13 using chi-square, t-test and fisher's exact test. 19.1% of neonates were LBW newborns. Mean values for maternal age, gestational age, maternal weight and height, and the interval between births of LBW neonates were significantly lower compared with normal birth weight neonates. The number of siblings of LBW neonates was more than normal birth weight neonates. Maternal infections and systemic diseases, occupation, the presence and absence of prenatal care in LBW neonates, showed no significant differences with normal birth weight newborns. Smoking and history of abortion in the mothers of LBW neonates were more than those of normal birth weight neonates. Maternal educational level of LBW neonates was lower than mothers of normal birth weight neonates. The most common maternal infection was vaginitis and the most common maternal systemic disease was hypertension. The results revealed a correlation between LBW in neonates with maternal age, gestational age, maternal weight and height. There was also a correlation with the interval between pregnancies, number of siblings, maternal smoking, previous abortion and level of mothers' education

[Evaluation of clofibrate in the treatment of non hemolitic indirect hyper bilirubinemia in term infants]

Background: hyperbilirubinemia is a common problem in neonates but sever hyperbilirubinemia will cause kernicterus. The aim of this study is to evaluate the efficacy of oral clofibrate in treatment of indirect hyperbilirubinemia in non hemolytic jaundiced full term neonates

Materials and Methods: in one clinical trial study were evaluated 60 healthy full term neonates with non hemolytic jaundice . 30 neonates [control group] received only phototraphy while the other 30 neonates treated with a single oral does of clofibrate [100mg/kg] with phototraphy. Two group were compared by the mean plasma total and indirect bilirubin after treatment and duration of hospitalization and need for exchange transfusion

Results: total and indirect bilirubin levels after treatment showed that decreasing amount of total and indirect bilirubin within time in clofibrate - treated group significantly is more than control group. also the average duration of hospitalization and need for phototraphy on clofibrate - treated group is lower than control group. In the studied neonates with a single dose of clofibrate no side effects were observed during hospitalization and after discharge

Conclusion: up to now many pharmacological agent have been used for prevention or treatment of neonatal jaundice. Drugs such as Phenobarbital, Activated charcol and plain agar and metalloporphyrins have been used for this purpose but None of this drugs has been accepted completely by efficacy and safety and not available for routine use. Clofibrate due to it's ideal efficacy in decreasing bilirubin and duration of hospitalization and oral easy use and availability of this drug is considered tobe suitable treatment way for neonatal nonhemolytic jaundice

[ Diagnostic Value of Ag-NOR analysis and SAPA score in Normal and skin lesions]

Background: evaluation of the diagnostic value of silver nucleolar organizer Region assessment in skin diseases is important. According to this reason, we want to study the Argyrophilic Nucleolar Organizer Region [Ag-NOR] count and Subjective Ag-NOR Pattern Assessment [SAPA] score in normal skin, Squamous Cell Carcinoma [SCC], Basal Cell Carcinoma [BCC] and Solar Keratosis [SK]

Materials and Methods: the study groups consisted of 69 cases [18 SCC, 18 SK, 17 BCC and 16 Normal skin]. The specimens were studied by microscope which were prepared by H and E staining and silver staining for Ag-NOR

Results: the mean count in SCC was 2.92, in SK 2.29 and in BCC 1.59, which was statistically significant compared to 0.93 in normal skin [p value <0.001]. The SAPA score was in SCC 7.94 in SK 7.61 in BCC 6.35 and in normal skin 5.00 [p value <0.001]

Conclusions: Ag-NOR count and SAPA score in normal and pathological status of skin has positive results

[Morbidity, mortality and associated anomalies in 126surgeriednewborns in Ekbatan hospital]

Early diagnosis and treatment of neonatal disease, particulary the surgical disease has great importance.We had studied the neonatal diseases needed to surgical treatment, associated anomalies, medical treatment, short-term complications and mortality in a period of October 2002 to October 2004 in NICU of Ekbatan hospital.We studied 126 surgeried neonate in a prospective descriptive study, 63.5% were male. The diseases were: Hirshprung 19.0%, imperforated anus 16.7%, esophageal atresia 18.7%, inguinal hernia 9.5%, clef lip 6.3%, omphalocele 4.0%, meconium ileus 3.96%, jugenalatresia, necrotizing enterocolitis and meningomyelocele 1.58%, pneumothorax, chylothorax, sacrocoxygeal teratoma, hepatoblastoma, ovarian cyst, mechel'sdiverticulum, gastrochesia, thyroglosal duct cyst, cystic hygroma, posterior urethral valve has 0.79% frequency in our study. We didn't find any associated anomaly in 58.73% of our cases. Electrolyte abnormality was the most post-operative complication, majority of them needed to medical treatment. In this study, mortality rate was 10.3%.Our study revealed that NICU, appropriate surgical techniques, appropriate pre and post operative medical treatment has dramatic effect in improving their outcome and diminishing surgical complications

[Determining the frequency of the bacterial agents in urinary tract infection in hospitalized patients under 18 years old in Ekbatan Hospital]

Background: Urinary tract infections [UTI] is the most common urogenital disease and the second common infectious disease in childhood. Appropriate, adequate and on time treatment result in cure and prevention of renal scar. The aim of this study is determining the frequency of the bacterial agents in urinary tract infection in patients [age < 18 y] and their antibiotic susceptibility pattern

Materials and methods: This study was a retrospective cross sectional [Descriptive -Analytic] study that included all of the recorded urine culture and antibiograms in Ekbatan Medical center in 2004 - 2005

Results: 1 56 patients including girls [74.7%] and boys [25.6%] with positive urine culture and antibiograms were studied. The most common age group in boys was 1-24m and 6-18y [40%], and in girls 1-24m [34.5%]. The most sensitive antibiotics were Nitrofurantion, Ciprofloxacin, Amikacin, Gentamicin, Nalidixic Acid, Ceftizoxime, Co-Trimoxazole, Ceftriaxone and Tobramycin, respectively. The most resistant antibiotics were Ampicilline and Tetracycline

Conclusions: This study suggests that useful antibiotics in different situation such as: Nitrofurantion, Ciprofloxacin, Amikacin, Gentamicin, Nalidixic Acid, Ceftizoxime, Co-Trimoxazole, Ceftriaxone and Tobramycin

Cleidocranial dysplasia syndrome in a newborn

Cleidocranial dysplasia is a rare congenital bone formation inherited as an autosomal dominant trait. The incidence is one per 200000 live births. Major symptoms include delayed ossification of the skull, excessively large fontanels and clavicular hypoplasia or aplasia, allowing the shoulders in front of the chest. Delayed eruption of teeth, high arched palate and wide pelvic joint may also be present. The case was a newborn boy who had admitted in neonatal ward of Ekbatan hospital because of respiratory distress. Anterior and posterior fontanels were completely large and connected. His shoulders were a little depressed. Chest X ray revealed bilateral clavicular agenesia and skull X-ray failed to demonstrat vortex bone

Early treatment of anemia of prematurity with recombinant human erthropoietin

Recombinant human erythropoietin [EPO] is known to accelerate erythropoesis in preterm infants. This study was designed to access EPO in treatment of anemia of prematurity. Materials and Preterm infants with hematocrit less than 30% when they were between 2 to 3 weeks of life, were divided randomly in two groups, each group included ten babies. The mean gestational age in control group was 31 +/- 1.65 weeks and birth weight was 1450 +/- 200 grams and in case group was 31 +/- 2.12 weeks and birth weight was 1370 +/- 211 grams. Infants in case group received EPO 400 u/kg twice weekly for 4 weeks. All infants in control and case groups were fed human milk and supplemented with entral iron, vitamin E and folic acid prophylactically. Levels of hematocrit and reticulocytes were determined for each infant at the beginning of the study, 3 days after treatment and one week after the end of treatment. The groups had significant differences in hematocrit and reticolocytic count at the end of study [P<0.001] and P=0.024 respectively]. In control group the prophylactic iron, vitamin E and folic acid supplementation was not sufficient to prevent anemia and we found a significant decrease in hematocrit level at the end of study [P<0.0001]. We concluded the early treatment of anemia of prematurity with recombinant human EPO plus iron, vitamin E and folic acid increase hematocrit and reticulocytes in preterm infants. If we can minimize blood sampling for laboratory analysis in preterm infants, treatment with EPO will reduce the need for blood transfusion in these infants

Determining the frequency of the bacterial agents in urinary tract infection in hospitalized patients under 18 years old in Ekbatan Hospital

Urinary tract infection [UTI] is the most common urogenital disease and the second common infectious disease in childhood. Appropriate, adequate and on time treatment result in cure and prevention of renal scar. The aim of this study is determining the frequency of the bacterial agents in urinary tract infection in patients [age < 18 y] and their antibiotic susceptibility pattern. This study was a retrospective cross sectional [Discriptive - Analytic] study that included all of the recorded urine culture and antibiograms in Ekbatan Medical center in 2004 - 2005. 156 patients including girls [74.7%] and boys [25.6%] with positive urine culture and antibiograms were studied. The most common age group in boys was 1-24m and 6-18y [40%],and in girls 1-24m [34.5%]. The most sensitive antibiotics were Nitrofurantoin, Ciprofloxacin, Amikacin, Gentamicin, Nalidixic Acid, Ceftizoxime, Co-Trimoxazole, Ceftriaxone and Tobramycin, respectively. The most resistant antibiotics were Ampicillin and Tetracycline. This study suggests that useful antibiotics in different situation such as : Nitrofurantoin, Ciprofloxacin, Amikacin, Gentamicin, Nalidixic Acid, Ceftizoxime, Co-Trimoxazole, Ceftriaxone and Tobramycin

Beckwith-wiedemann syndrome in a newborn

Beckwith-Wiedemann Syndrome is a congenital growth disorder with unknown etiology which correlates with a number and genetic disorders. The prevalence of this syndrome is 1/15000 live birth and the mortality rate is 20% due to complication of prematurity, emphalocele, macroglossia, neonatal hypoglycemia and rarely cardiomyopathy. The basis for diagnosis includes at least two major and one minor criteria. This article presents a 7 hours old neonate with emphalocele, macroglossia and late neonatal hypoglycemia. Having diagnosed as BWS, the patient underwent for repair of abdominal wall defect, correction of hypoglycemia and abdominal sonography to assess the embryonal tumors. A serum insulin level measurement plus an isotope scan on pancreas to determine the cause of hypoglycemia were requested

Phototherapy-induced hypocalcemia in icteric newborns

Bakground: Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia as well as the management of subsequent complications in the newborn. However, this treatment modality may itself result in the development of hypocalcaemia and create serious complications including convulsion and related conditions. This study was under-taken to investigate phototherapy- induced hypocalcemia in hyperbilirubinemic neonates. 63 healthy term newborns of >2.5 kg undergoing phototherapy were selected. Plasma bilirubin and calcium levels were determined before and after termination of phototherapy. The difference between pre- and post-phototherapy plasma calcium levels were found to be statistically significant [p<0.05]. The decline in plasma calcium level at times reached hypocalcemia threshold. Phototherapy in icteric neonates lowers serum calcium level

Kassabach-merrit syndrome in a newborn: a case report

Kassabach-Merrit syndrome is a consumption coagulopathy that occurs as a complication of angiomatous nevi. The neonate reported here was born without complication and with a good APGAR score. He had petechiae and purpura on the trunk, thighs and shoulders. Gradually, he developed anemia and thrombocytopenia. Serologic tests and cultures were negative for infectious disease. The subcutaneously located patches and nodules increased gradually in size. Biopsy of one of the lesions was consistent with hemangioma of the capillary type. He was treated as a case of consumption coagulopathy associated with cutaneous hemangiomas