[Nephrocalcinosis and nephrolithiasis in preterm neonates under 1500 grams birth body weight]

Background and Objectives: renal calcification [nephrocalcinosis and nephrolithiasis] are common in both term and preterm infants who have had difficult neonatal courses. Multiple factors including some medications may cause hypercalciuria and nephrocalcinosis in premature neonates. The aim of this research was to determine the rate of renal calcification and its relation with neonatal clinical course and medications in preterm neonates under 1500 grams birth body weight

Materials and Methods: in a cross sectional and descriptive-analytical study, 250 premature neonates with birth weight less than 1,500 grams who hospitalized in the neonatal intensive care unit of Alzahra Hospital of Tabriz/Iran from 2012-2013 were studied. Data including gender, gestational age, birth weight, first and fifth minute APGAR score, delivery type and receiving mechanical ventilation, CPAP and drugs were recorded. Renal ultrasound examination was done in all neonates at one month of age and was repeated at 40 weeks corrected gestational age

Results: the mean weight and gestational age of neonates were 1233.45+/-634.45 gram and 29.34+/-3.7 weeks respectively. One hundred and four neonates [41.6%] were male and 146 cases were female. Renal calcification was reported in the first ultrasound scan in 11 neonates [4.4%] and in the second one in 74 cases [29.6%]. There was not significant association between renal calcification and sex, gestational age, receiving surfactant, aminoglycosides and calcium [P>0.05]. There was a significant relationship between renal calcification and low birth weight, mechanical ventilation, CPAP, receiving diuretics, methyl xanthines, vancomaycin and corticosteroids [p<0.05]

Conclusion: we found renal calcification in less than one third of studied neonates. Renal calcification was more common in infants with less birth body weight and those receiving mechanical ventilation, CPAP, diuretics, methyl xanthines, vancomycin, and corticosteroids

Prevalence of multidrug resistant extended-spectrum beta-lactamase producing gram-negative bacteria in neonatal sepsis

Neonatal sepsis with extended-spectrum beta-lactamase [ESBL] producing microorganisms is recognized increasingly in recent years. ESBL can be produced by various bacterial strains. This study was conducted to determine the prevalence of ESBL producing pathogens in neonatal sepsis and its impact on clinical outcome. A study was carried out from Jan 2012 to Jan 2013 in a referral university hospital. All neonates who had diagnosed as sepsis were enrolled in this study. Blood cultures were processed using the automated BACTEC 9120 system. Antibiotic resistance and beta-lactamase production of bacterial isolates was tested. All patients were followed till discharge. One hundred three neonates with gestation age 36.7 +/- 3.2 weeks were enrolled in this study and 56 cases [54%] were boys. The most common isolated gram negative pathogens were Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa. The rate for beta-lactamase production were 97.7% in Klebsiella pneumoniae, 81.3% in Acinetobacter, 85.7% in E. coli, 53.3% in Pseudomonas aeruginosa and 100% in Serratia. Thirty eight [35.9%] neonates were dead, that 34 of them were beta-lactamase producers. The mean duration of hospitalization were longer in patients infected with beta-lactamase producers [30.2 +/- 20.5 vs. 22.8 +/- 16.6 days P=0.05] and ESBL producing strains [29.13 +/- 20.39 vs. 19 +/- 9.84 P=0.05]. ESBL production rate were determined 95.5% and 86.7% in Klebsiella pneumoniae by combined disk test [CDT] and double disk synergy test [DDST] method, respectively. These methods were positive for ESBL production in 78.6% and 64.3% of E. coli isolates, respectively. In our study, the high rate of beta-lactamase and ESBL production were determined for common isolated organisms in neonatal sepsis. Infection with ESBL producing pathogens was associated with longer hospital stay. CDT method was detected more ESBL producing pathogens than DDST method in our study. It is recommended future studies to determine the risk factors predisposing newborn infants with these pathogens

Vascular endothelial growth factor and insulin-like growth factor-1 in preterm infants with retinopathy of prematurity

<p><b>INTRODUCTION</b>Retinopathy of prematurity (ROP) can lead to severe visual impairment. This study was conducted to determine the levels of biochemical mediators (i. e. vascular endothelial growth f actor [ VEGF] and insulin- like growth factor-1 [IGF-1]) in the blood of premature infants with proliferative ROP.</p><p><b>METHODS</b>Blood samples from 71 preterm infants born at or before 32 weeks of gestation were obtained 6-8 weeks after birth. These infants were classified into two groups according to their eye examination results. The control group consisted of 41 infants who had no evidence of ROP, and the study group consisted of 30 infants with proliferative ROP at stage III or higher. Blood VEGF and IGF-1 levels were measured using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The mean gestational ages of the infants at birth were 28.4 ± 1.6 and 28.8 ± 1.6 weeks in the study and control groups, respectively (p = 0.259). The mean postmenstrual age of the infants at the time of blood sampling was 34.9 ± 1.2 weeks in the study group and 34.6 ± 1.3 weeks in the control group (p = 0.339). The mean blood IGF-1 (18.48 ± 11.79 µg/L and 16.75 ± 13.74 µg/L in the study and control groups, respectively; p = 0.580) and VEGF (267.35 ± 103.43 pg/mL and 237.52 ± 130.92 pg/mL in the study and control groups, respectively; p = 0.305) levels of the infants were not significantly different between the two groups.</p><p><b>CONCLUSION</b>At 6-8 weeks after birth, blood IGF-1 and VEGF levels were not found to be significantly different between premature infants with proliferative ROP and those without.</p>

Comparing the efficacy of face mask CPAP with nasopharyngeal CPAP for neonatal transport after delivery

Preterm infants have respiratory failure and complications because surfactant in alveolus is low. CPAP [Continuous positive airway pressure] is a method for respiratory support in pre-term neonates and is provided by different equipment and methods. This study aims to compare two different routes of CPAP delivery in preterm newborn infants and to determine the need for surfactant replacement therapy in two groups. This is a randomized controlled clinical trial. Eighty four preterm infants delivered in Al-Zahra Hospital with gestational age 28-32 weeks were enrolled in this study from January 2012 to September 2012. They were randomly allocated in two groups. After initial stabilization in delivery room, forty two infants transferred to neonatal intensive care unit [NICU] with face mask CPAP and 42 infant with nasopharyngeal CPAP and continued nasal CPAP in the NICU in both groups. All infants were followed for developing respiratory distress and need for surfactant replacement therapy and oxygen dependency till discharge. The neonates that treated with two methods of CPAP delivery were similar with respect to gestation age, birth weight and other demographic characteristics. Twenty three neonates [65.5%] in face mask group and 15 neonates [39.5%] in nasopharyngeal CPAP group need surfactant replacement therapy [p=0.08]. Mask CPAP or nasopharyngeal CPAP can used in preterm infants after delivery for neonatal transfer to NICU. This study showed no method of CPAP delivery is preferable to other in decreasing the need for surfactant therapy

Plasma leptin concentrations in preterm infants with retinopathy of prematurity [ROP]

Retinopathy of prematurity [ROP] is a postnatal disorder of retinal vessels that develops in the incompletely vascularized retina of preterm infants. This disorder regresses in most patients but can lead to severe visual impairment. There is evidence that leptin stimulates angiogenesis. This study was conducted to determine blood levels of leptin in premature infants with proliferative ROP. Blood samples were obtained 6-8 weeks after birth from 71 preterm infants born at or before 32 weeks of gestation. These infants consisted of two groups according their eye examination results. The control group consisted of 41 neonates without evidence of ROP and the case group included 30 patients with proliferative ROP at stage III or more. Plasma leptin concentrations were measured using enzyme-linked immunosorbent assay [ELISA]. The mean gestation age of studied patients at birth were 28.4 +/- 1.6 wk and 28.8 +/- 1.6 in case and control group respectively [P= .25]. The mean post menstrual age of studied patients at blood sampling was 34.9 +/- 1.2 wk in the case group and 34.6 +/- 1.3 wk in the control group [p=0.33]. Mean blood levels of leptin were not significantly different among patients of the two groups [0.64 +/- 0.41 ng/ml in case group and 0.79 +/- 0.83 ng/ml in control group respectively, p=0.39]. Our data demonstrated that plasma leptin concentrations were not significantly different in premature infants with proliferative ROP at 6-8 weeks after birth from premature infants without ROP at this age

Goldenhar syndrome in an infant of diabetic mother

Goldenhar syndrome [oculoauriculovertebral dysplasia] is a rare congenital anomaly with unknown etiology and consists of non accidental association of hemifacial microsomia, auricular anomalies, epibulbar dermoid and vertebral anomalies. Although some malformations are more frequent in infants of diabetic mothers, developmental defects of first and second branchial arch is not a common finding in these patients. We report a female case of Goldenhar syndrome in a newborn infant of a diabetic mother [IDM]. Follow up of this patient after 6 months showed normal neurodevelopment and no evidence of hearing loss. She had developed epibulbar dermoid tumor in her right eye. It is necessary to evaluate IDM for presence of anomalies implying oculoauriculovertebral dysplasia

effect of oral dextrose on pain relief of newborn infants

In comparision with children and adults pain in the newborn infants is under assessed and under managed. Recently oral sweet solutions such as sucrose has been used for painful procedures in neonates. The objective was to assess the efficacy of 25% dextrose for managing of infants pain in neonatal peripheral venepuncture. In a randomized controlled clinical trial, 60 term neonates were enrolled in the study. They were randomized to receive oral dextrose [25%] or sterile water two minutes before venepuncture. Pain reactions were scored with CRIES pain scoring system, Crying time and heart rate at five minutes after venepuncture were recorded. There were significantly lower pain score and shorter crying time in dextrose group after venepuncture [CRIES pain score: 2.23 +/- 1.45 vs 6.17 +/- 1.66 P=0.001], [Duration of crying [sec]: 2.83 +/- 1.64 vs 16.97 +/- 8.49 P=0.001] respectively. Using oral dextrose solution is a useful, non expensive and non pharmacologic method for managing pain of venepuncture in neonates