Effect of clofibrate on reducing neonatal jaundice:a systematic review and meta-analysis

In neonates, bilirubin tends to be deposited in body tissues, especially the skin and mucous membranes. Jaundice is an early symptom of bilirubin excretion disorders. Therefore, the aim of this study was to investigate the effect of clofibrate on reducing neonatal jaundice. In this systematic review, international databases, including PubMed, Scopus, Web of Science, Embase, Cochrane, and Google Scholar, were searched without time and language restrictions. The reference lists of all studies ultimately included were manually searched. In the 17 articles reviewed, with a sample size of 665 people published between 2005 and 2019, the average weight of the neonates varied from 2,186 g to 4,000 g. Furthermore, the average age of neonates varied from 2 days to 9 days. Four doses of clofibrate (25, 30, 50, 100 mg/kg of neonatal body weight) were used. The bilirubin level of neonates significantly decreased in the intervention group 24, 36, 48, and 72 hours after the start of treatment. Clofibrate administration decreased total serum bilirubin, especially from the second day onwards, and also reduced hospitalization time, hospital costs, and side effects from hospitalization.

Comparison of Purgative Manna Drop and Phototherapy with Phototherapy Treatment of Neonatal Jaundice: A Randomized Double-Blind Clinical Trial

OBJECTIVES: Herbal remedies such as purgative manna are used to treat neonatal jaundice. In this study Bilineaster drop (purgative manna) and phototherapy, and phototherapy treatment alone were compared by assessing phototherapy duration and number of days in hospital. METHODS: There were 150 consecutive term neonates with jaundice, weighting from 2,500 g to 4,000 g enrolled in this randomized double blind clinical trial. The neonates were randomly assigned to intervention and control groups. The control patients received only phototherapy and the intervention group underwent phototherapy treatment and purgative manna drop (5 drops per kg of body weight, 3 times a day). Direct and total measurements of bilirubin concentration in the serum were measured and the reduction in concentration of bilirubin was calculated. RESULTS: There were 28% of patients whose hospital duration following phototherapy was 2 days, for Bilineaster and phototherapy treatment this was 49.3% of patients. At 48 hours and 72 hours the reduction in the concentration of total bilirubin in the serum was statistically significantly different across groups (p 0.05). The reduction in direct bilirubin concentration in the serum was significantly different between groups at 72 hours and 96 hours (p > 0.001). CONCLUSION: Purgative manna and phototherapy, can statistically significantly reduce total bilirubin concentration at 48 hours and 72 hours compared with phototherapy alone, and reduce the length of hospital stay for jaundiced neonates at 2 days compared with phototherapy treatment.

Evaluation of diagnostic value of procalcitonin as a marker of neonatal bacterial infections

This study tried to assess sensitivity, specificity, positive and negative predictive value of procalcitonin for diagnosis of neonatal bacterial infections. This prospective cross sectional study was carried out during an 18-month period in NICU and neonatal wards of Besat Hospital in Hamedan province, Iran. 39 symptomatic infants with clinical and laboratory findings in favor of bacterial infection with a positive blood, CSF, and/or supra pubic urine culture entered the study; 32 newborns without any bacterial infection served as control group. Quantitative procalcitonin level >/= 0.5 ng/ml was accepted as pathological. Finally sensitivity, specificity, positive [PPV] and negative predictive value [NPV] were calculated for procalcitonin test. 20 blood cultures, 17 urine cultures and 8 CSF cultures were positive. Sensitivity, specificity, PPV and NPV for procalcitonin test was 76.9%, 100%, 100% and 78% respectively. Diagnostic value of procalcitonin test in accordance with blood culture for mentioned items was 85%, 100%, 100% and 91.4% respectively. Its diagnostic value according to urine culture was: sensitivity 70.6%, specificity 100%, PPV 100% and NPV 86.4%, and according to CSF culture was: sensitivity 75%, specificity 100%, PPV 100% and NPV 94.1% respectively. The results show that the procalcitonin test has high sensitivity, specificity, PPV and NPV for diagnosis of neonatal infections

Premature loss of permanent teeth in Allgrove [4A] syndrome in two related families

Allgrove syndrome is a rare autosomal recessive condition characterized by adrenal insufficiency, achalasia, alacrima and occasionally autonomic disturbances. Mutations in the AAAS gene, on chromosome 12q13 have been implicated as a cause of this disorder. We present various manifestations of this syndrome in two related families each with two affected siblings in which several members had symptoms including reduced tear production, mild developmental delay, achalasia, neurological disturbances and also premature loss of permanent teeth in two of them. The importance of this report is dental involvement [loss of permanent teeth] in Allgrove syndrome that has not been reported in literature

Urinary tract and other associated anomalies in newborns with esophageal atresia

Esphageal atresia is often associated with other anomalies. Hereditary and environmental factors may influence the incidence of associated anomalies, particularly of the urogenital system. WE had 63 neonates with esophageal atresia admitted to 2 centers in Hamadan, Iran, from 2002 to 2008. They were 38 girls [60.3%] and 25 boy [39.7%]. Tracheoesophageal fistula was present in 54 neonates [85.7%], and other associated anomalies in 10 [15.9%]. Cardiac anomalies were found in 7 neonates; anorectal anomalies, in 4; urinary tract anomalies, in 2; and limb anomaly, in 1. Urinary tract anomalies [3.2%] were bilateral polycystic kidney in 1 neonate and unilateral hydronephrosis due to ureteropelvic junction obstruction in another. Both neonates with urinary tract anomalies were female and both had tracheoesophageal fistula, as well. Many of associated congenital abnormalities influence the management protocol of esophageal atresia, and therefore, should be detected as soon as possible after birth

Auditory evaluation of high risk newborns by automated auditory brain stem response

The objective of this study was to assess the prevalence of hearing impairment by automated auditory brain stem response [AABR] in newborns admitted to an intensive and intermediate care unit and to analyze the associated risk factors. An observational cross-sectional study was conducted between January 2005 and January 2006. 834 newborns [62% boys and 38% girls] were assessed. Newborns had a mean [SD] gestational age of 36 [2.1] weeks with a mean [SD] birth weight of 2950 [1250] grams. The presence of the following neonatal pathologies was investigated: craniofacial malformations, hyperbilirubinemia [total bilirubin 20 mg/dl for all newborns], neonatal asphyxia, congenital infections, septicemia, birth weight [

Aplasia cutis congenita after methimazole exposure in utero; a case report and literature review

Aplasia Cutis Congenita [ACC] is a rare disorder with a complicated pattern of| inheritance. Babies are born with the absence of certain layers of skin. It most commonly manifests as a solitary defect on the scalp, but sometimes it may occur as multiple lesions. The affected area is typically covered with a thin, transparent membrane. The skull and/or underlying areas may be visible and be abnormally developed. ACC may be the primary disorder or it may occur in association with other underlying disorders. This article presents a case of ACC in a newborn whose mother was treated with methimazole due to thyrotoxicosis during the first trimester of pregnancy. He was born term with midline scalp defects. This case report is presented to highlight the steps to successful management and review the relevant literature. Management strategies are based on the size and presence of an underlying skull defect. A review of the literature seems to support the hypothesis that methimazole is a potential teratogen. Although the risk of birth defects is low with clinically applied doses of the drug, it cannot be regarded as safe and should therefore be avoided pregnant women. Propylthiouracil should be considered as the first choice drug for hyperthyroid pregnant women until further data on the safety of methimazole are available