[ frequency and characteristics of hypothyroidism jaundice in neonates with hyperbilirubinemia; a ten-year survey]

Background and Aims: Congenital hypothyroidism is a serious disorder that could be treated if detected early. Jaundice is one of the symptoms of these neonates. However, the prevalence, clinical course and severity of jaundice are not yet well defined. We compared the clinical course and severity of jaundice in a case-control study of congenital hypothyroidism and other neonates of unknown etiology who are yellow

Methods: The cross-sectional study was performed during 2002-2012 on 2780 four-day or older term neonates with jaundice. In addition to the usual procedures for diagnosis of jaundice, thyroid function was performed on 706 newborns referred to the neonatal or clinic part of Ghaem Hospital of Mashhad, Iran, and their thyroid function was evaluated. The clinical progress and severity of jaundice infected with hypothyroidism [thyroid-stimulating hormone [TSH] >/= 10 microu/ml or T4 less than 8 microg/dl] compared with infants with jaundice of unknown cause

Results: The neonates' mean age was 16.03 +/- 8.80 and 8.60 +/- 6.10 days [P = 0.001], age of onset of jaundice was 4.00 +/- 1.60 and 2.68 +/- 1.75 days [P = 0.008], total bilirubin was 15.70 +/- 5.25 and 21.88 +/- 5.10 mg/dl [P < 0.001], length of hospital stay was 0.80 +/- 1.11 and 3.37 +/- 1.71 days [P < 0.001], age of the jaundice improving was 21.00 +/- 15.23 and 49.40 +/- 14.60 days [P = 0.080], T4 level was 5.80 +/- 2.70 and 9.63 +/- 2.26 microg/dl and TSH level was 22.56 +/- 1.80 and 3.31 +/- 1.69 microu/ml in groups of case and control, respectively

Conclusion: Based on the findings of this study, in infants presenting with jaundice, after the second week of life, evaluation of hypothyroid may be recommended

effect of maternal selenium supplementation on pregnancy outcome and the level of oxidative stress in neonates

Pregnancy is regarded as a condition which is usually accompanied by oxidative stress. This study was undertaken to investigate the effect of maternal selenium supplementation during gestation on the level of oxidative stress in neonates and the pregnancy outcome. In this double-blind trial, 179 primigravid pregnant women in the first trimester of pregnancy were randomly assigned to receive 100 micro g of selenium [Se group] or a placebo [control group] per day until delivery. The level of oxidative stress and serum selenium concentration was determined in the maternal and umblical cord sera of the subjects. Oxidative stress was measured by means of a novel assay of prooxidant-antioxidant balance [PAB]. The incidence of any pregnancy complications and outcomes was also evaluated in all neonates, being fully examined and followed up until 45 days. Although maternal selenium concentration was significantly higher in the Se group [p<0.001], there was no statistically significant differences in the umblical cord selenium content between the two groups. Selenium supplementation was not associated with any significant decrease in PAB values in the Se group. The incidence of neonatal complications and outcomes did not differ significantly between the groups. Maternal selenium supplementation during pregnancy was safe but was not associated with a significant change in the extent of oxidative stress in neonates

[Evaluation of urinary tract infections following Neonatal hyper-bilirubinemia]

Urinary tract infection [UTI] is a common and serious clinical problem in newborns. Previous studies have suggested that jaundice may be one of the signs of a UTI in infants. The aim of this study was to evaluate the incidence, age presentation, severity of jaundice, signs and complications of UTI in newborns with asymptomatic, unexplained indirect hyperbilirubinemia in the first month of life. This case-control study was conducted at the Neonatal intensive care unit, Ghaem Hospital, in Mashhad from May 2004 to April 2009. We evaluated asymptomatic, jaundiced infants for the evidence of having UTI. Some laboratory tests such as a serum fractionated bilirubin level, as well as urinanalysis and a urine culture were performed in all patients. Renal ultrasound was performed in almost all the cases with UTI. Detailed questionnaires, which were included demographic information, prenatal, intrapartum, postnatal events and risk factors were filled. The control group was jaundiced-infants with unknown etiology. A total of 1487 patients were enrolled in this study. From these patients 1061 infants were evaluated for UTI. There was a statistically significant difference [P<0.05] between the two groups regarding age presentation, age admitted to hospital, age improved jaundice, serum bilirubin level and hospital stay. UTI was diagnosed in seventy four [6.97%]. Renal ultrasound showed urinary tract abnormalities in thirty two [32%] patients. Six infants had unilateral grade 1-3 reflux in voiding cystourethrogram. In our study UTI was found in 7% of asymptomatic, jaundiced infants. Therefore, we recommend that a UTI test should be included in asymptomatic, jaundiced infants presenting after five day of life as part of their evaluation.These infants should be evaluated for urinary tract abnormalities by renal ultrasound and voiding cystourethrogram

Evaluation of acute renal failure in neonates bedridden in Neonatal Intensive Care Unit [NICU] in Ghaem hospital

Acute renal failure [ARF] is defined as an abrupt severe decrease in glomerular filtration rate [GFR]. ARF is commonly seen in neonates admitted to neonatal intensive care unit. In this article, we have studied incidence, etiology, predisposing factors, management and mortality in neonates affected by ARF. A descriptive study was took placed at NICU of Qhaem hospital over a period of one year, between December 2005 and December 2006. 750 neonates were evaluated for ARF, according to having two of three following criteria: 1-oliguria: U/A<1/2cc/kg/h 2-BUN>20 mg/dl 3-Cr>1/2 mg/dl Patients were assessed for B.S [blood sugar], BUN, Cr, urine index [FENa, Uosm, BUN/cr, U/P osm, RFI, Una], ABG and kidney sonography. According to patient's response to the fluid therapy and kidney sonography, they were divided into two pre-renal and renal failure groups. Data were analyzed using descriptive statistics. From 750 neonates admitted in NICU, 38 patients [5%] demonstrated ARF. Pre-renal failure was found in 29 newborns [76.4%] and 9 neonates [23.6%]. Predisposing factors for ARF were as following: Asphyxia [42%], Respiratory distress syndrome [RDS] [26.7%], sepsis [13%], sever dehydration [13%] and congenital heart disease [CHD] [5%]. Nine infants [23.6%] were died. Mortality was significantly higher in intrinsic renal failure [88%]. ARF is still an important etiology of mortality in newborns. Diagnosis of predisposing factors [prematurity, asphyxia, RDS, ventilation and careful kidney control in newborn is essential in this problem

Evaluation of Auditory Brainstem Response [ABR] in neonatal hyperbilirubinemia

Jaundice is a common problem in newborns and clinical presentations resulting from early stages of hyperbilirubinemia toxicity. ABR is useful test to recognize the primary brain stem encepholapathy. This study has been carried out with the objective of evaluating the ABR in recognizing hearing disorders in newborns suffering from Jaundice. In this study, we describe ABR obtained in 60 full term newborns, with birth weight more than 2500 gr, and Bilirubin concentration Between 18-54mg/dl without immune hemolysis and hearing disorder risk factor, from march 2005 until January 2006. ABR was carried out before commencing therapy, While first ABR was abnormal, repeated ABR was done after treatment exactly after 3 months. In this study, sixty newborns were evaluated by ABR for detecting early hearing disorder. Mean weight were 3000 +/- 250 gr, Gestational age 38 +/- 1 weekes, bilirubin concentration 36 mg/d.l +/- 9 [18-54 range]. 17 patients had abnormal ABR pretreatment, and 12 patients done normal ABR second evalution after treatment [Bili: 26 +/- 3], 5 patients had persistent abnormal [mean Bili: 43 +/- 5]. ABR abnormalities includes latencies wave I,III,V and loger duration interpeaks I-V,I-III and III-V. [Mean values of ABR latencies when compared with a group of normal babies as a control group were significantly increased before treatment, but returned to normal value after treatment [p=0.001]. Our study proved that newborns with serum bilirubin ranging from 18 to 54 mg/dl would be increase in ABR waves I,III,V and also increase in interpeak I-III,III-V,I-V that may be irreversible in those infants with bilirubin more than 32 mg/dl

[ case report of fetal warfarin syndrome]

Warfarin is an anticoagulant drug, reducing the synthesis of vitamin K dependent coagulant factors. It has fewer complications than heparin during pregnancy, but it passes easily through the placenta. Therefore it may induce unfavorable condition so called as fetal warfarinsyndrome. The common presentations of this syndrome are nasal hypoplasia, epiphysial calcification, and skeletal disorders. Fetuses exposed to warfarin in the first trimester of pregnancy have an increased risk of embryopathy [nasal hypoplasia and stippled epiphyses]. A male neonate with new symptoms of fetal embryopathy [femoral agenesis bilateral dislocation of hip, agenesis of corpus callozom] is presented. He was born postdate from a mother using warfarin 2.5 mg/kg during the whole pregnancy. He also had short lower limb, finger deformity, nasal hypoplasia, radioulnar dislocation, hydrocephaly, and brachiocephaly

[Evaluation of quantitive IL6 in the diagnosis of neonatal sepsis]

Infection in the neonate presents a diagnostic dilemma as the clinical presentation is non- specific and final culture results are usually not available until at least 48-72[h] after sampling. Early confirmation of definitive infection with use of cytokine levels would cause significant reduction in health care costs by shortening the duration of treatment and hospitalization. The objective of the present study was to evaluate interleukin 6 [IL6] level in the early diagnosis of neonatal sepsis. This single blind clinical trial was done in NICU of Ghaem Hospital in 2003 - 2004. Subject included 60 neonates evaluated for suspected sepsis. All infants had IL6, CBC, B/C, CRP done at evaluation presentation. Infants were categorized into groups according to the Iikehood of infection on the basis of clinical presentation, blood culture results, i.e., group I [sepsis], group 2 [clinical sepsis] and group 3 [control]. IL6 was compared between two groups by the T-test of mann - whitney; logistic regression was done to establish the best predictors of infection; and sensitivity, specificity, positive and negative predictive values were determined. The lL6 Level was significantly raised in those infants with sepsis [184 pg/mL p value=0.000] and clinical sepsis [102 pg/ml p value= 0.001] when compared to those infants without infection [5 pg/ml]. An IL6 Value >/-11 pg/ml gave a NPV=9617%, PPV=100%, specifity=100%, sensitivity=96/8%. A CRP> 6pg/ml gave a sensitivity and specificity of 75% and 68% respectively. It is concluded that an IL6 value done at the time of presentation of sign and symptoms, suggestive of infection, is useful in the early diagnosis of neonatal sepsis. In particular, an IL6 < 11 and CRP < 6 pg/ml may allow antibiotics to be withheld in a number of infants evaluated for sepsis

[Multiple IV iimmunoglobulin therapy in newborns with immune hemolytic jaundice]

The Conventional treatment for neonatal immune hemolytic disease is, phototherapy and blood exchange transfusion. The aim of this study was to determine the efficasy of multiple dose of IVIG in reducing the need for exchange transfusion and phototherapy in hemolytic jaundice of newborn. The study was performed at NICU of Ghaem Hospital as a case - control study, over a period of one year [oct 2002-oct 2003]. Patients with ABO and RH incompatibility, proven by significant hyperbilirubinemia [Bill>8mg/dl at 12hr of age], positive direct or indirect comb's, and no other Risk factors, like sepsis and G6PD deficiency or early familial icterus, were randomly assigned to receive either conventional intensive phototherapy alone or phototherapy with IVIG 0.5gr/kg every 12hr for three times. Exchange transfusion was performed if billirubin exceded more than 20mg/dl. A total of 34 newborn infants were included in the study. There was no significant difference between two groups, with respect to birth weight, postnatal age, sex, bilirubin, hematocrit, or reticulocite count. The number of exchange transfusion, duration of phototheray and hospitalization, were significantly lower in IVIg treatment group than control one. Adverse effects were not observed during IVIG treatment. IVIG therapy is a safe treatment for newborns with hemolytic jaundice and Reduces exchange transfusion