[ etiology of acute renal failure in the newborn infants admitted to the NICU at Afzalipour medical centre, Kerman, Iran]

Despite the countless benefits of breast milk, each year many infants are admitted to NICU's with clinical symptoms and laboratory indicators of dehydration and renal failure due to the lack of a national program to monitor post discharge breastfeeding over the first few days of life. In addition to identifying the role of inadequate breast milk intake as a cause of renal failure, the purpose of this study was to assess causes, clinical presentations and laboratory tests in acute renal failure and to identify the most available and practical laboratory test to differentiate prerenal from renal azotemia. A cross-sectional prospective study was performed between April 2005 and May 2006 [14 months] at Afzalipour Medical Centre in Kerman, Iran. All neonates with high serum blood urea and creatinine were included in the study. The percentage of weight loss, breast feeding, mode of delivery, and clinical presentations were recorded. Laboratory tests such as blood urea, serum and urine sodium and creatinine and, urine specific gravity were done. Data were analyzed by SPSS software, chi- square test and t- test. Among 36 neonates, who were eligible for the study, 29 cases [80%] had dehydration [group I] and 7 cases [20%] had intrinsic renal failure [group II]. In the first group, mean weight loss was 14% and mean age at admission was 10 days. Reasons for admission were poor feeding [69%], lethargy [58%], fever [30%], jaundice, vomiting and seizure. The mode of delivery in 69% of cases were vaginal route and 82% of cases were breast-fed. Decreased urine frequency in the previous day [<6 times per day] was considered more significant than decreased stool frequency [< 3 times per day]. Serum sodium and urine specific gravity in group I was significantly higher than group II [P<0.05]. This study confirms that an excessive weight loss over the first few days of life and decreased urine and stool frequency might be considered as a warning for failure of receiving enough milk. Serum sodium and urine specific gravity are the most sensitive laboratory parameters, for the assessment of dehydration

[A case report of penis agenesis [aphallia]]

A neonate was admitted on the second day of birth in the pediatric ward of Kerman medical sciences university No.1 Hospital, because of abdominal distention and the absence of penis. Physical findings were lethargia, infancy hyporeflexia, abdominal distention without any organomegally, and absence of penis, two touchable masses in the scrotum and a hole on scrotum for urine discharge. CBC and electrolytes were normal. Urea and creatinin were higher than normal rate but decreased to normal rate on the 4[th] day of birth. Urine analysis showed a lot of white and red cells and bacteria, but urine culture and blood culture were negative. Abdominal radiography revealed intestinal lobes full of gas, but there was no gas in the rectum. Barium enema was normal. Vertebral radiograph and echocardiograph were normal. Abdominal sonography showed pyelocalisil distention in both kidneys, but more in the left kidney, right scrotum and a hypoplastic penis in scrotum. In CT-Scan, perfusion and function of right kidney were normal while no perfusion and function were observed in the left kidney. The karyotype was 46XY. Abdominal distention was relieved after the washing of rectum with normal salin and discharge of gas and meconium. Urea and creatinin levels decreased to normal rate and oral feeding was started. The neonate was discharged because of parents' discontent for genital repair, but readmitted on the 41[st] day of birth due to urinary retention and visiculotomy was performed. Genital repair was not done due to parents' discontent

[Accuracy of ultrasonographic parameters in detection of growth restricted foetuses]

The main objective of this study was to review the diagnostic accuracy of different single ultrasonographic parameters in predicting intrauterine growth restricted foetuses as defined by Ponderal Index at birth. The study sample composed of two sets of data from Iran and Australia. The Iranian samples consisted of 296 Iranian women. All the study women received prenatal care and delivered at Eatemieh Hospital in Shahrood, Iran. The data from 200 Australian fetuses were obtained from the ultrasound section at the Wollongong Hospital in Australia. Ultrasonographic measurements of Biparietal diameter [BPD], femur length [FL], head c circumiference [HC]. abdominal circumference [AG], amniotic fluid index [AFI] and Doppler from umbilical arteries [S/D ratio] were obtained. Only those pregnancies were included in which the estimated date of delivery [EDD] by LMP [last menstrual period] agreed within 14 days with the estimated date of delivery determined by the initial ultrasound examination. Sensitivity [SE], specificity [SP], positive predictive value [PPV] and negative predictive value [NPV] were calculated for single proposed ultrasound parameters in the both Iranian and Australian samples. When different variables are compared, with a cut off point at or below the 10[TH] percentile. AC and HC had the highest sensitivities in the Australian sample while AC was the most sensitive parameter for IUGR detection in the Iranian sample. BPD has a reasonably high sensitivity at this threshold. The AFI ratio had the lowest sensitivity in predicting IUGR in the Australian sample. Positive predictive values were low in all of the parameters in both the Iranian and Australian samples. Our results indicate that reduced AG was the best single parameter in discriminating between IUGR and non-IUGR fetuses with the highest sensitivity among the proposed parameters in the both Iranian and Australian sample. However the positive predictive value of this parameter is low. This means that a high number of false positive cases is detected using each parameter which reduces the usefulness of identification. Other ultrasound obstetrical parameters may also have a reasonable level of sensitivity, however the positive predictive value of all parameters is low. On the whole our results show that although the examined ultrasonographic criteria may detect a group of fetuses that need close antepartum surveillance, none of these parameters is appropriate enough to be used in isolation in clinical practice. Using single ultrasound parameters does not have high sensitivity and positive predictive values in detection of fetal growth restriction. This limits both accuracy and utility of these tests in the detection of IUGR fetuses