Comparison of two regimens of vitamin D supplementation for vitamin D-deficient neonates

<p><b>INTRODUCTION</b>Vitamin D deficiency is common in pregnant women, and supplementation of vitamin D is necessary for the infants of these women. This study explored the efficacy of an alternative way of vitamin D supplementation in an area with a high prevalence of vitamin D deficiency in mothers.</p><p><b>METHODS</b>This was a non-randomised clinical trial conducted in 2010 in Yazd, Iran. Full-term healthy infants born to vitamin D-deficient mothers (n = 82) were divided into the high-dose regimen (HDR; single oral bolus 30,000 IU vitamin D3, n = 34) and the standard-dose regimen (SDR; 400 IU/day vitamin D3 within two weeks of life, n = 48) groups. 25-hydroxyvitamin D (25OHD) was measured using chemiluminescent immunoassays, and 25OHD level > 20 ng/mL was deemed sufficient.</p><p><b>RESULTS</b>Over 90% of infants in the HDR group attained vitamin D sufficiency within one month, while comparable sufficiency was reached in the SDR group only after four months. At two months, the proportion of infants attaining 25OHD > 30 ng/mL was 93.3% and 27.9% in the HDR and SDR groups, respectively (p = 0.003). None of our infants achieved 25OHD levels > 100 ng/mL.</p><p><b>CONCLUSION</b>For infants born to vitamin D-deficient mothers, oral supplementation of 30,000 IU vitamin D3 during the first month of life, followed by a routine recommended dose of 400 IU/day, should be considered. The four-month lag for attaining vitamin D sufficiency in 90% of infants in the SDR group may have clinical implications and should be further investigated.</p>

Frequency of hearing impairment among full-term newborns in Yazd, Iran

Permanent congenital hearing loss, a common congenital anomaly, may affect speech and language acquisition, academic achievement and social development. Current standards emphasize early recognition of congenital hearing loss. This study was conducted to find the prevalence of hearing impairment in term newborns in Yazd, Iran. This was a descriptive-analytic study conducted in Yazd on 7250 term newborns. Otoacoustic emissions [OAEs] test was performed in all newborns during the first 24 hours after birth. Those who failed to respond at the first step were retested 15 days later. Those who failed to respond at the second step too, were tested by acoustic brainstem responses [ABR] test. Chi square test was used for data analysis. From 7250 newborns in the first step 598 [8.2%] and 682 [9.4%] ears [right and left, respectively] failed. In the second step 51 [0.7%] and 58 [0.8%] ears [right and left, respectively] failed. Consanguinity and route of delivery had significant effect on the frequency of hearing loss. The overall frequency of congenital hearing loss in this study was found high

case report of camptomelic dysplasia

Camptomelic Dysplasia [CMD] is a rare autosomal dominant congenital dwarfism characterized by shortness and bowing of long bones [camptomelia] and other severe skeletal and extra skeletal malformations. CMD is generally considered to be lethal and the majority of cases die in the neonatal period due to respiratory insufficiency. We hereunder report a term male neonate with characteristic clinical and radiological findings of CMD, hydrocephaly, no sex reversal, and a negative family history of skeletal problems who was born to non-consanguineous healthy parents and was admitted to Shahid Sadoughi Hospital, Yazd, Iran, immediately after birth due to respiratory distress. The patient required continuous mechanical ventilation support and all attempts to reduce respiratory support failed and the patient died on the 21th day of his life. Camptomelic Dysplasia is a terrible experience for parents; thus, prenatal diagnosis of CMD by ultrasound is essential and mandatory for a better therapeutic intervention

Developmental status of NICU admitted low birth weight preterm neonates at 6 and 12 months of age using ages and stages questionnaire

Low birth weight [LBW or birth weight<2500g] can be one of the serious problems in children. The purpose of this study was to evaluate the developmental status of LBW preterm neonates admitted to neonatal intensive care unit [NICU] at the corrected ages of six and 12 months via the Persian version of Ages and Stages Questionnaires [ASQ]. In a follow up study, fifty LBW preterm neonates admitted to Shahid Sadoughi Hospital NICU in 2008 were evaluated for developmental status at 6 and 12 months of age using ASQ. Twenty four boys and 26 girls with a mean gestational age of 31.3 +/- 2.7 weeks and a mean birth weight of 1480.3 +/- 422.8 grams were evaluated. Developmental delay in gross motor and personal social skills domains were the most prevalent abnormal developmental status at 6 and 12 months of age. Mean score in gross motor skills, personal social skills and problem solving domains at 12 months of age were significantly higher in neonates with birth weight >/= 1500 grams. Mean score in fine motor skills, communication and problem solving domains at 12 months of age were significantly higher in neonates who were exclusively breast fed. LBW and preterm infants admitted to the NICU showed degrees of developmental delay at the ages of 6 and 12 months, especially in the gross motor and personal-social developmental domains on the ASQ. So, evaluation and monitoring of development status of LBW should be emphasized for early and timely diagnosis, investigation, and management

Super giant coronary aneurysm in Kawasaki disease

Giant coronary artery aneurysms caused by Kawasaki disease are rare; however, they are one of the most serious complications and can be lethal. We report a 3.5-month-old boy referred to us because of high fever for fifteen days, generalized maculopapular rash, irritability and cough. Transthoracic echocardiography showed dilatation of right coronary [RCA] and left main coronary [LCA] arteries. Serial echocardiography revealed rapidly progressive dilatation of coronary artery aneurysms of RCA and LCA. We performed invasive cardiac catheterization with selective coronary angiography when the boy was 16 months old. Selective right and left coronary arteriography showed a super giant fusiform aneurysm of RCA and a diffuse giant aneurysm of the proximal LCA. Regression of coronary artery aneurysms was not observed during 6 years of follow up. Pediatricians should be alert for possibility of incomplete Kawasaki disease in young infants with atypical presentation. They are at higher risk of coronary aneurysm formation. The diagnosis often was late with higher complication rate of coronary aneurysm. Echocardiography is an important tool for diagnosis of incomplete Kawasaki disease. Selective coronary angiography is the gold standard for diagnosis, and estimation of shape and size of aneurysms

[Relationship between delivery type and successful breastfeeding]

Exclusive breastfeeding has a major effect on decreasing the mortality of the children, particularly in developing countries. The aim of this survey was to study the effect of type of delivery on success of exclusive breastfeeding. In a case-control study; 344 women including two equal groups of 172 cases were chosen based on the type of delivery, vaginal or by cesarean section, and followed for 6 months the way of feeding their infants and the rate of exclusive breastfeeding among them. The rate of exclusive breastfeeding was significantly lower in the mothers delivered by cesarean section than who delivered vaginally [13.4% vs. 41.8%]. The average duration of breastfeeding among the women with vaginal delivery was significantly longer than the cases with cesarean delivery [4.5 +/- 1.7 months vs. 4.0 +/- 1.5 months]. The rate of the onset of breastfeeding in the first hour of delivery was significantly higher among the group with vaginal delivery than the group with cesarean section [82% vs. 38%] and finally the rate of formula feeding among the infants of the mothers with cesarean section was higher than in the infants of the mothers with vaginal delivery [33% vs. 22%]. Cesarean section decreases the exclusive breastfeeding and hence attempts should be made to encourage the mothers for vaginal delivery and breastfeeding as well. Besides, discussing the benefits of breastfeeding for both mother and infant, supports the fact that mothers should be advised to attain executive breastfeeding