Iodine-containing disinfectants in preparation for caesarean section: impact on thyroid profile in cord blood.

BACKGROUND: Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known. OBJECTIVES: The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns. METHODS: This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method. RESULTS: We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥ 10 mIU/L and T4 ≤ 7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 < 13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group. CONCLUSIONS: It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies. TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1.

Assessment of Hearing Loss by OAE in Asphyxiated Newborns.

BACKGROUND: Severe birth asphyxia (apgar < 7 at the 5th minute of birth) is recognized as a hearing loss risk factor by the joint committee on infant hearing (JCIH). About half of the newborns with hearing loss do not indicate any sign and risk factor at birth. Accordingly, the joint committee recommended performance of hearing screening test in 2000, especially for babies born with risk factors. OBJECTIVES: The aim of this study was to evaluate hearing loss in asphyxiated neonates. Early diagnosis would result in early treatment of these newborns. PATIENTS AND METHODS: We assessed the relationship between asphyxia and hearing impairment in newborns admitted to a referral hospital, Tehran, Iran within 3 years (2003 - 2006). Hearing problems were diagnosed and followed by otoacoustic emission (OAE) in the third and fifth days of birth. Asphyxiated neonates with abnormal OAE were referred to an ENT specialist; second OAE and tympanometry were carried out after 2 weeks. Based on the results, newborns underwent treatment or were discharged. RESULTS: Of 149 asphyxiated neonates, 80 had mean first minute apgar score of 4.01, and mean 5th minute score was 7.24. Two percent (3/149) of asphyxiated neonates had abnormal OAEs. No statistical correlation was found between the 5th minute apgar score and abnormal OAE (P value = 0.391). However, a significant relationship between the mean birth weight and abnormal OAE (P value = 0.0406) was found. CONCLUSIONS: It seems that birth asphyxia is not correlated with hearing loss.

Risk factors for neonatal mortality among very low birth weight neonates.

The objective of this study is to determine risk factors causing increase in very low birth way (VLBW) neonatal mortality. The medical files of all neonates weighing ≤1500 g, born in Vali-e-Asr hospital (2001-2004) were studied. Two groups of neonates (living and dead) were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age (P=0.02), low birth weight, lower than 1000 g (P=0.001), Apgar score <6 at 5th minutes (P=0.001), resuscitation at birth (P=0.001), respiratory distress syndrome (P=0.001) need for mechanical ventilation (P=0.001), neurological complications (P=0.001) and intraventricular hemorrhage (P=0.001). Regression analysis indicated that each 250 g weight increase up to 1250 g had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 g should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 g. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage.

UDP-glucuronosyltransferase promoter polymorphism in Iranian neonates with idiopathic hyperbilirubinemia.

To determine the association between polymorphism of UGT1A1 gene and idiopathic hyperbilirubinemia in Iranian neonates. Fifty neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) more that 15mg/dl and 50 neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) less than 15mg/dl enrolled in this study. Thymine-adenine (TA)  repeats in the promoter region of UGT1A1 gene investigated by means of  polymerase- chain reaction (PCR) DNA sequencing. Demographic characteristics did not differ significantly between groups while STB was higher in case group (17.5±1.9 vs. 10.4±1.8, p value<0.001). Among one hundred neonates evaluated in this study, TA6/6, TA6/7 and TA7/7 genotypes found in 52%, 42% and 6%, totally. TA6/7 and TA7/7 genotypes observed in case group more than the control group (P<0.001). STB levels were significantly higher in cases with TA6/7 and TA7/7 genotype pattern (P<0.001). Heterozygous and variant homozygous genotypes of the promoter region of UGT1A1 gene in healthy Iranian neonates with idiopathic hyperbilirubinemia should be considered.

Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals.

INTRODUCTION: This study was conducted to determine the genetic characterization of extended-spectrum beta-lactamase (ESBL) producing strains of Klebsiella  pneumoniae isolated from Iranian patients in hospitals in Tehran. METHODOLOGY: Antibiotic susceptibility of 104 isolates was determined using the disk diffusion test. The Minimum Inhibitory Concentrations (MICs) of imipenem and meropenem were determined for isolates showing reduced susceptibility to carbapenems. The phenotypic confirmatory test (PCT) was used to screen the isolates for ESBL production. PCR was used to detect blaSHV, blaTEM and blaCTX-M and the amplicons from selected clones were sequenced. Isolates producing ESBLs were analyzed by pulsed-field gel electrophoresis (PFGE). RESULTS:   One isolate showed resistance to imipenem (MIC = 16 µg/ml). Resistance to amikacin and ciprofloxacin was 44.2% and 25.0%, respectively. ESBL production was detected in 72.1% (n = 75) of isolates. The prevalence of blaSHV, blaTEM and blaCTX-M genes among the isolates was 55.7% (n = 58), 30.7% (n = 32) and 45.2% (n = 47), respectively. The sequencing revealed the amplicons corresponding to bla (TEM-1, TEM-79, SHV-1, SHV-12, SHV-31, CTX-M-15) genes. While the blaCTX-M-15 is the dominant gene among the Iranian isolates, we detected the blaSHV-31 and blaTEM-79 genes for the first time in the country.  PFGE differentiated the 71 ESBL-producing isolates into 62 different genotypes. Clonal dissemination of ESBLs was found in the neonatal intensive care unit and intensive care unit of one hospital. CONCLUSION: The findings are evidence of the spread of multi-resistant clones of ESBL producers in Tehran hospitals.