Etiology and therapeutic management of neonatal jaundice in Iran: a systematic review and meta-analysis.

BACKGROUND: Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients. METHODS: We searched the databases of PubMed, Web of Sciences, Scopus and Google Scholar for English articles published since inception until May 2019. A search was also done for Persian articles in Magiran and Scientific Information Database. Studies were evaluated based on predefined criteria by two reviewers. Data analysis was performed by STATA software. RESULTS: A total of 33 articles were finally included. The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows: ABO blood groups incompatibility, 16.9% [95% confidence interval (CI) 10.9-22.8]; Rh blood group incompatibility, 4% (95% CI 2.5-5.5); ABO and Rh blood groups incompatibility, 3.6% (95% CI 0-7.7); glucose-6-phosphate dehydrogenase (G6PD) deficiency, 6.3% (95% CI 5.1-7.5); infection, 6.6% (95% CI 5.2-8.1); hypothyroidism, 4.2% (95% CI 0.1-8.3); infant of diabetic mother: 2.3% (95% CI 0.1-4.5); unknown, 50.7% (95% CI 33.4-68); cephalohematoma, 0.6% (95% CI 0.3-0.9). Regarding treatment of icterus, seven and eight articles were found on phototherapy and exchange transfusion, respectively. In five studies, all patients underwent phototherapy, but rate of exchange transfusion use was between 6.6% and 50.9%. CONCLUSIONS: According to the results, unknown factors were the most common causes of icterus in Iranian neonates, followed by ABO blood groups incompatibility, infections and G6PD deficiency. By the way, phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.

Screening of Hearing in Newborn Infants: Follow-Up and Outcome After 40930 Births in Babol, Northern Iran.

BACKGROUND: The purpose of this study was to investigate the results of hearing screening in all newborn infants, and their follow-up in Babol, northern Iran. METHODS: Between 2006 and 2014, all healthy neonates delivered in 3 hospitals were included in this cross-sectional study. Newborns were screened using the transient evoked otoacoustic emissions test before discharge. Those who failed to pass the examination were tested for auditory brainstem response (ABR) by the age of one month. The infants referred from the previous level underwent tests of auditory steady state response, ABR and impedance audiometry before the age of 3 months. For infants with the diagnosis of bilateral hearing impairment, it was recommended to use a hearing aid in 3 months. Then, their parents were recommended to take infants again to the hearing testing centers within next 6 months. If the infant's hearing was not improved, he/she was advised to undergo cochlear implantation. RESULTS: In total, 40930 newborns were screened. Out of them, 62 (1.5 per 1000 live births) were finally diagnosed to have hearing impairment, of whom 14 had unilateral and 48 had bilateral disorders (candidate for supportive measures). Overall, 986 (2.4%) were lost to follow-up and 11 (0.03%) died over the first 3 months of age. At the end of the 6-month follow-up for supportive stage, 15 out of 48 infants received a hearing aid and 18 (0.4 per 1000 children) underwent cochlear implant surgery. Fourteen out of 48 cases were lost to follow-up over supportive stage. CONCLUSION: It is recommended that all newborns undergo hearing screening test before hospital discharge, and those with impairment receive supportive measures from 3 months of age, and be re-examined at 12 months of age.

Prevalence of Birth Defects in Iran: A Systematic Review and Meta-Analysis.

INTRODUCTION: Birth defects are a series of disorders that occur during embryonic life. In Iran, no national situation analysis is available to show the rate of congenital disorders. We aimed to estimate the prevalence of structural birth defects in Iran. METHODS: We searched for English studies on PubMed, Scopus and Google Scholar from January 1990 to July 2016. The search for Persian articles was performed in Scientific Information Database and Magiran. Two reviewers assessed the identified articles independently. The relevant studies were selected based on predefined criteria. Data were analyzed using the Comprehensive Meta-Analysis software. Random effect method was used for meta-analysis. RESULTS: In total, 42 studies were included. The prevalence of congenital anomalies was as follows: orofacial clefts, 1.4 per 1,000 births (95% confidence interval [CI]: 1.2-1.6); neural tube defects, 3.2 per 1,000 births (95% CI: 2.5-4.3); urogenital anomalies, 3.9 per 1,000 births (95% CI: 1.2-12.9); musculoskeletal malformations, 3.3 per 1,000 births (95% CI: 2.3-4.9); cardiovascular anomalies, 3.3 per 1,000 births (95% CI: 2.2-5.1); Down syndrome, 0.9 per 1,000 births (95% CI: 0.7-1.2); gastrointestinal disorders, 1.4 per 1,000 births (95% CI: 0.9-2.1). CONCLUSION: Our results show that urogenital disorders are the most prevalent births defects in Iran, followed by musculoskeletal and cardiovascular malformations.