Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure after surfactant administration in preterm neonates with respiratory distress syndrome.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of humidified high-flow nasal cannula (HHHFNC) therapy, and compare it with the effect of nasal Continuous Positive Airway Pressure (NCPAP) in neonates with respiratory distress syndrome (RDS). METHOD: In this clinical study, consecutively admitted 27-32 weeks preterm infants with RDS who received surfactant through a brief intubation (INSURE method) were randomly assigned immediately after extubation to HHHFNC or NCPAP. Primary outcomes were oxygen saturation values and oxygen need at 6, 12 and 24 h after surfactant administration as well as duration of oxygen and respiratory support, need for intubation and mechanical ventilation and incidence of apnea. Secondary outcomes were duration of hospitalization and incidence of complications such as pneumothorax. RESULTS: Sixty-four infants met the inclusion criteria and were enrolled in the study, 32 per arm. Two cases in HHFNC group dropped due to congenital pneumonia/sepsis. No differences were seen between groups in primary and secondary outcomes except for arterial oxygen saturation values (SaO2) 24 h after surfactant administration that were significantly higher in the NCPAP group [95.97% ± 1.96% vs. 95.00% ± 1.80% (P = .04)] with similar oxygen needs. The treatment failure was observed in four (11.8%) infants of the NCPAP group compared to five (16.7%) cases of the HHHFNC group (P = .57). CONCLUSION: Based on the results of the present study, the HHHFNC can be as effective as NCPAP to treat the neonates with RDS after surfactant administration.

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.

Lifestyle Interventions to Promote Healthy Nutrition and Physical Activity in Middle-Age (40-60 Years) Adults: A Randomized Controlled Trial in the North of Iran.

BACKGROUND: This study was conducted to evaluate the effectiveness of short-term structured interventions on healthy lifestyle behaviors, dietary intake, anthropometric measures, blood pressure, fasting blood glucose, and serum lipid profile of middle-aged adults. STUDY DESIGN: Randomized controlled trial study. METHODS: Overall, 300 individuals out of apparently healthy (non-patient) adults aged 40-60 yr living in Amirkola, Babol the north of Iran were enrolled in 2016-2017. The Persian translation of the Health Promoting Lifestyle Profile II (HPLP-II) and two days 24-h food recall questionnaires were used for data collection. Eligible participants were allocated randomly in three groups (high-intensive, low-intensive and the control). The follow-up examination has been conducted after 16 wk of intervention. RESULTS: The three study groups had no significant difference in age (P=0.888), sex (P=0.395), BMI (P=0.969), healthy lifestyle score (P=0.675) and total daily energy intake (P=0.612). After intervention, the mean scores of all the six subdomains of HPLP-II questionnaire had significant improvement (P<0.001). Mean weight loss was 1.5, 1.0 and 0.3 kg, in high-intensive, low-intensive and control groups, respectively. BMI although reduced, was still in the overweight range in two sexes. Mean of neck, arm, waist and buttock size, diastolic blood pressure, serum triglyceride, total cholesterol, and HDL levels have been changed to a better condition in comparison with the baseline values (P<0.001). Dietary intake had good changes in total daily energy (P<0.001), daily intake of carbohydrate, protein, and fat (P<0.001), and proportion of energy from carbohydrate (P=0.007) and fat (P=0.022) after the intervention. CONCLUSION: Our intervention program could have positive impact on healthy lifestyle behaviors, dietary intake and weight in addition to some other anthropometric variables and serum lipid profile of middle-aged adults.

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.

Cord Blood Alkaline Phosphatase as an Indicator of Neonatal Jaundice.

BACKGROUND: Management of hyperbilirubinemia remains a challenge for neonatal medicine because of the risk of neurological complications related to the toxicity of severe hyperbilirubinemia. OBJECTIVES: The purpose of this study was to examine the validity of cord blood alkaline phosphatase level for predicting neonatal hyperbilirubinemia. PATIENTS AND METHODS: Between October and December 2013 a total of 102 healthy term infants born to healthy mothers were studied. Cord blood samples were collected for measurement of alkaline Phosphatase levels immediately after birth. Neonates were followed-up for the emergence of jaundice. Newborns with clinical jaundice were recalled and serum bilirubin levels measured. Appropriate treatment based on serum bilirubin level was performed. Alkaline phosphatase levels between the non-jaundiced and jaundiced treated neonates were compared. RESULTS: The incidence of severe jaundice that required treatment among followed-up neonates was 9.8%. The mean alkaline phosphatase level was 309.09 ± 82.51 IU/L in the non-jaundiced group and 367.80 ± 73.82 IU/L in the severely jaundiced group (P = 0.040). The cutoff value of 314 IU/L was associated with sensitivity 80% and specificity 63% for predicting neonatal hyperbilirubinemia requiring treatment. CONCLUSIONS: The cord blood alkaline phosphatase level can be used as a predictor of severe neonatal jaundice.

Prevalence of permanent and transient congenital hypothyroidism in Babol City -Iran.

AIM: To determine the incidence of transient and permanent hypothyroidism in Babol, Iran. METHODS: The cross sectional study on 10,573 newborns who participated in a thyroid screening program in Babol between 2006 and 2008 was performed. It recalled patients who had been diagnosed in the initial screening program and treated for at least 3 years, discontinued their treatment for 4 weeks and then measured their plasma thyroid hormone concentrations. If their thyroid stimulating hormone (TSH) concentration was greater than 10 m/l they were considered to have permanent CH. T3 uptake, T4 and TSH were measured in venous blood samples. Other information collected and recorded included age, presence of diabetes, birth weight and gestational age at birth. RESULTS: The incidence of transient and permanent hypothyroidism in the studied infants was 5.7 and 20.8 per 10,000, respectively. The incidence of transient hypothyroidism in male and female infants was 16.9 and 24.6 per 10,000, respectively, and of permanent hypothyroidism in male and female infants 7.5 and 3.8 per 10,000, respectively. CONCLUSION: A noteworthy incidence of permanent hypothyroidism in infants found in this study confirms that screening programs need to be continued in our region and that interventions to address the causes of hypothyroidism are necessary.