ORIGINAL_ARTICLE
Frequency of neonatal abstinence syndrome (NAS) and type of the narcotic substance in neonates born from drug addicted mothers
Abstract Background and objective: NAS is a combination of signs and symptoms that due to physical and mental dependency, develops in neonates born from drug addicted mothers. The onset of NAS varies in accordance with the type, amount, frequency and duration of substance used. Because of diverse and unclear pattern of substance abuse in Iranian addicted pregnant mothers in comparison with western countries, this multi-center study has been designed to evaluate NAS in neonates born from drug addicted mothers. Material and method: A cross sectional study was carried out on newborns of narcotic addicted mothers during the first six months of 2008. The newborn’s status and clinical signs were checked by physical examination and scored by the Finnegan scoring system. Results: In this study 100 neonates born from narcotic addicted mothers were examined; the most used narcotic was crack (36%). 60% of neonates showed signs of NAS. The most prevalent signs of NAS were increased muscle tonicity (60%/7), irritability (59%/6) and increased moro reflex (51%/8). Neonates born from crack abusers, in comparison with other drugs, were significantly at risk of NAS (100% vs.87%, p
https://ijn.mums.ac.ir/article_3181_27017d75c55eed961b13da671522c5cd.pdf
2015-02-01
1
5
10.22038/ijn.2015.3181
NAS
Addiction
pregnancy
Fatemeh
Nayeri
fnayeri@tums.ac.ir
1
Neonatologist, Valiasr Hospital NICU, Materno- fetal Neonatal health research center, Tehran University of medical sciences
AUTHOR
Mamak
shariat
mshariat@tums.ac.ir
2
Matherno and child health specialist, Materno- fetal Neonatal health research center, Tehran University of medical sciences
AUTHOR
Majeed
Firozi
mrnhrc@yahoo.com
3
Neonatologist, Lorestan University of medical sciences
AUTHOR
Majeed
Kalani
mfnhrc@tums.ac.ir
4
Neonatologist,Shahid Akbarabadi Hospital, Tehran University of medical sciences
AUTHOR
Bita
Ebrahim
bitaebrahim@yahoo.ca
5
Materno- fetal Neonatal health research center, Tehran University of medical sciences
LEAD_AUTHOR
Hudak ML, Tan RC; Committee on Drugs; Committee on Fetus and Newborn; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012; 129(2):e540-60.
1
Lam SK, To WK, Duthie SJ, Ma HK. Narcotic addiction in pregnancy with adverse maternal and perinatal outcome. Aust N Z J Obstet Gynaecol. 1992; 32(3):216-21.
2
Sweeney PJ, Schwartz RM, Mattis NG, Vohr B. The effect of integrating substance abuse treatment with Prenatal care on birth outcome. J Perinatol. 2000; 20(4):219-24.
3
Lipsitz PJ. Proposed narcotics Withdrawal score for use with newborn infants. A pragmatic evaluation of its efficacy. Clin Pediatr (Phila). 1975; 14(6):592-4.
4
Choo RE, Huestis MA, Schroeder JR, Shin AS, Jones HE. Neonatal abstinence syndrome in Methadone –exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend. 2004; 75(3):253-60.
5
Dysart K, Hsieh HC, Kaltenbach K, Greenspan JS. Sequela of preterm versus term infants born to mothers on a Methadone maintenance Program: differential Course of neonatal abstinence Syndrome. J Perinat Med. 2007; 35(4):344-6.
6
Doberczak TM, Kandall SR, Friedmann P. Relationship between maternal methadone dosage, maternal-neonatal methadone levels, and neonatal withdrawal. Obstet Gynecol. 1993; 81(6):936-40.
7
Lipsitz PJ. Proposed narcotics Withdrawal score for use with newborn infants. A pragmatic evaluation of its efficacy. Clin Pediatr (Phila). 1975; 14(6):592-4.
8
Tenebein M, Casiro OG, Seshia MM, Debooy VD. Neonatal withdrawal from maternal volatile substance abuse. Arch Dis Child Fetal Neonatal Ed. 1996; 74(3): F204–F207.
9
Serane VT, Kurian O. Neonatal abstinence Syndrome. Indian J Pediatr. 2008; 75(9):911-4.
10
Strauss ME, Andresko M, Stryker JC, Wardell JN. Relationship of neonatal withdrawal to maternal methadone dose. Am J Drug Alcohol Abuse. 1976; 3(2):339-45.
11
Dashe JS, Sheffield JS, Olscher DA, Todd SJ, Jackson GL, Wendel GD. Relationship between maternal methadone dosage and neonatal withdrawal. Obstet Gynecol. 2002; 100(6):1244-9.
12
Najari F. The Evaluation of Addiction in Female Addicts Admitted to Detoxification Centers in Tehran during 1384 and 1385. Journal of Medical Council of Islamic Republic of Iran. 2008; 25(4):457-63
13
Creanga AA, Sabel JC, Ko JY, Wasserman CR, Shapiro-Mendoza CK, Taylor P, et al. Maternal Drug Use and Its Effect on Neonates. Obstet Gynecol. 2012; 119(5):924-33.
14
Bläser A, Pulzer F, Knüpfer M, Robel-Tillig E, Vogtmann C, Nickel P, et al. Drug withdrawal in newborns - clinical data of 49 infants with intrauterine drug exposure: what should be done?. Klin Padiatr. 2008; 220(5):308-15.
15
Crocetti MT, Amin DD, Jansson LM. Variability in the evaluation and management of opiate-exposed newborns in Maryland. Clin Pediatr (Phila). 2007; 46(7):632-5.
16
Jansson LM, Dipietro JA, Elko A, Velez M. Maternal vagal tone change in response to methadone is associated with neonatal abstinence syndrome severity in exposed neonate. J Matern Fetal Neonatal Med. 2007; 20(9):677-85.
17
United States Department of Health and Human Services, National Institutes of Health. National Institute on Drug Abuse. National Pregnancy and Health Survey: Drug Use Among Women Delivering Live Births, 1992. ICPSR02835-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-07-31. http://doi.org/ 10.3886/ICPSR02835.v2
18
King JC. Substance abuse in pregnancy a bigger problem than you think. Postgrad Med. 1997; 102(3):135-7, 140-5, 149-50.
19
Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG. 2009; 116(5):665-71.
20
O'Brien CM, Jeffery HE. Sleep deprivation disorganization and Fragmentation during opiate withdrawal in newborns. J Paediatr Child Health. 2002; 38(1):66-71.
21
Fajemirokun-Odudeyi O, Sinha C, Tutty S, Pairaudeau P, Armstrong D, Phillips T, et al. Pregnancy outcome in women who use opiates. Eur J Obstet Gynecol Reprod Biol. 2006; 126(2):170-5.
22
ORIGINAL_ARTICLE
Prophylactic effect of zinc sulphate on hyperbilirubinemia in premature very low birth weight neonates: a randomized clinical trial
Introduction: One of the common problems in neonatal period is jaundice that occurs in the first week of birth in 60% of term and 80% of preterm neonates. In preterm newborn hyperbilirubinaemia is higher, persistent, longer, and more likely to be associated with neurological injury than term neonates. The purpose of this study was to determine Prophylactic effect of zinc sulphate on hyperbilirubinemia in premature very low birth weight neonates. Method and Material: Sixty Newborns who admitted in our NICU which had inclusion criteria were eligible in this trial. Included neonates were randomly placed in two groups (case and control) and before intervention the total serum bilirubin (TSB) was measured at second day. The participant received either 20 mg of zinc sulfate or placebo through NG-tube divided in two doses till day seven of age. Then total and indirect bilirubin was measured at 3ed, 5th and 7th day of life. If any of newborns in duration of hospitalization develop clinical jaundice, after assessment of bilirubin, need for phototherapy was evaluated based on phototherapy and exchange schedule as described by the American Academy of Pediatrics guidelines. The termination point of phototherapy was defined as a bilirubin level less than 50 percent of starting point. After gathering Data, they were analyzed using SPSS software (version 11.5) and T-test, Chi-square and repeated measurement tests. Results: Seventy eight patients enrolled in this trial that 18 cases were excluded and the remaining cases divided into two equal groups (N=30 in each group). Demographic condition was similar in two groups. There were no different between two groups in decreasing total serum bilirubin and duration of phototherapy. Conclusion: This study showed that zinc sulfate has no preventing effective in hyperbilirubinemia in preterm very low birth weight neonates. It has also no effect on duration of phototherapy.
https://ijn.mums.ac.ir/article_3139_deaa3a6e2852064f166401d3fb444296.pdf
2015-02-01
6
10
10.22038/ijn.2015.3139
Jaundice
Premature
zinc
Phototherapy
Ashraf
Mohammadzadeh
mohamadzadeha@mums.ac.ir
1
Professor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
LEAD_AUTHOR
Ahmad shah
Farhat
farhata@mumsa.c.ir
2
Assistant Professor of Neonatology. Neonatal Research Center, Imam Reza hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Abbas
Alizadeh kaseb
alizadeha911@mums.ac.ir
3
Fellowship of Neonatology, Neonatal Research Center, Imam Reza hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Fatemeh
Khorakian
khorakianf@mums.ac.ir
4
Assistant professor of Pediatric Dentistry, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad
Ramezani
ramezanim@mums.ac.ir
5
Pharmaceutical and Biotechnology Research Center, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the newborn. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics.17th ed. Philadelphia: WB Saunders; 2004: p. 562-96.
1
Ambalavarna N, Carlo WA. Jaundice and hyperbilirubinemia. In: Behrman RE, Kliegman RM. Nelson Textbook of Pediatrics: 19th ed. Philadelphia: WB Saunders; 2011: 603-12
2
Maisels MJ. Jaundice. In: MacDonald MG, Mullett MD, Seshia MK. Avery’s Neonatology: Pathophysiology and Management of the Newborn. 6th ed. Philadelphia: Lippincott Williams & Wilkins: 2005;768-846.
3
Kaplan M, Wong RJ, Sibley E, Stevenson DK. Neonatal jaundice and liver disease. In: Martin RJ, Fanaroff A, Walsh MC. Fanaroff and Martin's Neonatal-Perinatal Medicine: 9th ed. Elsevier: 2011; 2:1443-96.
4
Jahnson LH, Brown AK, Bhutani VK. System-based approach to management of neonatal Jaundice and prevention of kernicterus. Indin J Pediatr. 2002; 140: 396-403.
5
Dennery PA. Pharmacological interventions for the treatment of neonatal Jaundice. Semin Neonatal. 2002; 7: 111-19
6
Bourget P, Broise I, Quinquis-Desmaris V, Gabilan JC. Pharmacokinetics of colofibratein jaundiced newborn infants at term. Arch Pediatr. 1995; 2:722-8.
7
Kawade N, Onishi S. The prenatal and postnatal development of UDP-glucuronyltransferase activity toward bilirubin and the effect of premature birth on this activity in the human liver. Biochem J. 1981; 196: 257-60
8
Mohammadzadeh A, Farhat A, Esmaeli H, Javanrouh N. Prophylactic effect of clofibrate on hyperbilirubinemia in very low birth weight twins. British Journal of Pharmaceutical Research.2014; 4:818-25
9
Mohammadzade A, Farhat AS, Amiri R, Esmaely H, Bagheri S. Treatment Effect of Clofibrate in Jaundiced Low Birth Weight Neonates. International J Hematol Oncol. 2009; 19:100-5
10
Mohammadzadeh A, Farhat AS, Iranpoor R. Effect of clofibrate in healthy full – term Jaundice newborn. The Indian Journal of Pediatrics. 2005; 72:123-6.
11
Mohammadzadeh A, Farhat AS, Jafarzadeh M, Mirzarahimi M, Esmaeli H, Amiri R. Prophylactic effect of clofibrate in low birth weight neonates hyperbilirubinemia. Journal of Chinese Clinical Medicine; 2008, 3:140-4
12
Odell GB, Gutchetr GR, Whitington PF, Yang G. Enteral administration of agar as an effective adjunct to phototherapy of neonatal hyperbilirubinemia. Pediatr Res. 1983; 17:810–4.
13
Mendez-Sanchez N, Roldan-Valadez E, Flores MA, Cardenas-Vazquez R, Uribe M. Zinc salts precipitate unconjugated bilirubin in vitro and inhibit enterohepatic cycling of bilirubin in hamsters. Eur J Clin Invest. 2001; 31:773–80.
14
Mendez-Sanchez N, Martinez M, Gonzalez V, Roldan-Valadez E, Flores MA, Uriebe M. Zinc Sulphate inhibits the enterohepatic circulation of unconjugated bilirubin in subjects with Gilbert syndrome. Ann Hepatol. 2002; 1: 40-3.
15
Lathe GH, Ruthven CR. Factors affecting the rate of coupling of bilirubin and conjugated bilirubin in the van den bergh reaction. J Clin Pathol.1958; 11:155-61.
16
Rana N, Mishra S, Bhatnagar S, Paul V, Deorari AK, Agarwal R. Efficacy of zinc in reducing hyperbilirubinemia among at-risk neonates: a randomized, double-blind, placebo-controlled trial. Indian J Pediatr. 2011; 78:1073-8.
17
Patton DR, Sukadi A. Effect of oral zinc on hyperbilirubinemia in full term neonates. Paediatr Indones. 2011; 51:107-10
18
Maamouri G, Boskabadi H, Mafinejad S, Bozorgnia Y, Khakshur A. Efficacy of Oral Zinc Sulfate Intake in Prevention of Neonatal Jaundice. Iranian Journal of Neonatology. 2013; 4(4): 11-6.
19
Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics. 2002; 109:898–903.
20
Bahl R, Bhandari N, Saksena M, Strand T, Kumar GT, Bhan MK, et al. Efficacy of zinc fortified oral rehydration solution in 6- to 35-month-old children with acute diarrhea. J Pediatr. 2002; 141:677–82.
21
Fischer C, Harvey P. Low risks of adverse effects from zinc supplementation. The USAID Micronutrient Program; 2005.
22
Vitek L, Munchova L, Zelenka J, Zadinova M, Malina J. The effect of zinc salts on serum bilirubin levels in hyperbilirubinemic rats. J Pediatr Gastroenterol Nutr. 2005; 4:135–40.
23
ORIGINAL_ARTICLE
Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism
Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases.Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province.The following clinical features were used as inclusion criteria for investigation of the patients.Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.Result: Organic acidemia with 40 cases (42%) was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%), 15 patient had classic galactosemia(GALT
https://ijn.mums.ac.ir/article_3184_0b70ccbb89d048aed3add100ca9955d6.pdf
2015-02-01
11
14
10.22038/ijn.2015.3184
metabolic disorders
Screening
Fars
Narges
Pishva
pishvan@sums.ac.ir
1
Neonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
AUTHOR
Alie
Mirzaee
mirzaia@sums.ac.ir
2
Neonatlaogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
LEAD_AUTHOR
Zohre
Karamizade
z karamizade@yahoo.com
3
Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
AUTHOR
Shahnaz
Pourarian
porarish@sums.ac.ir
4
Neonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
AUTHOR
Fariba
Hemmati
hemmati@sums.ac.ir
5
Neonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
AUTHOR
Mostajab
Razvi
razavimo@sums.ac.ir
6
Neonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran
AUTHOR
Forough
Saki
sakif@sums.ac.ir
7
Neonatalogy Research Center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Arthur B Zinn. Inborn Error of Metabolism. FANARROF and MARTIN. Neonatal- Perinatal medicine, 2011; 1621-1677.
1
Metabolic crises: Textbook of Critical Care, 5th ed. (web site) mhtml: file://I:MD Cosult Fink Textbook of Critical Care .mht
2
Sule U. Cataltep and Harvey L. Levy. Inborn Error of Metabolism. Cloherty, Manual of Neonatal Care. 2007:558-573.
3
Nagaraja D, Mamatha SN, De T, Christopher R. Screening for inborn errors of metabolism using automated electrospray tandem mass spectrometry: study in high-risk Indian population. Clinical biochemistry. 2010; 43(6):581-8.
4
Golbahar J, Honardar Z. Selective Screening of Phenylketonuria, Tyrosinemia and Maple Syrup Urine Disease in Southern Iran. Iran J Med Sci. 2002; 27(3):134.
5
Satwani H, Raza J, Hanai J, Nomachi S. Prevalence of selected disorders of inborn errors of metabolism in suspected cases at a Tertiary Care Hospital in Karachi. JPMA. 2009; 59:815-9.
6
Elsobky E, Elsayed SM. Extended metabolic screen in sick neonates and children. Egypt J Med Hum Genet. 2004; 5: 1-7.
7
Coelho JC, Wajner M, Burin MG, Vargas CR, Giugliani R. Selective screening of 10,000 high-risk Brazilian patients for the detection of inborn errors of metabolism. Eur J Pediatr. 1997; 156(8):650-4.
8
Wajner M, Coelho DDM, Ingrassia R, Oliveira ABD, Busanello ENB, Raymond K, et al. Selective screening for organic acidemias by urine organic acid GC–MS analysis in Brazil: Fifteen-year experience. Clinica Chimica Acta. 2009; 400(1):77-81.
9
10. Huang X, Yang L, Tong F, Yang R, Zhao Z. Screening for inborn errors of metabolism in high-risk children: a 3-year pilot study in Zhejiang Province, China. BMC Pediatrics. 2012; 12(1):18.
10
11. Lee Jy, Chiong MA , Strada SC, Ctiongco-De la paz EM, Silao CL, Padilla CD. Maple Syrup Urine disease (MSUD) -Clinical profile of 47 Filipino patients; J Inherit Metab Dis .2008 Dec:31 Supp 2:581-5.
11
12. Saadat M, Ansari-Lari M, Farhud DD. Consanguineous marriage in Iran. Ann Hum Biol. 2004; 31:263-69 .
12
ORIGINAL_ARTICLE
Equity in health: Comparison of children health indices in poor and rich zones
Background: Although many efforts made for the advancement of medical science, it is distributed inequitably despite of all existing financial and human resources facilities. Children as the most important and vulnerable groups of society are influenced by these inequities. The Objective of this study is comparison of children health indices in rich and poor rural zones in Mashhad/Iran. Methods: This is a cross sectional study, We considered a poor (Andad) and a rich (Toos) zones to compared for some health indices. We compared some indices like: maternal mortality rate (MMR), neonatal mortality rate (NMR), children under 1 (IMR) and under 5 years mortality rate (U5MR), low birth weight prevalence (LBW), exclusive breast feeding (EBF) and fertility rate. Data collected with check list and analyzed by SPSS-11.5. Results: in our study in two poor (Andad) and rich (Toos) zones we have: Neonatal mortality rate (zero versus 5.46) (P=0.00); breast feeding indices like exclusive breast feeding indices up to 6 month (54.4% versus 79%) (P=0.01); have significant differences between two zones. But fertility rate indices like total fertility rate (2.09 versus 1.95) (p=0.98) and Mean children mortality rates during 2011-2013 like children less than 5 years mortality (18.65 versus 12.13 per thousand live birth) (p=0.29) does not have statistically significant differences. Conclusion: This study shows that health indices in rich and poor zones, have significant differences
https://ijn.mums.ac.ir/article_3933_0e0b1d0c9dc5883f87122d706d0c68b5.pdf
2015-02-01
15
18
10.22038/ijn.2015.3933
children mortality rate
neonatal mortality rate
equity in health
Reza
Saeidi
saeedir@mums.ac.ir
1
Associate Professor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Vahid
Sadeghi
sadeghiv851@mums.ac.ir
2
General physician, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Bagheri lankarani K, An abstract of equality in health system. 2010.
1
U.N. Development Program Human Development Indicators, The Equality Trust. 2011.
2
Gordon D, Measuring Child Poverty and Deprivation. UNICEF Global Study on Child Poverty and Disparities Workshop, 2008.
3
Ministry of health and medical educations, collections of forms and instructions for gathering information about equality in health indexes according to entry systems 2012.
4
Hattersley L, Expectation of life by social class. In: Drever F, Whitehead M, editors. Health Inequalities: decennial supplement. ONS Series DS no. 15, 1997: p. 73-82.
5
Scottish Executive Health Department, Scottish Executive Health Department Performance assessment framework 2003/04. 2003.
6
Department of Health Technical Briefing, Health inequalities: national targets on infant mortality and life expectancy. 2002.
7
Movahhedi M, Hejazizade B, and Rahihmi A, Trend and geographical inequality pattern of main health indicators in rural population of Iran. Hakim Research Journal, 2008. 10(4): p. 1-10.
8
minister's consultant and office headquarters advisor of Iran's ministry of health and medical education, letter No.172418. 2013.
9
10. World bank, world development report: A Better Investment Climate for Everyone. 2005.
10
11. Ghavi A, et al., Survey associated maternal Factors with low-weight infants in Women referred to health centers in Rasht. Holistic Nursing and Midwifery, 2011. 21(2): p. 35-39.
11
12. Ministry of health and medical educations, An overview of national breast feeding propagation program. 2012.
12
ORIGINAL_ARTICLE
Epidemiologic features of early onset sepsis in neonatal ward of Shabih Khani hospital in Kashan
Background and objective: Neonatal sepsis is defined as presence of clinical signs accompanied by positive blood culture in newborns less than one month of age. Sepsis is a common cause of hospital admission in neonates, and it is known as one of the main causes of mortality among them, not only in developed countries but in developing ones. Delay in diagnosis and appropriate antibiotic therapy would result in death. The aim of this study is to find the main pathogens of sepsis and evaluate sensitivity changes of organisms to antibiotics in comparison with the past. Method: In this descriptive study, 104 (files of) neonates, admitted to the neonatal ward of Shabih Khani Hospital, with positive blood culture over a 24-month period ( 2005-2007) were assessed. Data were extracted for analysis. Results: Over this 24-month study on 104 neonates with sepsis, the most common organisms included flavobacterium 43.3% , pseudomonas 33.3%, coagulase negative staphylococcus 17.3%, coagulase positive staphylococcus 5.9% followed by enterobacter , E.coli, beta-haemolytic streptococcus, klebsiella, diphtheriod and lysteria. Conclusion: In this study Flavobacterium is found to be the most common organism for early sepsis. Although infection with flavobacterium is rare, its rate of mortality is high and it is resistant to majority of common antibiotics. Therefore, early diagnosis and appropriate antibiotic prescription helps reduce its complications.
https://ijn.mums.ac.ir/article_3934_bbc66bd086d8ec9074b03efb0ea4ecbb.pdf
2015-02-01
19
23
10.22038/ijn.2015.3934
Early onset sepsis
Neonatal sepsis
neonate
Ziba
Mosayebi
mosayebi ir@gmail.com
1
Neonatologist,Tehran medical university
AUTHOR
Amir Hossein
Movahedian
movahedian. ah@gmail.com
2
pediatrics cardiologist,Kashan medical university
AUTHOR
Bita
Ebrahim
mfnhrc@tums.ac.ir
3
Materno- fetal Neonatal health research center, Tehran University of medical sciences
LEAD_AUTHOR
Polin RA, Papile LA, Baley JE, Bhutani VK, Carlo WA, Cummings J, et al. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012; 129:1006-15.
1
Lukacs SL, Schrag SJ. Clinical Sepsis in Neonates and Young Infants, United States, 1988-2006. J Pediatr.2012; 160: 960-5.
2
Movahedian AH, Moniri R, Mosayebi Z. Bacterial Culture of Neonatal Sepsis. Iranian J Publ Health. 2006; 35:84-9.
3
Hofer N, Müller W, ReschB. The neonate presenting with temperature symptoms: Role in the diagnosis of early onset sepsis. Pediatr Int. 2012 Feb 2.
4
Klinger G, Levy I, Sirota L, Boyko V, Reichman B, Lerner-Geva L. Epidemiology and risk factors for early onset sepsis among very low birthweight infants. Am J Obstetrics. 2009; 201: 38-e1.
5
Robinson DT, Kumar P, Cadichon SB. Neonatal Sepsis in the Emergency Department. Clin Ped Emerg Med. 2008; 9:160-8.
6
Kliegman RM, Stanton B, Geme JS, Schor NF, Behrman RE. Nelson text book of pediatrics. 5th ed. Netherlands: Elsevier- Health Sciences Division; 2006: 349-352.
7
Tekerekoglu MS, Durmaz R, Ayan M, Cizmeci Z, Akinci A. Analysis of an outbreak due to chryseobacteriummeningosepticum in neonatal intensive care unit. New Microbial. 2003; 26:57-63.
8
Mosayebi ZIBA, Movahedian A, Moniri R. Profile of Bacterial Sepsis IN Neonates From Kashan in Iran. J Infect Dis Antimicrob Agents. 2003; 20:97-102.
9
Karthilkeyan G, Premkumar K. Neonatal sepsis: staphylococcus aureus the predominant pathogent. Indian l pediatr. 2001; 68:715-7.
10
Morioka I, Morikawa S, Miwa A, Minami H, Yoshii K, Kugo M, et al. Culture-proven neonatal sepsis in Japanese neonatal care units in 2006-2008. Neonatology. 2012; 102:75-80.
11
Waheed M, Laeeq A, Maqbool S. The etiology of neonatal sepsis and pattern's of Antibiotic resistance. J Coll Physicians Surg Pak. 2003; 13:449-52.
12
Mulgua J, Nakaketo MK, kigulis S, Kaddu–Mulindwa DH. Aetiology risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in mulago hospital. Afr Health Sci. 2006; 6:120-6.
13
Rahman S, Hameed A, Roghani MT, Ullah Z. Multi drug resistant neonatal sepsis in pishawar Pakistan. Arch Dis Child Fetal Neonatal. 2002; 87: F52-4.
14
Mosayebi Z, Movahedian AH, Soori T. Flavobacterium sepsis outbreak due to contaminated distilled water in a neonatal intensive care unit. J Hosp Infect. 2011; 78:214-5.
15
Pokrywka M, Viazanko K, Medvick J, Knabe S, McCool S, William Pasculle A, Dowling JN. A flavobacterium meningosepticum outbreak among intensive care patients. Am J Infect Control. 1993; 21:139-45.
16
Zulaika A. Neonatal bacterial septicaemia at the mount hope woman's hospital, trinided. Ann Trop Pedit. 2006; 24:41-4.
17
Elbashier AM, Malik AG, Khot AP. MD Blood stream infections, Micro organism Risk factors and mortality rate in Qatif central hospital. Ann Saudi Med. 1998;18:176-80.
18
Weber MW, Carlin JB, Gatchalian S, Lehmann D, Muhe L, Mulholland EK, et al. Predictors of neonatal sepsis in developing countries. Pediater Infect Dis J. 2003; 22:711-7.
19
Trotman H, Bell Y, Neonatal sepsis in very low birth weight infants at the university Hospital of the west indies. West Indian Med J. 2006; 55:165-9.
20
Ojukwu JU, Abonyi LE, Ugwu J, Orji IK. Neonatal septicaemia in high risk babies in south – Eastern Nigeria. J Perinat Med. 2006; 34:166-72.
21
Michael w, et al, Atypical chryseobacteriummeningosepticom and Meningitis and sepsis in newborns and the immunocompromised, Taiwan, 1996;481-486.
22
ORIGINAL_ARTICLE
Evaluation of Nutritional Status in a Teaching Hospital Neonatal Intensive Care Unit
Background:Extrauterine growth restriction remains a common and serious problem in newborns especially who are small, immature, and critically ill. Very low birth weight infants (VLBW) had 97% and 40% growth failure at 36 weeks and 18-22 months post-conceptual age respectively. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may cause significant growth delay or morbidity in VLBW infants. The purpose of this study was to evaluate current nutritional status in the neonatal intensive care unit in a teaching hospital.Methods:During this prospective observational study, the nutritional status of 100 consecutive critically ill neonates were evaluated by anthropometric and biochemical parameters in a tertiary neonatal intensive care unit. Their demographic characteristics (weight, height and head circumference), energy source (dextrose and lipid) and protein were recorded in the first, 5th, 10th, 15th and 20th days of admission and blood samples were obtained to measure serum albumin and prealbumin. The amount of calorie and protein were calculated for all of preterm and term neonates and compared to standard means separately. Results: The calorie and amino acids did not meet in the majority of the preterm and term neonates and mean daily parenteral calorie intake was 30% or lower than daily requirements based on neonates’ weight. Mortality rate was significantly higher in neonates with lower serum albumin and severity of malnutrition but not with serum prealbumin concentration. Conclusion: Infants were studied did not receive their whole of daily calorie and protein requirements and it is recommended early and enough administration of calorie source (dextrose, lipids) and amino acids. Prealbumin was a more benefit biochemical parameter than albumin to evaluate short term nutrition especially in critically ill patients.
https://ijn.mums.ac.ir/article_3138_d07c1cf8c23245cdfbd0c858e480530f.pdf
2015-02-01
24
29
10.22038/ijn.2015.3138
Infants
NICU
Malnutrition
Albumin
Prealbumin
Mohammadreza
Rafati
mrrafati@mazums.ac.ir
1
Department of Clinical Pharmacy, College of Pharmacy, Mazandaran University of Medical Sciences
LEAD_AUTHOR
Maryam
Nakhshab
pegahch@yahoo.com
2
Department of pediatrics, School of Medicine,Mazandaran University of Medical Sciences
AUTHOR
Vagihe
Ghaffari
vghaffari@yahoo.com
3
Department of pediatrics, School of Medicine,Mazandaran University of Medical Sciences
AUTHOR
Mohammadreza
Mahdavi
mahdavi899@gmail.com
4
Department of medical technology, School of Medicine, Mazandaran University of Medical Sciences
AUTHOR
Mustafa
Sharifi
amir11aina@yahoo.com
5
Mazandaran University of Medical Sciences
AUTHOR
Skillman HE, Wischmeyer PE. Nutrition therapy in critically ill infants and children. JPEN J Parenter Enteral Nutr. 2008; 32:520-34.
1
López-Herce Cid J, Sánchez Sánchez C, Mencía Bartolomé S, Santiago Lozano MJ, Carrillo Alvarez A, Bellón Cano JM. Energy expenditure in critically ill children: Correlation with clinical characteristics, caloric intake, and predictive equations. An Pediatr (Barc). 2007; 66:229-39.
2
López-Herce Cid J. Nutrition in the critically ill child. An Pediatr (Barc). 2009; 71:1-4.
3
Delgado AF, Okay TS, Leone C, Nichols B, Del Negro GM, Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics (Sao Paulo). 2008; 63:357-62.
4
Botrán M, López-Herce J, Mencía S, Urbano J, Solana MJ, García A, et al. Relationship between energy expenditure, nutritional status and clinical severity before starting enteral nutrition in critically ill children. Br J Nutr. 2011; 105:731-7.
5
Zamberlan P, Delgado AF, Leone C, Feferbaum R, Okay TS. Nutrition therapy in a pediatric intensive care unit: Indications, monitoring and complications. JPEN J Parenter Enteral Nutr. 2011; 35:523-9.
6
Hulst J, Joostenb K, Zimmermannb L, Hop W, van Buuren S, Büller H, et al. Malnutrition in critically ill children: from admission to 6 months after discharge. Clin Nutr. 2004; 23:223-32.
7
Cooke RJ, Embleton ND. Feeding issues en preterm infants. Arch Dis Child Fetal Neonatal Ed. 2000; 83:F215-8.
8
Ibrahim HM, Jeroudi MA, Baier RJ, Dhanireddy R, Krouskop RW. Aggressive early total parenteral nutrition in low-birth-weight infants. J Perinatol. 2004; 24:482-6.
9
Lucas A, Morley R, Cole TJ. Randomized trial of early diet in preterm infants and later intelligence quotient. BMJ. 1998; 317:1481-7.
10
Latal-Hajnal B, von Siebenthal K, Kovari H, Bucher HU, Largo RH. Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr. 2003; 143:163-70.
11
Ho MY, Yen YH, Hsieh MC, Chen HY, Chien SC, Hus-Lee SM. Early versus late nutrition support in premature neonates with respiratory distress syndrome. Nutrition. 2003; 19:257-60.
12
Dusick AM, Pointdexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up. Semin Perinatol. 2003; 27:302-10.
13
Denne SC, Poindexter BB. Evidence supporting early nutritional support with parenteral amino acid infusion. Semin Perinatol. 2007; 31:56-60.
14
Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003; 111:986-90.
15
Hulzebos CV, Sauer PJ. Energy requirements. Semin Fetal Neonatal Med. 2007; 12:2-10.
16
Schutzman DL, Porat R, Salvador A, Janeczko M. Neonatal nutrition: a brief review. World J Pediatr. 2008; 4:248-53.
17
American Academy of Pediatrics Committee on Nutrition: Nutritional needs of low-birth-weight infants. Pediatrics. 1985; 75:976-86.
18
American Academy of Pediatrics Committee on Nutrition: Nutritional needs of low-birth weight infants. 1985; Pediatrics 76:976-986.
19
Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypogylcaemia. BMJ. 1988; 297:1304-8.
20
Biesalski HK, Bischoff SC, Boehles HJ, Muehlhoefer A; Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Water, electrolytes, vitamins and trace elements - Guidelines on Parenteral Nutrition, Chapter 7. Ger Med Sci. 2009; 7:21.
21
Lucas A, Morley R, Cole TJ. Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ. 1998; 317:1481-7.
22
Simmer K, Rao SC. Early introduction of lipids to parenterally-fed preterm infants. Cochrane Database Syst Rev. 2005; 2:CD005256.
23
te Braake FW, van den Akker CH, Wattimena DJ, Huijmans JG, van Goudoever JB. Amino acid administration to premature infants directly after birth. J Pediatr. 2005; 147:457-61.
24
Thureen PJ, Anderson AH, Baron KA. Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res. 2003; 53:24-32.
25
Sankaran K, Berscheid B, Verma V, Zakhary G, Tan L. An evaluation of total parenteral nutrition using Vamin and Aminosyn as protein base in critically ill preterm infants. JPEN J Parenter Enteral Nutr. 1985; 9:439-42.
26
Yip YY, Lim AK, R J, Tan KL. A multivariate analysis of factors predictive of parenteral nutrition- related cholestasis (TPN cholestasis) in VLBW infants. J Singapore Paediatr Soc. 1990; 32:144-8.
27
Grover A, Khashu M, Mukherjee A, Kairamkonda V. Iatrogenic Malnutrition in Neonatal Intensive Care Units: Urgent Need to Modify Practice. JPEN J Parenter Enteral Nutr. 2008; 32:140-4.
28
Acosta JA. Valoración del Estado Nutricional en el Paciente Grave. Libro Electrónico Medicina Intensiva; Madrid, Spain: 2008. [Accessed on 16 November 2011]. Available online: http://intensivos.uninet.edu/06/0601.html.
29
Sánchez C, López-Herce J, García C, Rupérez M, García E. The effect of enteral nutrition on nutritional status in the critically ill child. Clinical Intensive Care. 2005; 16:71-8.
30
Botrán M, López-Herce J, Mencía S, Urbano J, Solana MJ, García A. Enteral nutrition in the critically ill child: Comparison of standard and protein-enrich diets. J Pediatr. 2011; 159:27-32.
31
Yoder MC, Anderson DC, Gopalakrishna GS, Douglas SD, Polin RA. Comparison of serum fibronectin, prealbumin and albumin concentrations during nutritional repletion in protein-calorie malnourish infants. J Pediatr Gastroenterol Nutr. 1987; 6:84-8.
32
Briassoulis G, Zavras N, Hatzis T. Malnutrition nutritional indices, and early enteral feeding in critically ill children. Nutrition. 2001; 17:548-57.
33
Delgado AF, Kimura HM, Cardoso AL, Uehara D, Carrazza FR. Nutritional follow up of critically ill infants receiving short term parenteral nutrition. Rev Hosp Clin Fac Med Sao Paulo. 2000; 55:3-8.
34
Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003; 237:319-34.
35
Kenny SE, Pierro A, Isherwood D, Donnell SC, Van Saene HK, Lloyd DA. Hypoalbuminaemia in surgical neonates receiving parenteral nutrition. J Pediatr Surg. 1995; 30:454-7.
36
Atkinson SD, Tuggle DW, Tunell WP. Hypoalbuminemia may predispose infants to necrotizing enterocolitis. J Pediatr Surg. 1989; 24:674-6.
37
Wong CS, Hingorani S, Gillen DL, Sherrard DJ, Watkins SL, Brandt JR, et al. Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease. Kidney Int. 2002; 61:630-7.
38
Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby SM, et al. Hypoalbuminaemia in critically ill children: incidence, prognosis, and influence on the anion gap. Arch Dis Child. 2003; 88:419-22.
39
ORIGINAL_ARTICLE
Predicting Factors of INSURE Failure in Low Birth Weight Neonates with RDS; A Logistic Regression Model
Background:Respiratory Distress syndrome is the most common respiratory disease in premature neonate and the most important cause of death among them. We aimed to investigate factors to predict successful or failure of INSURE method as a therapeutic method of RDS.Methods:In a cohort study,45 neonates with diagnosed RDS and birth weight lower than 1500g were included and they underwent INSURE followed by NCPAP(Nasal Continuous Positive Airway Pressure). The patients were divided into failure or successful groups and factors which can predict success of INSURE were investigated by logistic regression in SPSS 16th version.Results:29 and16 neonates were observed in successful and failure groups, respectively. Birth weight was the only variable with significant difference between two groups (P=0.002). Finally logistic regression test showed that birth weight is only predicting factor for success (P: 0.001, EXP[β]: 0.009, CI [95%]: 1.003-0.014) and mortality (P: 0.029, EXP[β]: 0.993, CI [95%]: 0.987-0.999) of neonates treated with INSURE method.Conclusion:Predicting factors which affect on success rate of INSURE can be useful for treating and reducing charge of neonate with RDS and the birth weight is one of the effective factor on INSURE Success in this study.
https://ijn.mums.ac.ir/article_3935_3566ea09a99a425c786526426ea5f078.pdf
2015-02-01
30
34
10.22038/ijn.2015.3935
Respiratory Distress Syndrome (RDS)
Intubation-Surfactant-Extubation (INSURE)
Nasal continuous positive airway pressure (NCPAP)
Surfactant
Bita
Najafian
dr.najafian@yahoo.com
1
Assistant Professor, Pediatrics Department, Faculty of Medicine, Baqiyatallah University of Medical Science, Tehran, Iran
AUTHOR
Aminsaburi
Aminsaburi
aminsaburi@yahoo.com
2
Baqiyatallah university of medical sciences
LEAD_AUTHOR
Seyyed Hassan
Fakhraei
md.researcher@yahoo.com
3
Assistant Professor, Pediatrics Department, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
AUTHOR
Abolfazl
afjeh
naslesevomy@yahoo.com
4
Assistant Professor, Pediatrics Department, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
AUTHOR
Fatemeh
Eghbal
naslesevomy@gmail.com
5
Pediatrics Department, Faculty of Medicine, Birjand University of Medical Science, Tehran, Iran
AUTHOR
Reza
Noroozian
noroozian.reza@gmail.com
6
Students Research Committee, Baqiyatallah University of Medical Science, Tehran, Iran
AUTHOR
Fanaroff AA, Martom RH. Neonatal Perinatal medicine: diseases of the fetus and infant. 7th ed. St Louis, USA: Mosby company; 2002; pp: 1097-8.
1
Sweet D, Bevilacqua J, Carnielli V, Greisen G, Plavka R, Saugstad OD, et al. European Vonsensus guidelines on the management meonatal respiratory distress syndrome. J Perinat Med. 2007; 35:175-86.
2
Jobe AH, Ikegmi M. Biology of surfavtant. Clin Perinatol. 2001; 28:655-69.
3
Henderson-Smart DJ, Wilkinson A, Raynes-Greenow CH. Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease. Cochrane Database Syst Rev. 2002; 4:CD002770.
4
Stevens TP, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for RDS. Cochrane Database Syst Rev. 2002; 2:CD003063.
5
Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A, et al. Nasal continuous positive airway pressure and earlysurfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics. 1999; 103:E24.
6
Alba J, Agarwal R, Hegyi T, Hiatt IM. Efficacy of surfactant therapy in infants managed with CPAP. Pediatr Pulmonol. 1995; 20:172-6.
7
Mandy GT, Moise AA, Smith EO, Hansen TN. Endotracheal continuous positive airway pressure after rescue surfactant therapy. J Perinatol. 1998; 18:444-8.
8
Habeman B, Shankaram S, Sterenson DK. Dose surfactant (S) and immediate extubtion to nasl continuos positive airway pressure (sp ap) reduce use of Mechanical ventilation. Pediatr Res. 2002;51:349.
9
Soll RF, Conner JM, Howard D. Early surfactant replacement in spontaneously breathing premature infant with RDS. Pediatr Res. 2003;53:312.
10
Cherif A, Hachani C, Khrouf N. F Factors associated with INSURE method failure in preterm infants with respiratory distress syndrome. Internet J Pediatr Neonatol. 2008; 8(1).
11
Andersen T, Holm HS, Kamper J. Surfactant treatment of newborn infants receiving continuous positive airway pressure treatment. Ugeskr Laeger. 2006;168:3723-7.
12
Reininger A, Khalak R, Kendig JW, Ryan RM, Stevens TP, Reubens L, et al. Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: arandomized controlled trial. J Perinatol. 2005; 25:703-8.
13
Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, et al. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics. 2009; 123:137-42.
14
Cherif A, Hachani C, Khrouf N. Risk factors of the failure of surfactant treatment by transient intubation during nasal continuous positive airway pressure in preterm infants. Am J Perinatol. 2008; 25:647-52.
15
Gutbrod T, Wolke D, Soehne B, Ohrt B, Riegel K. Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison. Arch Dis Child Fetal Neonatal Ed. 2000; 82:F208-14.
16
Torrance HL, Mulder EJ, Brouwers HA, van Bel F, Visser GH. Respiratory outcome in preterm small for gestational age fetuses with or without abnormal umbilical artery Doppler and/or maternal hypertension. J Matern Fetal Neonatal Med. 2007; 20:613-21.
17
Dani C, Corsini I, Poggi C. Risk factors for intubation-surfactant-extubation (INSURE) failure and multiple INSURE strategy inpreterm infants. Early Hum Dev. 2012; 88:S3-4.
18
Afjeh SA, Sabzehei MK. The INSURE method in VLBW preterm infant with RDS. Pajoohandeh Journal. 2010; 15:199-203.
19
ORIGINAL_ARTICLE
Petechial Hemorrhage: A clinical diagnosis of neonatal Thrombocytopenia and sepsis
A preterm female baby with birth weight of 1.5kg was referred to our hospital on day 6 for difficulty in breathing. Baby was admitted at birth for respiratory distress and feed intolerance to other hospital and in view of clinical deterioration baby was referred. Baby had thrombocytopenia with platelets counts of 11000/ mm3 and high CRP titer. Baby had petechial haemorrhagic spots all over the body with hepatosplenomegaly and sclerema (figure 1,2,3). Baby further platelets counts were 3000, 43000, 67000 and then normal. Baby was managed with antibiotics and platelets transfusion. Gradually baby counts improved and petechial spots disappeared. DiscussionNeonatal Sepsis is a common complication in the neonatal intensive care unit. It is most common in the smallest and most premature infants in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is the common manifestation of neonatal sepsis in sick babies(1). The manifestation can be seen in newborn as petechial spots over the body with predominance over chest and abdomen(2).Thrombocytopenia is seen in 18% to 35% of NICU patients, and in 73% of extremely low birth weight (ELBW) infants(3). Bacterial,fungal and viral infection causes thrombocytopenia. Infection causes damage to vascular endothelium which increases the destruction of platelets and there removal by reticuloendothelial system(4)
https://ijn.mums.ac.ir/article_3179_130780b43fc8f7a0156412caa5dbaaa1.pdf
2015-02-01
35
36
10.22038/ijn.2015.3179
Petechial Hemorrhage
Neonatal Thrombocytopenia
Neonatal sepsis
Deepak
sharma
dr.deepak.rohtak@gmail.com
1
Fernandez Hospital ,ooposite OLD MLA quarters
LEAD_AUTHOR
Srinivas
Murki
dr.deepak.rohtak1@gmail.com
2
Fernandez Hospital,
AUTHOR
Tejo
Pratap
dr.deepak.academic@gmail.com
3
Fernandez Hospital Hyderabad
AUTHOR
Lee KH, Hui KP, Tan WC. Thrombocytopenia in sepsis: a predictor of mortality in the intensive care unit. Singapore Med J. 1993; 34:245-6.
1
Sinha ND, Mukherjee AK. Septicemia in neonates and early infancy. Indian J Pediatr. 1986; 53:243-56.
2
Reidler GF, Straub PW, Frick PG. Thrombocytopenia in septicemia. A clinical study for the evaluation of its incidence and diagnostic value. Helv Med Acta. 1971; 36:23-38.
3
Thorne KJ, Oliver RC, MacIntyre DE, Gordon JL. Endotoxin-induced platelet aggregation and secretion changes in plasma membrane proteins. J Cell Sci. 1977; 28:225-36.
4
ORIGINAL_ARTICLE
Octreotide for the Management of Chylothorax in newborns, case report
Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT) or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.
https://ijn.mums.ac.ir/article_3936_1f2eac090fde8d40bf66671af63f78df.pdf
2015-02-01
37
39
10.22038/ijn.2015.3936
Octreotide
Chylothorax
Newborns
Reza
Saeidi
saeedir@mums.ac.ir
1
Assistant Professor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Shadi
Nourizadeh
2
Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Shih YT, Su PH, Chen JY, Lee IC, Hu JM, Chang HP. Common Etiologies of Neonatal Pleural Effusion. Pediatr Neonatol. 2011; 52(5):251-5.
1
Roehr CC, Jung A, Proquitté H, Blankenstein O, Hammer H, Lakhoo K, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006; 32(5):650-7.
2
Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg. 2000; 66(12):1165-7.
3
Cheung Y, Leung MP, Yip M. Octreotide for treatment of postoperative chylothorax. J Pediatr. 2001; 139(1):157-9.
4
Octreotide acetate. Drug facts and comparisons. Efacts [online] 2004; Available from Wolters Kluwer Health, Inc. Accessed August 4 2004
5
Sandostatin prescribing information. Novartis Pharmaceuticals Corp., September 2002.
6
Pratap U, Slavik Z, Ofoe VD, Onuzo O, Franklin RC. Octreotide to treat postoperative chylothorax after cardiac operations in children. Ann Thorac Surg. 2001; 72(5):1740-2.
7
Rosti L, Bini RM, Chessa M, Butera G, Drago M, Carminati M. The effectiveness of octreotide in the treatment of post-operative chylothorax. Eur J Pediatr. 2002; 161(3):149-50.
8
Ibrahim A, Dammas AS. Congenital neonatal chylothorax with hydrops fetalis treated with octreotide. Sudan J Paediatr 2013; 13(1):43-8.
9
Pessotti CF, Jatene IB, Buononato PE, Elias PF, Pinto AC, Kok MF. Use of octreotide in the treatment of chylothorax and chyloperitoneum. Arq Bras Cardiol. 2011; 97(2):e33-6.
10
Sivasli E, Dogru D, Aslan AT, Yurdakok M, Tekinalp G. Spontaneous Neonatal Chylothorax Treated with Octreotide in Turkey: A Case Report. J Perinatol. 2004; 24(4):261-2.
11
Saeidi R, Tafazoli M, Gholami Robatsangi M. Kangaroo mother care for infantile colic: a randomized clinical trial. Tehran University Medical Journal 2010: 2333-9721 12. Nagendra Monangi. Congenital Chylothorax. Journal of Obstetric, Gynecologic, & Neonatal Nursing; 2012: 41(1):181-182
12
14. Saeidi R, Asnaashari Z, Amirnejad M, Esmaeili H, Robatsangi M. Use of “Kangaroo Care”to Alleviate the Intensity of Vaccination Pain in Newborns. Iranian Journal of Pediatrics. 2011: , 21 ( 1): 99-102
13