Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Frequency of neonatal abstinence syndrome (NAS) and type of the narcotic substance in neonates born from drug addicted mothers15318110.22038/ijn.2015.3181ENFatemeh NayeriNeonatologist, Valiasr Hospital NICU, Materno- fetal Neonatal health research center, Tehran University of medical sciencesMamak ShariatMatherno and child health specialist, Materno- fetal Neonatal health research center, Tehran University of medical sciences0000-0002-7547-8004Majeed FiroziNeonatologist, Lorestan University of medical sciencesMajeed KalaniNeonatologist,Shahid Akbarabadi Hospital, Tehran University of medical sciences0009-0001-2878-2695Bita EbrahimMaterno- fetal Neonatal health research center, Tehran University of medical sciencesJournal Article20140210Abstract <br/>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. <br/>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. <br/>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%, pMashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Prophylactic effect of zinc sulphate on hyperbilirubinemia in premature very low birth weight neonates: a randomized clinical trial610313910.22038/ijn.2015.3139ENAshraf MohammadzadehProfessor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0001-2345-6789Ahmad Shah FarhatAssistant Professor of Neonatology. Neonatal Research Center, Imam Reza hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAbbas Alizadeh KasebFellowship of Neonatology, Neonatal Research Center, Imam Reza hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranFatemeh KhorakianAssistant professor of Pediatric Dentistry, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, IranMohammad RamezaniPharmaceutical and Biotechnology Research Center, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20140707Introduction: 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. <br/>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. <br/>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. <br/>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.Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism1114318410.22038/ijn.2015.3184ENNarges PishvaNeonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, IranAlie MirzaeeNeonatlaogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, IranZohre KaramizadeDepartment of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, IranShahnaz PourarianNeonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran0000-0002-7286-6108Fariba HemmatiNeonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, IranMostajab RazviNeonatalogy Research center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences ,Shiraz, Iran0000-0002-2759-7009Forough SakiNeonatalogy Research Center, Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20130821Objective: 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.<br/>Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province.<br/>The following clinical features were used as inclusion criteria for investigation of the patients.<br/>Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.<br/>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(GALTMashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Equity in health: Comparison of children health indices in poor and rich zones1518393310.22038/ijn.2015.3933ENReza SaeidiAssociate Professor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-0075-5732Vahid SadeghiGeneral physician, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150202Background: 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. <br/>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. <br/>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. <br/>Conclusion: This study shows that health indices in rich and poor zones, have significant differencesMashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Epidemiologic features of early onset sepsis in neonatal ward of Shabih Khani hospital in Kashan1923393410.22038/ijn.2015.3934ENZiba MosayebiNeonatologist,Tehran medical universityAmir Hossein Movahedianpediatrics cardiologist,Kashan medical universityBita EbrahimMaterno- fetal Neonatal health research center, Tehran University of medical sciences0009-0001-2878-2695Journal Article20140210Background 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. <br/>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. <br/>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. <br/>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.Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Evaluation of Nutritional Status in a Teaching Hospital Neonatal Intensive Care Unit2429313810.22038/ijn.2015.3138ENMohammadreza RafatiDepartment of Clinical Pharmacy, College of Pharmacy, Mazandaran University of Medical SciencesMaryam NakhshabDepartment of pediatrics, School of Medicine,Mazandaran University of Medical SciencesVagihe GhaffariDepartment of pediatrics, School of Medicine,Mazandaran University of Medical SciencesMohammadreza MahdaviDepartment of medical technology, School of Medicine, Mazandaran University of Medical SciencesMustafa SharifiMazandaran University of Medical SciencesJournal Article20131223Background:<br/>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.<br/>Methods:<br/>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. <br/>Results: <br/>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. <br/>Conclusion: <br/>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.Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Predicting Factors of INSURE Failure in Low Birth Weight Neonates with RDS; A Logistic Regression Model3034393510.22038/ijn.2015.3935ENBita NajafianAssistant Professor, Pediatrics Department, Faculty of Medicine, Baqiyatallah University of Medical Science, Tehran, IranAminsaburi AminsaburiBaqiyatallah university of medical sciencesSeyyed Hassan FakhraeiAssistant Professor, Pediatrics Department, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, IranAbolfazl AfjehAssistant Professor, Pediatrics Department, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, IranFatemeh EghbalPediatrics Department, Faculty of Medicine, Birjand University of Medical Science, Tehran, IranReza NoroozianStudents Research Committee, Baqiyatallah University of Medical Science, Tehran, IranJournal Article20140711Background: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.<br/>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.<br/>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.<br/>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.Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Petechial Hemorrhage: A clinical diagnosis of neonatal Thrombocytopenia and sepsis3536317910.22038/ijn.2015.3179ENDeepak KumarSharmaFernandez Hospital ,ooposite OLD MLA quartersSrinivas MurkiFernandez Hospital,Tejo PratapFernandez Hospital HyderabadJournal Article20140624A 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. <br/>Discussion<br/>Neonatal 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)Mashhad University of Medical SciencesIranian Journal of Neonatology2251-75105420150201Octreotide for the Management of Chylothorax in newborns, case report3739393610.22038/ijn.2015.3936ENReza SaeidiAssistant Professor of neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-0075-5732Shadi NourizadehNeonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20140901Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. <br/>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. <br/>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. <br/>We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. <br/>Our case was treated successfully with octreotide without the need to insertion of chest tube.