Complications of Neonatal Jaundice and the Predisposing Factors in ‎Newborns

BACKGROUND AND OBJECTIVE: Hyperbilirubinemia is one of the most common problems during the neonatal period. Despite the severe complications of jaundice, no reliable data is available regarding the prevalence of acute and chronic complications of jaundice and the predisposing factors in our community. Therefore, this study aimed to determine the complications of neonatal jaundice and the predisposing factors in neonates. METHODS: This cross-sectional study was performed on icteric, term newborns with bilirubin level higher than 20 mg/dl, referring to Ghaem Hospital during 2003-2013. After history taking and physical examinations, developmental status of infants was followed within six and twelve months after birth, using Denver Developmental Screening Test-II. The newborns were divided into two groups, based on the occurrence or non-occurrence of complications (e.g., acute or chronic kernicterus, auditory disorders and developmental disorders). Afterwards, predisposing factors for these complications were evaluated.  FINDINGS Complications of jaundice were reported in 143 (13.37%) out of 1069 neonates. The two groups were not significantly different in terms of variables such as neonatal age and gender or maternal age. However, there was a significant difference between the children with and withod complication regarding treatment modality and mean total serum bilirubin level (27 mg/dl vs. 32 mg/dl) (p<0.05). The predisposing factors for neonatal complications were as follows: idiopathic jaundice (30%), ABO incompatibility (18%), Rh incompatibility (14.8%), G6PD deficiency (12.6%) and sepsis (3.3%). CONCLUSION: Our findings showed that ABO incompatibility, Rh incompatibility and G6PD deficiency were the most common risk factors for jaundice, followed by idiopathic jaundice

Effect of Treatment Delay on Survival in Patients with Breast Cancer

Background: The effect of time interval from diagnosis to treatment on survival has remained controversial. The aim of this study was to assess treatment delay in Iranian breast cancer patients and to examine its impact on overall survival and disease free survival. Materials and Methods: A historical cohort study was undertaken on breast cancer patients who were diagnosed and treated in two university hospitals between 2003 and 2013. The impact of interval to treatment defined as the time between date of pathological diagnosis, usually via open biopsy, and the date of initial therapy, either surgical or systemic was measured on overall survival and disease free survival. Prognostic factors and outcomes of the patients were analyzed using log-rank test and Cox regression model. Results: The median and mean of interval to treatment were 15 and 25.98±42.31 SD days, respectively. There was no association between the interval to treatment after a diagnosis of breast cancer and overall survival or disease free survival. In univariate analyses, statistically significant predictor for overall survival was tumor stage but not in disease free survival. In multivariate analyses, the stage II [Hazard Ratio: 0.145, 95% CI: 0.04 to 0.49, P Value: 0.002] and III [Hazard Ratio: 0.227, 95% CI: 0.08 to 0.64, P Value: 0.005] Compared with the stage IV were significantly associated with increased overall survival. Conclusion: The study suggests that delay to treatment up to two weeks has no adverse effect on overall and disease free survival. It seems that when patients diagnosed with early stage could have a waiting time longer than two weeks