Nutritional Status Of Preterm Infants At Discharge: A Study At Tehran Valie-E-Asr Hospital

Background: Nutrients meeting recommended dietary intakes take time to establish and once established are rarely maintained throughout hospital stay in preterm infants. Methods: Our purpose is to define the nutritional status and growth parameters of hospitalized patients at discharge in our hospital. Data were obtained concerning all 50 infants born weighing <1800 g and <34 weeks of gestation who survived until at least 21 days of age. At weekly intervals, intakes of fluid, energy, and protein from all sources were determined and body weight, head circumference and length were recorded. Results: 50 premature neonates with gestational age of 30.5 ± 2.35 weeks and birth weight of 1337 ±232 g comprising 26 (52%) females and 24 (48%) males were entered into this study from April to July 2004. The mean time of caloric intake of 120Kcal /kg/d was 18.41 ± 6.7 days of age. 37.8% of mothers provide breast milk, 51% preterm formula and the rest of the patients consumed both. Biochemical markers of nutritional status showed that 64% of neonates had blood urea nitrogen <5 mg/dL, 70% had al-kaline phosphatase >450 IU/L, 73% had serum phosphorus <4.5 mg/dL, and 49% had serum albumin <3 g/dL at time of discharge. Except for serum albumin, comparisons of biochemical parameters between small for gestational age & appropriate for gestational age infants were not significant at discharge time. Comparisons of weight and head circumference at birth and at discharge time showed that a significant number of neonates became small for gestational age at discharge (p<0.05). Conclusion: Availability of appropriate amino acid solutions for neonates, parenteral phosphorus, trace elements and human fortifier could reduce these problems

Pedunculated Sacral Lipomapresenting As A Human Pseudotail

A long pedunculated egg-shaped lipoma of the sacrum in a newborn infant, presenting as a tail, was treated surgically. Occult spinal dysraphism may be accompanied with this entity. Investigations for underlying dysraphism and its treatment are mandatory

Comparison Of Morbidities Between Infants Of Pregestational & Gestational Diabetic Mothers

To describe and compare the clinical outcome of infants born to mothers with gestational and pregestational diabetes mellitus, this study was conducted between January 2000 to January 2002 in Tehran Vali -E- Asr Hospital. Among 4472 deliveries, we found 107 infants born to diabetic mothers out of whom 6 were twins. The prevalence of diabetes in total deliveries was 2.39%. Mean age of gestational and pregestational diabetic mothers was 30.9 ±5.86 and 31 ± 5.37 respectively. 74 infants (69%) belonged to gestational diabetic mothers. 50% of infants were male. Mean birth weight of infants was 3067±784.917 (700 -5600g). Gestational age in 57% of infants was less than 38 weeks.APGAR score at 1 & 5 minutes was <6 in 10 and 5 cases respectively. Hypoglycemia was detected in 31%, hypocalcemia in 13%, hypomagnesemia in 4.5%, polycythemia in 6.8%, macrosomia in 28.6%, small for gestational age in 2%, respiratory distress syndrome in 8.2%, early sepsis in 9.2%, NICU admission in 23.7%, and hyperbilirubinemia in 34%. The incidences of most of these morbidities were higher in infants of pregestational diabetic mothers. The differences between the incidence of hypoglycemia, hypocalcemia & 5 minute APGAR score in infants of pregestational and gestational diabetic mothers were significant (p<0.05). There was a significant correlation between the incidence of hypoglycemia and birth weight of infants (p<0.05). The existence of congenital anomalies in infants of gestational diabetic mothers could be due to unrecognized cases of noninsulin dependent diabetes mellitus, and with respect to mean age of mothers it is advisable to detect diabetes before pregnancy in high risk groups and correct the level of hemoglobin A1c before pregnancy. Cleft palate and undescended testes among the anomalies support this hypothesis that prostaglandin deficiency may have a role in the pathophysiology of congenital malformations in these infants

Nutritional Status Of Preterm Infants At Discharge: A Study At Tehran Valie-E-Asr Hospital

Background: Nutrients meeting recommended dietary intakes take time to establish and once established are rarely maintained throughout hospital stay in preterm infants. Methods: Our purpose is to define the nutritional status and growth parameters of hospitalized patients at discharge in our hospital.Data were obtained concerning all 50 infants born weighing 450 IU/L, 73% had serum phosphorus <4.5 mg/dL, and 49% had serum albumin <3 g/dL at time of discharge. Except for serum albumin, comparisons of biochemical parameters between small for gestational age & appropriate for gestational age infants were not significant at discharge time. Comparisons of weight and head circumference at birth and at discharge time showed that a significant number of neonates became small for gestational age at discharge (p<0.05).Conclusion:Availability of appropriate amino acid solutions for neonates, parenteral phosphorus, trace elements and human fortifier could reduce these problems

Conventional versus combined apgar scores in neonatal asphyxia: a prospective study

Background: Respecting gestational age and medical intervention at birth, Combined Apgar score, a new method proposed by American Academy of Pediatrics (AAP) may better evaluate neonatal condition at birth compared with conventional Apgar score. The combined Apgar consists of the Specified and the Expanded Apgar describe a more detailed condition at birth. In Expanded Apgar, administered intervention and in Specified Apgar, infant`s condition regardelless of gestational age and intervention are emphesised. To evaluate combined Apgar score in perinatal asphyxia, we compared conventional versus Combined Apgar scores to anticipated neonatal asphyxial complications. Methods: In a prospective cohort study, we assessed 464 neonates admitted in, Vali-e-Asr University Hospital, during one year from September 2012 to September 2013. We assessed neonates by Conventional and Combined Apgar scoring at 1, 5 and 10 minutes after birth. Asphyxia was recognized based on newborn`s records. Diagnostic criteria for asphyxia include, occurrence of metabolic or mixed acidosis, apgar score less than three in 5th minute, occurrence of neurological complications like seizure, hypotonia, coma and multiple organ failure. Then we used SPSS V16 for data analysis and compare sensitivity between two methods of Apgar scoring. Results: From 2200 delivered neonates, we assessed 464 neonates. 9.3% of studied neonates had Asphyxia, which equals 2% of live births. The Apgar score was lower in asphyxiated neonates by both methods (6±1 vs. 9±1 according to conventional method and 9±1 vs. 16±1 scored in combined method). Combined method was more sensitive than the Conventional Apgar scoring (99% vs. 88%). Conclusion: In asphyxiated neonates sensitivity and specificity of combined apgar were more than conventional apgar. With respect to this study, better assessment could be achieved by combined apgar score method instead of conventional Apgar

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Background: The antibacterial, antifungal and probable anti-inflammatory effects of menthol were evaluated in the treatment of napkin dermatitis (ND). Methods: A pilot clinical trial was conducted in Iran at the Tehran University of Medical Sciences. Eligible neonates with a diagnosis of candidial ND who did not require critical care or systematic antifungal and antiinfl ammatory drugs were included in the study. Overall, 84 patients were randomly allocated into two groups: menthol group (n=42) receiving standard therapy (topical clotrimazole) plus menthol drops applied topically and control group (n=42) receiving standard therapy plus a placebo. Thirty-five neonates in each group finished the course of study and were analyzed for skin rash using Munz and Concannon rash scoring methods before therapy and on the 1st, 3rd, 5th and 7th day after the treatments. Results: Demographic data and the baseline total skin rash score were not significantly different between the menthol and control groups. The total course of therapy for complete healing was found to be shorter in the menthol group (4.3±1.6 vs. 6.9±1.8 days, P=0.0001) and erythema and pustules had a signifi cant (P=0.0001) relief in this group. During the study no severe adverse effects of the drug were observed. Conclusion: Topical application of menthol may be effective in treatment of candidial ND. World J Pediatr 2011;7(2):167-17

Association between Maternal and Neonatal Blood Pressure

Objective: This study aims to describe the blood pressure profile of newborns of preeclampsia mothers in Vali-e-Asr hospital during 2003-2004. Materials and methods: In this cross-sectional descriptive analytical study 200 mothers and their newborns were studied. Blood pressure of all newborns was checked by oscillometric method on the first day after birth and recorded in a questionnaire along with information pertaining to the mother, obtained by interview or through medical file retrieval. Results: The newborns of mothers with high systolic (>140 mmHg) and diastolic (>90 mmHg) blood pressure had mean systolic (65.40 mmHg) and diastolic (42.85 mmHg) blood pressures higher than that in neonates of normotensive mothers( P <0.006). Mean systolic and diastolic blood pressure of neonates whose mothers were preeclampsia (68.2/42.11 mmHg or chronically hypertensive (68.59/ 41.50 mmHg-) were significantly higher than neonates of normotensive mothers (P<0.0001 and P<0.002, respectively).Newborns of smokers had significantly higher blood pressures too (P<0.02). Conclusion: Mother's blood pressure can affect neonatal blood pressure. Chronic hypertension, pre-eclampsia, and cigarette smoking in mothers can adversely alter neonatal blood pressure. These maternal conditions should be screened and managed as soon as possible.  

Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes.

To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes.This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure.The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01).The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates

Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes.

OBJECTIVES:Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar. METHODS:This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality. RESULTS:Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75-51.29), IVH (OR,4.8; 95%CI,1.91-12.01), and neonatal mortality (OR,20.22; 95%CI,4.22-96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups. CONCLUSIONS:The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates

The Combined-Apgar scoring system, consists of the Expanded and Specified Apgar scoring systems.

<p>In 2012 the Combined-Apgar score was introduced by Rudiger et al.</p