Bilinorm administration combined with Phototherapy in the management of neonatal jaundice: a hospital based clinical trial

Background: Neonatal jaundice (NJ) is a common problem worldwide and frequent in Iraq . Several reports were published on prevalence, distribution, causes and treatment of NJ.This clinical trial was carried out to demonstrate the effect of combinations of Castrol oil, riboflavin and magnesium in mechanical elimination of bilirubin after enhancing hepatic excretion by phototherapy. Patients & methods: This clinical trial included a total of 61 significantly jaundiced neonates who were admitted to the special care baby unit of Children Welfare Teaching Hospital, medical city complex, Baghdad, Iraq, during the period June 1st to Dec.31st 2007. Phototherapy was applied alone in 30 neonates (group 1) and phototherapy with Bilinorm in 31 neonates (group 2),(Bilinorm oral gel constituted of riboflavin sodium phosphate, magnesium oxide and castor oil). Student’s t test was used to examine the differences in variables between the two groups. Results: There were no significant differences between the two groups in body weight, age of onset of jaundice, age on admission, and TSB on admission (p =0.9,0.4, 0.4, 0.4, respectively). A significant difference in total decrease in TSB was noticed between group II (7.2 ± 2.4) and group I (5.9 ± 1.8)(p = 0.02). Days of hospitalization were significantly lower in group II (2.4 ± 0.8 days) than in group I (3.3 ± 1.5 days) (p = 0.009), and hours of phototherapy were significantly lower in group II (47.4 ± 19.7 hours) than in group I (66.8 ± 27.4 hours) (p= 0.002). Conclusions: There was a statistically significant difference regarding total decrease in TSB, days of hospitalization and hours of phototherapy when both Bilinorm and phototherapy were used than when phototherapy was used alone. So mechanical elimination of bilirubin from intestinal lumen may enhance the effect of phototherapy

Death rates and causes among admitted neonates in Children Welfare Teaching Hospital – Medical city –Baghdad (2000- 2004)

Background: The neonatal deaths account for two-third of all deaths in the first year of life, and 40% of under-five mortality. Extreme prematurity, respiratory distress syndrome , neonatal infections , and congenital malformations are among the common causes of neonatal deaths. Methods: We retrospectively studied 668 neonates who died over 5 years period from first of Jan. 2000 to the end of Dec. 2004 in neonatal care unit of children Welfare Teaching Hospital-medical city, by obtaining data from reviewing their medical records and death certificates. Results: The death rate in neonates admitted to SCBU (special Care baby Unit) during the period of study was (10.7%), male constituted 432 (64.7%) and female 236 (35.3%) with male to female ratio 1.8:1. The major causes of death were congenital malformations (41.6%), neonatal infections (33.4%),and prematurity (10.3%). Conclusions: There was no decline in the neonatal death rate in our hospital especially from sepsis and prematurity and low birth weight. Death due to late onset sepsis was lower than that due to early onset sepsis .There was a significant increase in the death from congenital malformations

Neonatal Birth Traumas: Risk factors and types

Background: Birth trauma is defined as injury to neonates resulting from mechanical forces (such as compression or traction) during the process of birth. Birth injury is used to denote avoidable and unavoidable mechanical and hypoxic- ischemic injury incurred by neonates during labor and delivery. Maternal, labor and infant factors can predispose to birth traumas. Many types of birth traumas can be found including intra and extra cranial, spinal, peripheral nerves, fractures and visceral. Patients and methods: A cross sectional study was done on 200 babies (100 babies for the study group and 100 babies for the control group), admitted to special care baby unit of Baghdad Teaching Hospital, during the period between 1st of October 2007 to the 30th of March 2008. Results: There was an increased percentage of birth trauma in preterm babies, large birth weight, mothers who were primigravida, had history of contracted pelvis, diabetes mellitus, prolong second stage of labor, abnormal fetal presentation, and shoulder dystocia. Trauma of cranium was the most common type of birth trauma, of which caput succedaneum (68%) was the most common one. Conclusions: Birth trauma is still a significant problem in this maternity ward causing some morbidity. The significant risk factors were macrosomia, prematurity and multiple pregnancies, primigravida, chronic maternal illness like diabetes mellitus, history of pelvic anomalies or contracted pelvis, prolonged labor especially the second stage, abnormal fetal presentation and shoulder dystocia. So we recommend assessment of the fetal weight, mother pelvis capacity and presentation before delivery, so that macrosomic fetus might be delivered by cesarean section, and prevent premature delivery, and better use of investigations like ultrasound,x-ray,CT scan for early diagnosis and further management of birth trauma

Neonatal Polycythemia in Children Welfare Teaching Hospital, Medical city complex, Baghdad

Backgroun1d: Polycythemia is defined as a central Hematocrit of at least 65%. Its` incidence is increased in babies who have intrauterine growth restriction (IUGR), are small for gestational age (SGA), and are born post term.  Many infants with polycythemia are asymptomatic. However, it may be associated with feeding problems and lethargy.    Objectives: This work aimed to study the polycythemic neonates admitted to neonatal care unit in children welfare teaching hospital, medical city complex, Baghdad, including demographic features, risk factors, management and early outcome. Patients and Methods: A descriptive study was carried out over 8 months period from 10th of April to the 10th of December 2012, on 50 neonates with polycythemia. The information collected including; age, sex, gestational age, birth weight, risk factors, clinical presentations, management and early outcome. All collected information were taken from patient's medical records, mothers, relatives of patients& residents in the neonatal care unit. Results: Males were more affected than females with male: female ratio of 1.6:1, irritability was present in 11(22%), Tachypnea 21(42%), Respiratory distress 14(28), Cyanosis 11(22%), Feeding disturbance 28(56%), Jaundice 5(10%), Hypoglycemia 15(30%), and thrombocytopenia in 4(8%). the risk factors include Hypertensive mother in 7(14%), diabetic mother 12(24%), twin pregnancy 7(14%). The gestational age:  18(36%) were term, 8(16%) were preterm, 24(48%) were post term. Regarding birth weight 9(18%) were Appropriate for gestational age, 32(64%) were Small for gestational age, 9(18%) were large for gestational age. The complications include seizure 4(8%), necrotizing enterocolitis 3(6%), renal failure in 2(4%). Partial exchange transfusion (PET) was done to 10 (20%). The early outcome include 36(72%) were discharged well, 5(10%) were discharged on family responsibility, 4(8%) were referred to other hospital, 3(6%) died. Conclusions: There is a male predominance in neonatal polycythemia. The most common and significant clinical finding was feeding problem. The most significant laboratory finding was hypoglycemia. The most significant risk factors are small for gestational age and Post term neonates. The outcome is generally good

Short Term Outcome Of Macrosomic Neonates Of Diabetic & Non-Diabetic Mothers

Background: Big birth weight is one of the important factors affecting the perinatal morbidity & mortality. It may result in an irreversible squeal because of birth trauma & fetal asphyxia. Patients & Methods: This is a prospective study of 50 singleton macrosomic newborns weighting 4000 g & more aged 1-3 days admitted in the neonatal care unit of Children Welfare Teaching Hospital & Baghdad Teaching Hospital during a 6 months period from 1st of March to 1st of September 2010. The maternal & neonatal records were reviewed & infant morbidities including hypoglycemia, respiratory distress, feeding intolerance, birth injury & associated anomalies were discussed. All the infants were followed until they were discharged from the hospital.Objectives: to compare the short term outcomes of macrosomic infants born to diabetic and non-diabetic mothers. Results: Infants of diabetic mothers (52%) were more likely to develop neonatal morbidity compared to infants of non diabetic mothers (48%), these include hypoglycemia (76.9% vs. 8.3%), Respiratory distress (61.5% vs. 37.5%), and birth injury (7.7% vs. 4.2%) & nearly equal incidence of feeding intolerance (11.5% vs. 12.5%). Associated anomalies especially congenital heart disease (10%) found in infant of diabetic mothers only. Conclusions: Most of birth weight variation remains unexplained & most non-IDM macrosomic infants do not have identifiable risk factors. Macrosomia is generally associated with neonatal morbidity & neonatal injury. The potential dangers of birth injury in vaginal delivery have increased the rates of cesarean section to (68%). Infants of diabetic mothers have a higher rate of neonatal morbidity overall including hypoglycemia, respiratory distress, birth injury & congenital heart disease