Is Maternal Hypertension a Reducing Factor for Intraventricular Hemorrhage in Iranian Preterm Newborns?

Background: Hypertensive disorders of pregnancy including preeclampsia can be associated with preterm birth and infant mortality and morbidity. It seems that intraventricular hemorrhage (IVH) in preterm neonates born to hypertensive mothers is less common compared to the other ones. In this study, we assessed the relationship between hypertensive disorders of pregnant mothers and the incidence of intraventricular hemorrhage in preterm neonates weighing less than 1500 grams.Methods: In this case-control study, 305 singleton preterm neonates with a birth weight less than 1500 g were entered. The presence of IVH in all preterm neonates was assessed using brain ultrasonography and its correlation to hypertensive disorders of their mothers were evaluated.Results: The prevalence of preeclampsia in mothers with and without pre pregnancy hypertension was 40%, and 15.09% respectively. The prevalence of IVH in preterm neonates was 26.9% (n=82). The incidence of IVH in preterm neonates of mothers with and without preeclampsia was 16.07%, and 29.31%, respectively (p=0.028). The prevalence of IVH in preterm neonates of mothers with hypertension and without hypertension was 12.5% and 29.05%, respectively (p=0.018). Preterm neonates with IVH had a lower mean birth weight, smaller gestational age and lower Apgar scores compared to preterm neonates without IVH with p values of <0.001, <0.001 and <0.01, respectively.Conclusion: Hypertensive disorders of pregnancy increase the risk of preterm delivery, but the incidence of IVH in preterm neonates weighing less than 1500 gr is lower in infants born to mothers with hypertension including preeclampsia compared to those born to non-hypertensive mothers. And also lower gestational age, birth weight, and Apgar scores were important predicting factors for IVH in preterm neonates

The Prevalence of Acute Kidney Injury in Neonates with Asphyxia

Introduction: Asphyxia is a common cause of mortality and morbidity among neonates. Following severe asphyxia and ischemia, reperfusion occurs which damages vital organs like the kidneys. This study was conducted to determine the prevalence of AKI based on the definition of a serum creatinine level higher than 1.5 mg/dL, in neonates with asphyxia.Materials and Methods: This retrospective study was performed in Ali-Asghar and Shahid-Akbar-Abadi Hospitals, Tehran, Iran in a period of one year. The medical documents of all newborns diagnosed with asphyxia were studied. The asphyxia grade was determined according to the asphyxia Sarnat criteria. The kidney function was evaluated based on the serum creatinine level.Results: Thirty-eight cases met the inclusion criteria. There were 13 Sarnat grade-1 cases (34.2%), 19 grade 2 cases (50%), and 6 grade 3 patients (17.6%).  Three (7.8%) patients (2 patients in grade 3 and one patient in grade 2 of the Sarnat grading scale) developed AKI. AKI was detected in 33% of the patients in grade 3 and 5.2% of the patients in grade 2 of the Sarnat grading scale. Nine patients (23%) died, of whom 83% were in grade 3 and 16.9% in grade 2 of asphyxia.Conclusions: AKI developed in 7.8% of the cases, of whom 33% were in grade 3 and 5.2% were in grade 2 of the Sarnat grading scale. The low rate of AKI development in our study might be duo to the small sample size and patient mortality in the first 3 days of life.Keywords: Acute kidney injury; Neonates; Asphyxia

The Effect of Intensive Phototherapy on Management of Hyperbilirubinemia in Neonates with the Gestational Age of 34 Weeks and More

Background: Neonatal hyperbilirubinemia is one of the most common causes of neonatal morbidity and a global health priority. This study aimed to evaluate the effect of intensive phototherapy on management of hyperbilirubinemia with different etiologies. Methods: This retrospective cohort study was conducted on 219 neonates with indirect hyperbilirubinemia, who had the indication for phototherapy, admitted to neonatal intensive care unit of Akbar-abadi Hospital, Tehran, Iran, during 2014-2016. The levels of total bilirubin, hemoglobin, reticulocyte, and glucose 6-phosphate dehydrogenase (G6PD) enzyme were examined and direct Coombs test was performed during hospital stay. The participants were assigned to four groups based on the etiology of hyperbilirubinemia and underwent intensive phototherapy.Finally, the level of total bilirubin was compared among the groups to assess the effect of intensive phototherapy. Results: According to the results of this study, nonhemolytic jaundice was the most frequent cause of hyperbilirubinemia (82.19%). The mean bilirubin levels after 6 and 24 hours of intensive phototherapy were 4 and 6.2 mg/dl, respectively. Intensive phototherapy after 6 hours led to more significant reduction in the total bilirubin level of the neonates with total bilirubin level of higher than 14 mg/dl in comparison to those with the total bilirubin level of 14 mg/dl or less. The total bilirubin level was significantly decreased in all the groups after 6 and 24 hours of intensive phototherapy. Comparison of the rate of decrement of the total bilirubin level among the groups demonstrated that the neonates with ABO incompatibility showed the greatest decline after 6 and 24 hours of treatment (the rate of bilirubin decline: -5.16;

Prevalence of Meningitis among Hospitalized Neonates with Urinary Tract Infection

Background: Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI.Methods: This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged Results: A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54% of the neonates were male. Out of all neonates, 23 (14.1%) cases had positive blood culture. The positive CSF culture was observed in only two (1.2%) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50% of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50% and 24.2%, respectively; P=0.432).Conclusion: The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2%. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results

Effect of Protein Supplementation on the Growth of Infants Weighing Less than 1,000 Grams Hospitalized on the Neonatal Intensive Care Unit of Akbar Abadi Hospital in Tehran, Iran (2015-2016)

Background: Breast milk provides adequate protein to facilitate growth for term infants. Appropriate nutrition is necessary for the growth of preterm infants. Extremely-low-birth-weight (ELBW) infants require higher protein intakes to achieve adequate growth. The present study aimed to evaluate the effect of protein supplements on the physical growth of infants weighing less than 1,000 grams through the serial measurement of their anthropometric indices (weight, height, and head circumference) during admission at the neonatal intensive care unit (NICU). Methods: This triple-blind, randomized clinical trial was conducted on 64 infants weighing less than 1,000 grams, who were admitted to the NICU of Akbar Abadi Hospital in Tehran, Iran during 2015-2016. Data on the daily nutritional intake of the subjects were recorded until discharge from the hospital. Data analysis was performed in SPSS version 24. Results: In total, 63 infants were enrolled in the study. Mean daily weight gain of the infants was 55.92±36.90 and 30.80±13.91 grams in the case and control groups, respectively (P=0.001). Mean weekly linear growth in the case and control groups was 0.77±0.67 and 0.76±0.29 centimeter, respectively (P=0.939). Mean weekly head circumference growth in the case and control groups was 0.51±0.10 and 0.34±0.16 centimeter, respectively (

Does Adding Intravenous Phosphorus to Parenteral Nutrition Has Any Effects on Calcium and Phosphorus Metabolism and Bone Mineral Content in Preterm Neonates?

The use of parenteral nutritional supplementation of phosphorus may lead to exhibit higher plasma phosphate concentrations and less radiological features in premature neonates susceptible to osteopenia. The present study aimed to assess the beneficial effects of adding intravenous phosphorus to total parenteral nutrition (TPN) on calcium and phosphorus metabolism in preterm neonates by measuring bone mineral content. This open-labeled randomized clinical trial was conducted on premature neonates who were hospitalized at NICU. The neonates were randomly assigned to two groups received TPN with intravenous sodium glycerophosphate or Glycophos (1.5 mmol/kg/day) or TPN without sodium glycerophosphate. At the end of the four weeks of treatment, the presence of osteopenia was examined using DEXA Scan. After completing treatment protocols, the group received TPN with intravenous Glycophos had significantly lower serum alkaline phosphatase (360±60 versus 762±71, P<0.001), as well as higher serum calcium to creatinine ratio (1.6±0.3 versus 0.44±0.13, P<0.001) compared to the control group received TPN without Glycophos. Those who received TPN with intravenous Glycophos experienced more increase in bone mineral density than those in control group (0.13±0.01 versus 0.10±0.02, P<0.001). There was no significant difference in serum calcium and serum vitamin D between the case and control groups. Adding intravenous sodium glycerophosphate to TPN in premature neonates can compensate the lack of bone mineral content and help to prevent osteopenia

Standard Multiple and Single Daily Dosing of Amikacin in Premature Infants

Background: Bacterial sepsis is highly prevalent among premature infants. Amikacin is an antibiotic widely recommended for the treatment of neonatal sepsis, one of the consequences of which might be nephrotoxicity. The present study aimed to compare the efficacy and nephrotoxicity of multiple daily dosing (MDD) and once-daily dosing (ODD) of amikacin in preterm infants suspected of sepsis. Methods: This triple-blind, randomized, controlled clinical trial was conducted on 40 premature infants suspected of sepsis, who were randomly divided into two groups. In addition to ampicillin, one group was administered with the standard daily dose, and the other group received an ODD of intravenous amikacin. Maximum and minimum serum levels of amikacin and urine neutrophil gelatinase-associated lipocalin (NGAL) were measured in both groups. Data were extracted and analyzed based on the research hypothesis and literature review. Results: No significant differences were observed between the study groups in terms of gender, gestational age, mode of delivery, birth weight, and Apgar score. After the intervention, mean plasma creatinine reduced in both groups, while the mean reduction was significantly higher in the group administered with the ODD of amikacin (P=0.0001). However, mean changes in the urine NGAL had no significant difference between the groups (P=0.635). Minimum and maximum serum levels of amikacin in the study groups indicated a more significant reduction in mean level of the infants administered with the ODD of amikacin compared to the MDD group (P=0.0001). Conclusion: Considering the higher maximum and lower minimum levels of amikacin in the neonates receiving the daily dosage regimen, it seems that this regimen is more effective in the treatment of sepsis in preterm infants. Moreover, no significant difference was observed in the efficacy and nephrotoxicity of the daily amikacin dosing in the premature infants suspected of sepsis compared to those treated by multiple doses of amikacin