The Frequency of Intraventricular Hemorrhage and its Risk Factors in Premature Neonates in a Hospital’s NICU

Abstract Objective Intraventricular hemorrhage (IVH) is an important cause of mortality and disability in premature neonates. Regarding this, the present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU)at Fatemieh Hospital in Hamedan, Iran, 2016.  Materials & Methods  This cross-sectional study was conducted on178 neonates with a gestational age of ≤ 32 weeks admitted to Fatemieh Hospital affiliated to Hamadan University of Medical Sciences, Hamedan, Iran, in 2016. The study population was selected using census method. The newborns were subjected to cranial ultrasound on the seventh day of life. and they were assigned into two case and control groups (namely neonates with IVH and those without IVH, respectively). Intra- ventricular hemorrhage was classified into four grades regarding Papile classification. The patients’ demographic specifications, including 1- and 5-minute Apgar scores, type of delivery, birth weight, use of mechanical ventilation, prenatal corticosteroid, gestational age, and some complications (e.g., Pneumothorax), were collected using a checklist. The data were analyzed using SPSS software version 16 Results According to the results, prevalence of IVH in premature infants admitted to NICU was approximately 20 %,  , 61.2% of the neonates were male. The mean gestational age of the participants was 30.39 weeks. The comparison of delivery type between the case and control groups showed no significant difference between them in this regard(P=0.197). Furthermore, there was a significant difference between the two groups in terms of need for mechanical ventilation (P=0.03), pneumothorax risk of this condition in the preterm neonates is enhanced by some factors, such as low birth weight, 5-minute Apgar score, and gestational age as well as the need for mechanical ventilation. (P=0.001), and 5-minute Apgar scores (P=0.04). Additionally,the incidence of IVH showed a significant relationship with the mean gestational age (P=0.001) and birth weight (P=0.04). Conclusion According to the findings, the premature newborns admitted to the NICU revealed a relatively high prevalence of IVH. The condition is aggravated in preterm neonates by some factors such as low birth weight, 5-minute Apgar score, gestational age, and the need for mechanical ventilation

Nasal Intermittent Positive Pressure Ventilation (NIPPV) Vs. Nasal Continuous Positive Airway Pressure (NCPAP) after Less Invasive Surfactant Administration (LISA) in Preterm Infants with Respiratory Distress Syndrome

Background: There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).Methods: The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth.Results: The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth  compared to the control group (8.3% vs. 27.7%, P=0.014); however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56.2%, P=0.332), the mean respiratory support duration (6.89±3.20 vs. 6.70±3.71 days, P=0.295), the mean hospital stay (19.52±12.364 vs. 17.40±9.57 days, P=0.591), development of bronchopulmonary dysplasia (4.2% vs. 8.5%, P=0.435), and mortality (6.25% vs. 12.8%, P=0.317).Conclusion: Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LIS

ROS-mediated genotoxicity of asbestos-cement in mammalian lung cells in vitro

Asbestos is a known carcinogen and co-carcinogen. It is a persisting risk in our daily life due to its use in building material as asbestos-cement powder. The present study done on V79-cells (Chinese hamster lung cells) demonstrates the cytotoxic and genotoxic potential of asbestos-cement powder (ACP) in comparison with chrysotile asbestos. A co-exposure of chrysotile and ACP was tested using the cell viability test and the micronucleus assay. The kinetochore analysis had been used to analyse the pathway causing such genotoxic effects. Thiobarbituric acid-reactive substances were determined as evidence for the production of reactive oxygen species. Both, asbestos cement as well as chrysotile formed micronuclei and induced loss of cell viability in a concentration- and time- dependent way. Results of TBARS analysis and iron chelator experiments showed induction of free radicals in ACP- and chrysotile exposed cultures. CaSO(4 )appeared to be a negligible entity in enhancing the toxic potential of ACP. The co-exposure of both, ACP and chrysotile, showed an additive effect in enhancing the toxicity. The overall study suggests that asbestos-cement is cytotoxic as well as genotoxic in vitro. In comparison to chrysotile the magnitude of the toxicity was less, but co-exposure increased the toxicity of both

Comparison of Restricted Fluid Volume with Standard Fluid Volume in Management of Transient Tachypnea of the Newborns: A Randomized Controlled Trial

Background Transient tachypnea of the newborn (TTN) is one of the most common neonatal respiratory disease and its symptoms usually begins in the first few hours after birth. The volume of fluid intake according to the neonate's conditions varies. We aimed to compare the restricted fluids volume with standard fluids volume in treatment of neonates with TTN. Materials and Methods: This clinical trial was performed on 80 neonates with a diagnosis of TTN admitted in the Neonatal intensive care unit (NICU) of Fatemiyeh Hospital and Beasat Hospital of Hamadan Medical University in Iran. Patients were randomly divided to standard fluids volume (control = 40), and restricted fluids volume treatment groups (case = 40). The hospitalization duration, oxygen therapy duration as well as the number of days need for oxygen with hood; Nasal continuous positive airway pressure (NCPAP), and mechanical ventilation therapy was recorded. After data collection, the data were statistically analyzed via SPSS software (version 21.0). Results: The subjects were 30 (37.5%) females and 50 (62.5%) males (62.5%) with an average gestational age of 38.12(±1.07) weeks.The main aim from this interventional study was effect of restricted fluidtherapy on management of TTN in NICU section. The hospitalization duration, oxygen therapy duration and need for oxygen therapy with hood in the intervention group were significantly lower than the control group (P0.05). Conclusion TTN treatment with restricted fluids volume, compared with standard volume of fluids, significantly reduces the need for respiratory supports as well as the duration of hospitalization in the NICU section

Characterization of the molecular basis underlying the subversion of dendritic cells homoeostasis by implantable biomaterials

In modern medicine, biomaterials are used in several medical applications ranging from tissue regeneration to antigen-delivery systems. Despite the widespread use of biomaterials, the reaction of the host immune system against implants still constitutes a problem sometime causing implant failure. Thus, there is a major need to understand how biomaterials interact with the immune cells. Dendritic cells (DCs) are the specialized antigen-presenting cells that have the unique ability to sense intruding pathogens, activate naïve antigen-specific T cells and regulate immunological responses. In this study, I have analyzed the molecular interactions between chemically and physically diverse biomaterials and DCs using several murine knockout systems. I found that DCs could sense biomedical polymers through a mechanism, which involves multiple TLR/MyD88-dependent signalling pathways, in particular TLR2, TLR4 and TLR6. TLR-biomaterial interactions induce the expression of activation markers and pro-inflammatory cytokines and are sufficient to confer on DCs the ability to activate antigen-specific T cells. This takes place through direct biomaterial-DC interactions although, for degradable biomaterials, soluble polymer molecules can also alter DC function. Finally, the engagement of TLRs by biomaterials profoundly alters DC adhesive properties. These findings should be useful for designing structure-function studies aimed at developing more bio-inert materials. Moreover, given the major role of TLR2, TLR4 and TLR6 in the alteration of DC functions by biomaterials shown in this work, I also envisage the possibility to design biomaterials that specifically activate TLR2 or TLR4 to achieve antigen-specific TH1- or TH2-type immune responses, respectively

Characterization of the molecular basis underlying the subversion of dendritic cells homoeostasis by implantable biomaterials

In modern medicine, biomaterials are used in several medical applications ranging from tissue regeneration to antigen-delivery systems. Despite the widespread use of biomaterials, the reaction of the host immune system against implants still constitutes a problem sometime causing implant failure. Thus, there is a major need to understand how biomaterials interact with the immune cells. Dendritic cells (DCs) are the specialized antigen-presenting cells that have the unique ability to sense intruding pathogens, activate naïve antigen-specific T cells and regulate immunological responses. In this study, I have analyzed the molecular interactions between chemically and physically diverse biomaterials and DCs using several murine knockout systems. I found that DCs could sense biomedical polymers through a mechanism, which involves multiple TLR/MyD88-dependent signalling pathways, in particular TLR2, TLR4 and TLR6. TLR-biomaterial interactions induce the expression of activation markers and pro-inflammatory cytokines and are sufficient to confer on DCs the ability to activate antigen-specific T cells. This takes place through direct biomaterial-DC interactions although, for degradable biomaterials, soluble polymer molecules can also alter DC function. Finally, the engagement of TLRs by biomaterials profoundly alters DC adhesive properties. These findings should be useful for designing structure-function studies aimed at developing more bio-inert materials. Moreover, given the major role of TLR2, TLR4 and TLR6 in the alteration of DC functions by biomaterials shown in this work, I also envisage the possibility to design biomaterials that specifically activate TLR2 or TLR4 to achieve antigen-specific TH1- or TH2-type immune responses, respectively

Causes and Outcomes of Respiratory Distress in Neonates Hospitalized in the Neonatal Intensive Care Unit of Be’sat Hospital in Hamadan, Iran

Background Neonatal respiratory distress is one the most common problems in the first few day of neonatal life. The present study intended to determine the frequency of the causes and outcomes of respiratory distress in neonates hospitalized in the neonatal intensive care unit (NICU) in Hamadan city, Iran. Materials and Methods In this descriptive and cross-sectional study, all the neonates with respiratory distress (RD), who were hospitalized in the NICU of Be’sat Hospital in Hamedan city, Iran, during 2014 to 2015, entered the study. The required demographic information was extracted from patients’ dossiers. The collected data were analyzed using SPSS version 16.0. Results The mean neonatal age upon admission, mean gestational age and mean birth weight were 5.22±7.18 days, 36.58±3.54 weeks and 2743.9±727.9 grams, respectively. According to the results, intercostal retraction (75.3%), tachypnea (67.7%), and grunting (61.3%) were the most common symptoms of neonatal respiratory distress (NRD), while respiratory distress syndrome (RDS) (36.6%), pneumonia (30.1%), and transient tachypnea of the newborn (TTN) (%14), were the most common causes of respiratory distress. Furthermore, about 19.3% of the neonates died of the disease. The results of logistic regression for the independent risk factors associated with RD outcomes showed that the death rate of neonates with RD had a significant correlation with respiratory failure requiring mechanical ventilation (odds ratio[OR]: 33.49, 95% confidence interval [CI]: 6.95-161.38), and incidence of apnea (OR: 5.87, 95% CI: 1.072-32.167). Conclusion It was found that RDS is the most common cause of respiratory distress in the hospitalized neonates. Moreover, infant mortality rate increased due to respiratory failure requiring mechanical ventilation and occurrence of apnea

Urinary tract infection profile among a hospitalized newborn: a single center study in Iran, 2006-2015

Background: Urinary tract infection in infants is associated with septicemia and genitourinary anomalies. This study was aimed at investigating the frequency, clinical signs, and anomalies in infants hospitalized for urinary tract infection. Methods: This cross-sectional study was conducted on all infants with urinary infection who were hospitalized in the neonatal ward of Be’sat Hospital from 2006 to 2015. Results: Of 79 infants with urinary infection, 62% were male and 87.3% were term infants. The mean age at admission was 16.62±7.17 days, and the mean weight was 3276±478.23 grams. The most frequent clinical sign and the most common pathogen reported were prolonged jaundice (62%) and Escherichia coli (69.6%), respectively. Of the samples, 93.7% were obtained by suprapubic aspiration, 23% had leukocytosis, and 2.5% had urosepsis. In urinalysis examination, 81% had pyuria and 19% had positive nitrate. Among 25.3% infants who had abnormal ultrasound findings, the most abnormal finding was mild bilateral hydronephrosis and 6.3% of the infants had abnormal voiding cystourethrogram (VCUG) in which vesicoureteral reflux was the most frequent finding. Conclusion: It showed that a prolonged jaundice in infants should be considered as a strong factor predicting urinary tract infection

Incidence and short outcome in multiple pregnancies: a single center cross-sectional study in Iran 2016–2017

BACKGROUND The incidence of multiple pregnancies in industrialized countries due to the use of assisted reproductive techniques has increased over the past two decades. Multiple births are more dangerous than single pregnancies for mother and baby. This study evaluated the frequency of multiple pregnancies and its neonatal complications. METHODS In this cross-sectional study, we assessed all multiple neonates hospitalized in Fatemieh Hospital of Hamadan, Iran from September 2016 to September 2017 in terms of gender, gestational age, birth weight, the use of assisted reproductive techniques, delivery method, cause of hospitalization, therapeutic intervention, and hospitalization outcome. RESULTS Of 10,581 deliveries during the study period, 351 (3.3%) was multiple pregnancies and 232 neonates hospitalized. The incidence of twin, triplet, and quadruplet birth were 1.7%, 0.39%, and 0.11% respectively. In this study, 178 twin and 54 triplet and quadruplet birth were compared. The mean gestational age and mean birth weight of triplet and quadruplet were lower than that of twin births (p<0.001). A significant difference was found on the frequency of assisted reproductive techniques (p<0.001). Female sex (p=0.007), lower mean gestational age (p=0.009), lower mean birth weight (p=0.017) and need to mechanical ventilation (p<0.001) were significantly associated with early neonatal death in multiple pregnancies. CONCLUSIONS The incidence of multiple births was high in the Hamadan province, which was often followed by infertility treatment. Moreover, multiple births cause prematurity, low birth weight, respiratory distress syndrome, and increased neonatal mortality rate