Maternal Dietary Pattern with an Emphasis on Child Growth Pattern and Exclusive Breastfeeding Duration

Background: maternal nutrition and breast milk nutrient concentration are associated with infant's growth. Enhanced knowledge encourages mothers to breast feed for the sake of optimizing growth and development. Methods: the current study was performed longitudinally in some rural areas, south of Iran, from birth to six months. Out of 319 candidates with serial anthropometric measurements of an infant, including weight, height, and head circumference at four times (birth, two, four, and six months ), 195 were included in the multivariate regression model (total measurements, n=776) to construct the pattern of growth. Then, information regarding demographic background, lactation status and infant supplementation intake status, feeding practices, maternal anthropometric measurements, and food frequency questionnaire were collected from mothers and their children during six months in two rural health centers. Results: The most important association between dietary factors and infant anthropometrics (weight, height, and head circumference) involved Factor2 vegetables, including leafy vegetables, tomato, onion and garlic, (weight β=0.35 95%CI 0.27 - 0.44, length β=3.82 95%CI 3.42 - 4.22, head circumference β=2.55 95%CI 2.32 - 2.79) and Factor1 fruit, including orange, kiwi, cherries, watermelon, date, and grapes) (weight β=0.117 95%CI 0.04-0.189, length β=0.59 95%CI 0.257-0.929, head circumference β=0.307 95% CI 0.108-0.507), respectively. Generalized Estimation Equation model revealed that Factor2 dairy (including low fat milk, yogurt and dough) significantly contributed to weight growth velocity (β=-0.009 95% CI -0.016 - 0.001). Conclusion: a dietary habit of fruit and vegetables, which are rich in bioactive components by breast feed mother showed better growth for infants. As growth is multifactorial, maternal nutrition and breastfeeding duration is a simple modifiable factor which can affect the subsequent growth and development of the child during the first six months. Key words: exclusive breastfeeding, growth, anthropometric measures, maternal nutrition, and multivariate multiple regression

Transient Hyperammonemia of the Newborn: A Case Study

Background: Transient hyperammonemia of the newborn (THAN) is an overwhelming condition presenting with coma within 2-3 days of life and requiring immediate treatment. The etiology of this condition remains unknown. Duration of coma determines the degree of neurologic impairment and developmental delay in hyperammonemia. Case report: A newborn (BW=2900 g) was presented with a clear prenatal and perinatal medical history, poor sucking, refusal to feed, and deep coma within 72 hours of birth; the infant required ventilator assistance. On admission, physical examinations showed normal conditions, except for mild generalized weakness. Moreover, there was no history of consanguinity or maternal or obstetrics illnesses. However, the laboratory tests revealed marked hyperammonemia (plasma ammonia > 397 μg/dL, normal: 27-102 µg/dl) and elevated lactate (36.1 mg/dl, normal < 20 mg/dl). With aggressive therapy (no dialysis), he survived and was discharged without any complications.  The follow-up examinations during the next six months showed that his development was within the normal range without any signs of delay. Conclusion: Hyperammonemia should be considered in infants presenting with neurological deterioration as timely and appropriate intervention could result in good prognosis

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

Pattern and extent of off-label and unlicensed drug use in neonatal intensive care units in Iran

Abstract Background Many newborns may need to be hospitalized and receive drugs during the first days of their lives. These drugs are fundamentally prescribed as off-label and unlicensed. This study aimed to investigate the amount of these kinds of drugs administered in the Neonatal Intensive Care Units (NICUs) of Abuzar and Imam Khomeini Teaching Hospitals in Ahvaz, Iran. Methods This was a 3-month descriptive, cross-sectional study with retrospective nature in which 193 hospitalized newborns were studied. Demographic data were extracted from the patients’ files. The drugs were classified as off-label, unlicensed or licensed according to the Pediatric & Neonatal Dosage Handbook (Lexicomp®, 22nd Edition). Results In total, 1049 prescriptions were registered for the 193 hospitalized newborns (term and preterm). For each newborn, the mean numbers of prescriptions and drugs received were 5.4 and 4.5, respectively. The mean numbers of prescriptions and drugs were greater for preterm newborns. Of the total 1049 prescriptions, 38.1% were off-label and 1.9% were unlicensed. Of the 193 newborns, 85% received at least one off-label or unlicensed prescription. Off-label prescriptions were mostly related to dose (44.8%) and dosing interval (36.5%). Most off-label drugs were antibiotics (mainly Gentamicin). Albuterol was used off-label in 100% of the cases. Conclusions The results of the present study show that the prescription of off-label and unlicensed drugs in NICUs is as high in Iran as in other countries. This suggests that it is necessary to provide information to neonatologists to decrease the prescription of off-label and unlicensed drugs

Prevalence of celiac disease in siblings of Iranian patients with celiac disease

CONTEXT: Celiac disease, one of the best-known autoimmune human leukocyte antigen-dependent disorders, has a relatively increased prevalence in first-degree relatives. OBJECTIVE: To determine the prevalence of celiac disease in siblings of patients with confirmed celiac disease. METHODS: Siblings of confirmed celiac disease patients in our center were identified and enrolled in this study. Their serum immunoglobulin A and tissue transglutaminase antibody-enzyme-linked immunosorbent assay (anti-tissue transglutaminase, immunoglobulin A, and immunoglobulin G) were measured and multiple endoscopic duodenal biopsy specimens were obtained with parental consensus. Celiac disease was confirmed by observation of characteristic histological changes. RESULTS: A total of 49 children (male, 29; female, 20; age, 2-16 years) with confirmed celiac disease in a pediatric gastroenterology ward were studied from 1999 to 2006. We found 30 siblings (female, 16) all shared in both parents. The only measurement available was for immunoglobulin A tissue transglutaminase antibody. A duodenal biopsy was performed in all 30 siblings. Clinical findings such as abdominal pain, fatigue, growth retardation and diarrhea were found in 53.3% of the completely studied siblings, and positive serology without histological changes was identified in four cases. Both serology and biopsy (confirmed new cases) were positive in 2 of the 30 siblings. CONCLUSION: High prevalence of celiac disease among siblings of patients with confirmed celiac disease necessitates serologic screening (and confirmatory biopsy if indicated) in families having celiac disease. It is advantageous to diagnose the disease as soon as possible because early diagnosis and diet intervention may prevent serious complications such as growth retardation, short stature, chronic diarrhea, and malignancy

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

COMPARING STRESS LEVEL IN PARENTS OF PREMATURE NEONATES HOSPITALIZED IN NEONATAL INTENSIVE CARE UNITS [NICU] IN EDUCATIONAL-MEDICAL CENTERS OF AHVAZ

Objective: birth of premature and low birth weight baby is the most underlying factor of mortality during the first year of life. Paying attention to social-mental effective aspects of birth of premature baby in parents is also important. The main objective of this study is to compare the stress of fathers and mothers of premature babies hospitalized in NICUs of Ahvaz Educational-Medical Centers. Method: the study is a descriptive-analytical research and the statistical population consists of all families of premature babies hospitalized in Abuzar and Imam Hospitals. 192 people of these families were selected as sample based on number of beds in each unit of hospital. The data collection was done using two questionnaires of demographic information and Parent Stressor Scale: neonatal intensive care unit [PSS: NICU]. Validity and reliability of the instrument was confirmed in similar studies. Data analysis was done using SPSS software. Results: mean value and standard deviation [SD] of environmental factor is equal to [3.30±0.514] in fathers and to [3.81±0.532] in mothers. Independent t-test showed also significant difference between mothers and fathers [p<0.0001]. However, mean value and SD of the appearance and behavior of baby and parent role change showed respectively no significant difference between them using independent t-test [p=0.206] [p=0.175]. Conclusion: after birth of premature babies and hospitalization in NICU, parents experience high level of stress. Hence, it is necessary for the medical personnel to pay specific attention to the parents in addition to provide care for the babies. Key words: premature Neonates, NICU, family, stres

Pearson correlation coefficient showing the association between different Apgar scores and cord blood gas parameters.

<p><b>*:</b> P value less than 0.05</p><p>Pearson correlation coefficient showing the association between different Apgar scores and cord blood gas parameters.</p