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The aim of this study was to investigate the effect of co-bedding among premature twin or multiple birth infants on their growth and physiological stability. In this randomized clinical trial, a total number of 80 pairs of premature twin or multiple birth infants hospitalized in the neonatal intensive care unit (NICU) of Shahid Akbar-Abadi Hospital in Tehran, Iran, were randomly allocated into two groups; co-bedded and routine care. The required data were collected through a demographic characteristics information questionnaire and a co-bedding checklist and compared between groups. In the following, data analysis showed that the weight gain and mean of NICU hospitalization days in the co-bedded group were significantly different from those in the standard care infants (P

Background: Screening for critical congenital heart defects should be done as early as possible and is essential to save lives and reduce the incidence of undetected adult congenital heart diseases. Over 50% of neonates with heart malformations remain unrecognized at birth. Accurate screening for congenital heart malformations is achievable using a certified and internationally patented digital intelligent phonocardiography machine. This study aimed to assess the actual incidence of newborn heart defects in a well-baby nursery and evaluate digital intelligent phonocardiogram screening for critical congenital heart defects. Methods: We conducted the “Neonates Cardiac Monitoring Research Project” (ethics approval number: IR-IUMS-FMD. REC.1398.098) at the Shahid Akbarabadi Maternity Hospital. This study is a retrospective analysis of screening congenital heart malformation in 840 neonates. Randomly, 840 neonates from the well-baby nursery underwent standard clinical examinations at birth and digital intelligent phonocardiogram examination in a double-blinded format. Pediatric cardiologist performed echocardiography for each neonate classified as abnormal using the intelligent machine or routine medical examinations. If a follow up was demanded by the pediatric cardiologist, the neonate was considered as having a congenital heart malformation and the cumulative incidence proportion was calculated accordingly. Results: The incidence of heart malformations in the well-baby nursery was 5%, and 44% of neonates with heart malformations were unrecognized at birth based on the standard medical examination results, including those with critical congenital heart defects (CCHD). An intelligent phonocardiogram recognized 100% of neonates with heart malformations. Conclusion: We accurately and cost-effectively screened for congenital heart malformations in all neonates in our hospital using a digital intelligent phonocardiogram. We detected neonates with CCHD and congenital heart defects using an intelligent machine; these could not be detected using standard medical examinations. In addition, the intelligent machine interpreted innocent murmurs as healthy heart sounds.

Background: It is vital to screen all critical congenital heart defects as early as possible. Screening for congenital heart diseases in neonates is essential for saving children's lives and reducing undetected adult congenital heart diseases. Unfortunately, over 50% of neonates with heart malformations are unrecognized at birth. Accurate screening for congenital heart malformations can be accomplished using the certified and internationally patented digital intelligent phonocardiography machine. The objective of this study is 2-fold: assess the actual prevalence of newborn heart defects in our well-baby nursery and evaluate the digital intelligent phonocardiogram screening for critical congenital heart diseases. Methods: In this study, we have accomplished "The Neonates Cardiac Monitoring Research Project" (ethics approval IR-IUMS-FMD. REC.1398.098) at Shahid Akbarabadi Maternity Hospital. Eight hundred forty neonates from our well-baby nursery have undergone both the standard clinical examinations at birth and the digital intelligent phonocardiogram examination in a double-blinded format. The median age of the neonates was 30,85 hours, and the median weight was 3.12 Kg. In addition, the pediatric cardiologist has performed echocardiography diagnosis for each neonate classified as abnormal either by the intelligent machine or by the standard medical examinations of a neonate. Detailed dataset of the eight hundred neonates’ examinations and printouts of the intelligent machine are available online.Results: We have found that the prevalence of heart malformations in our well-baby nursery is 5%. 44% of the heart malformations are unrecognized at birth through the standard medical examination of the hospital, including neonates with CCHD, Whereas the intelligent phonocardiogram has recognized 100% of neonates with heart malformations.Conclusions: We have accomplished screening for congenital heart malformations in all neonates accurately and cost-effectively in our hospital using the digital intelligent phonocardiogram. The intelligent machine has detected CCHD, where we have not detected it through the hospital's standard medical examinations, including pulse oximetry and the heart sound auscultation. In addition, the intelligent machine interprets innocent murmurs as healthy heart sounds.

The heart rate characteristic (HeRO score) is a figure derived from the analysis of premature neonate's electrocardiogram signals, and can be used to detect infection before the onset of clinical symptoms. The United States and Europe accept this diagnostic technique, but we require more tests to prove its efficacy. This method is not accepted in other developed countries so far. The present study aimed to investigate changes in the heart characteristics of two neonates in Akbar Abadi Hospital in Tehran. Experts chose one newborn as a sepsis case, and the other neonate was healthy. The results were analyzed and compared with previous studies. In this research, a group of five neonates was selected randomly from the neonatal intensive care unit, and cardiac leads were attached to them for recording heart rates. We selected two neonates from the five cases, as a case (proven sepsis) and control, to analyze heart rate variability (HRV). Then, we compared the differences in the heart rate of both neonates. Analysis of HRV of these two neonates showed that the pattern of HRV is compatible with reports from US studies. Considering the results of this study, heart rates and their analysis can provide useful indicators for mathematical modeling before the onset of clinical symptoms in newborns.

Participatory video involves co-researchers using digital or video cameras to create their own videos and present issues according to their sense of what is important. In 2018, the authors—including three co-researchers from refugee backgrounds—collaborated through participatory video research to document views on better access and participation in higher education. Here, we reflect on key ethical issues encountered and share lessons learnt from our project. Our aim is not to discredit this methodology but to contribute new discussions on how participatory video can be used effectively as a form of self-representation to target wide audiences and effect social and policy change. This way, debates on the social and political potentialities of arts-based methods such as participatory video can be expanded. Since deploying participatory video in forced migration research is a relatively novel approach, there is much scope to expand the contours of knowledge on its potential to reach diverse audiences and open up new opportunities for social and political impact.

Preterm birth is the most important cause of neonatal mortality and morbidity. Finding the best treatment regimen of antenatal corticosteroids, in order to reduce neonatal complications, has been under serious concern.Objective:The purpose of the present study was to compare the efficacy of intravascular (IV) versus intra muscular (IM) betamethasone phosphate on neonatal outcomes in the cases of imminent preterm birth.Method:The study was conducted as a double-blind randomized clinical trial. 136 pregnant women with gestational age of 26- 34 weeks of pregnancy and imminent preterm birth (delivery within 24 hours) were randomly assigned into two groups. Group A received intramuscular betamethasone phosphate as a dose of 12 mg, and group B received a similar dose of betamethasone phosphate intravenously. Women were followed up to delivery, and their neonatal outcomes were compared.Results:The women of the two groups (68 women in each group), did not show a significant difference in maternal age, BMI, gravidity and parity, gestational age at the time of admission and delivery, history of miscarriage and assisted reproductive techniques, delivery route, sex and weight of newborns, and Apgar score in minutes 1 and 5. The need for NICU admission, duration of hospitalization, neonatal respiratory distress syndrome, surfactant requirement, and intubation were lower in the IV betamethasone group. There were no significant differences between the two groups according to necrotizing enterocolitis, intraventricular hemorrhage (IVH) and neonatal death.Conclusion:Using IV betamethasone, in cases where there is no enough time to complete the 24-hour betamethasone course due to the possibility of impending delivery, may reduce neonatal complications due to more rapid action.

There is increased commitment to the participation and self-representation of people with lived experiences as refugees and asylum seekers in advocacy, especially at international, high-level event...

Objective: The aim of this study was to determine the effect of high dose intralipid in compared to its gradual dose in very low birth weight newborns in Iran. Methods: This study was a case-control study that conducted on 104 very low birth weight infants (0.05). Conclusion: Given that the better and faster growth of newborns in the intralipid group with high-dose in compared to intralipid group with gradual dose, the use of higher initial doses is recommended in newborns with very low birth weight.

Introduction Choice of appropriate nutrition has a special place, which variations in dietary nutrient can potentially be involved in growth deficits in preterm neonates. Aim to investigate the effect of protein supplementation in very low birth weight (VLBW= birth weight under 1500 grams) infants on neurological growth in the third year of birth. Material and methods We investigated neurological growth in two groups of control and intervention (each group, n= 18 subjects). The intervention group includes 3-year-old children who weighting less than 1200 grams at birth and have received protein supplementation at the course of NICU hospitalization, protein was added to maternal milk when the amount of milk reaches to 100 cc/kg/day, at this time parenteral nutrition was discontinued and the volume of feeding was increased 20cc/kg/day until reached to 150-180cc/kg/day. We also added the fortifier to breast milk at this time (FMS- Aptamil- DANON). The fortification and the protein supplementation were stopped when the weight of the baby reached to 1500 grams. The control group was fed similar to the intervention group, without protein supplemental intake. Neurodevelopmental outcomes were evaluated using ASQ, NEWSHA and BINS tools. Results There was no significant difference between the mean head circumference in the two groups (p=0.209). There was no significant relationship between neurological growth rate evaluated by BINS tool in two groups (p=0.266). There was a significant correlation between the neurological development assessed by the ASQ tool in the areas of communication (p=0.014) and gross motor (p=0.001) in the two groups, however, no significant relationship was found in terms of fine motor (p=0.63), problem solving (p=0.07) and personal-social relationships in both groups (p=0.152). There was a significant correlation between neurological development evaluated using the NEWSHA tool in terms of auditory (p=0.031), verbal language (p=0.024), cognitive (p=0.007), social connection (p=0.034) and motor (p=0.002) in the two groups. Conclusion Protein intake in preterm infants didn't reveal long term effects on the growth of head circumference. Moreover, it was capable of improving neurological growth in the areas of communication and gross motor (based on the ASQ) and auditory, verbal language, cognitive, social connection, and motor (based on the NEWSHA).

Background: The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care. Methods: Three–hundred pregnant mothers without COVID–19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID–19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID–19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21. Results: Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers’ anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID–19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%). Conclusion: COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.

Background: Mercury is a one of the pollutant that can cross the placenta. Contamination by mercury in mothers and their neonates is associated with many problems. Objectives: This study aimed to compare mercury levels of cord blood in term and preterm neonates in Akbarabadi Hospital, Tehran, Iran, 2014. Methods: In this analytical cross-sectional study, we evaluated 50 term and 50 preterm neonates who were born in Akbarabadi Hospital in 2014. Necessary information including mother’s age, location, mother’s job, use of amalgam, use of fish, use of blood products and level of mercury were collected. Data were entered into SPSS V.16 and analyzed. Results: Mean age of mothers was 30.1 (SD = 6.4) years. Location in 86 (86%) were Tehran and in 14 (14%) were out of Tehran. Mean of mercury in neonatal cord blood was 2.7 (SD = 1.3) µg/L. There was significant difference between this mean in term and preterm neonates (P value = 0.009), while mean of mercury level in term neonates was 2.3 (SD = 0.7) µg/L and in preterms was 3 (SD = 1.7) µg/L. Mean of using fish in term neonates was1.2 (SD = 1.3) and in preterms was 1.6 (SD = 2.5). We could not find any significant difference between mercury level and using amalgam, fish and blood products in term and preterm neonates (P value > 0.05). Conclusions: Mercury level of cord blood in our study was higher compared to other studies, although it is not in the level of toxicity. Also we found that mercury level in preterm neonates is significantly higher than term neonates, therefore evaluating factors affecting mercury levels in neonates is essential.

Very Low Birth Weight (VLBW) infants have higher nutritional needs than term infants. Energy and protein are two important factors influencing their growth. Breastfeeding is not enough to meet VLBW infants’ needs, for this reason, complementary protein is required by them. Hence, the present study aimed at investigation of renal function among VLBW infants receiving complementary proteins. The study was conducted on two groups of intervention and control (n= 18 in each group) (Case study: VLBW infants born in Akbarabadi hospital of Tehran in 2014 2015). The intervention group includes 3-year-old children who weighting less than 1200 grams at birth and have received protein supplementation at the course of NICU hospitalization, protein was added to maternal milk when the amount of milk reaches to 100 cc/kg/day, at this time parenteral nutrition was discontinued and the volume of feeding was increased 20cc/kg/day until reached to 150-180cc/kg/day. We also added the fortifier to breast milk at this time. The fortification and the protein supplementation were stopped when the weight of the baby reached to 1500 grams. The control group was fed similar to the intervention group but had received no complementary protein . The renal function was evaluated by measuring such criteria as BUN, Cr, ALB and U/A. After data collection, a statistical analysis was performed using SPSS software Ver. 22. Following to BUN evaluation, a significant correlation was seen between BUN and received protein (p-value=0.010). However, there was no significant correlation between Cr and received protein as well as mean values of the two groups (p-value=0.0766). Similarly, an insignificant correlation was found between the two groups following to investigation of ALB (p-value=0/257), while the mean values of the two groups were similar. The both groups were also equal in U/A. The complementary protein increased the BUN with no effect on Cr, ALB and U/A, providing no impact on renal function. Therefore, complementary protein intake made no conflict in renal function.

A homozygous truncating mutation in nonreceptor tyrosine phosphatase 14 (PTPN14) has recently been associated with an extremely rare autosomal recessive syndrome of congenital posterior choanal atresia and childhood-onset lymphedema. PTPN14 has been shown to interact directly with the vascular endothelial growth factor receptor 3 (VEGFR3), a receptor tyrosine kinase essential for lymphangiogenesis. Here we present an Iranian family with a single child affected by high-arched palate, congenital hypothyroidism, dysmorphic face, bilateral choanal atresia and infantile-onset lymphedema. Screening of the PTPN14 revealed a novel homozygous frameshift mutation in exon 4 predicted to result in premature truncation of the polypeptide product, which segregated with the disease phenotype. To our knowledge, this is the second family with “choanal atresia and lymphedema syndrome” to be reported worldwide. In contrast to the first reported family that showed lymphedema in late childhood, the patient described here displays lymphedema in her lower limbs at early infancy associated with growth delay, mild facial swelling, congenital hypothyroidism and some minor developmental abnormalities. This report confirms the causality of PTPN14 loss-of-function mutations and further expands the clinical phenotype of this rare genetic syndrome.

OBJECTIVES: The objective of this study was to investigate the relationship between the postnatal umbilical coiling index (pUCI), and intrapartum and neonatal outcomes in parturients with gestational diabetes mellitus (GDM) and non-GDM. METHODS: An evaluation of the umbilical cords and pUCI of 117 neonates of GDM and 105 of non-GDM parturients were prospectively studied within 24 h after delivery. Furthermore, obstetric history, intrapartum and neonatal data were recorded. RESULTS: Premature rupture of membrane (PROM) (p = 0.001), emergency cesarean delivery (p = 0.01), spontaneous preterm delivery (p = 0.006), duration of hospital admission (p

Aims A dramatic increase in newborn infants with neonatal abstinence syndrome has been observed and these neonates are frequently treated with complex methadone dosing schemes to control their withdrawal symptoms. Despite its abundant use, hardly any data on the pharmacokinetics (PK) of methadone is available in preterm neonates. Therefore we investigated developmental PK of methadone and evaluated current dosing strategies and possible simplification in this vulnerable population. Methods A single-centre open-label prospective study was performed to collect PK data after a single oral dose of methadone in preterm neonates. A population PK model was built to characterize developmental PK of (R)- and (S)-methadone. Model-based simulations were performed to identify a simplified dosing strategy to reach and maintain target methadone exposure. Results A total of 121 methadone concentrations were collected from 31 preterm neonates. A one-compartment model with first order absorption and elimination kinetics best described PK data for (R)- and (S)-methadone. Clearance increases with advancing gestational age and differs between R- and S-enantiomer, being slightly higher for the former (0.244 vs 0.167 L/h). Preterm neonates reached target exposure after 48 hours with currently used dosing schedules. Output from simulations revealed that target exposures can be achieved with a simplified dosing strategy during the first 4 days of treatment. Conclusion Methadone clearance in preterm neonates increases with advancing gestational age and its disposition is influenced by its chirality. Simulations that account for developmental PK changes indicate a shorter methadone dosing strategy can maintain target exposure to control withdrawal symptoms.

Background: Persistent pulmonary hypertension (PPHN) is a life-threatening condition in neonates. In developing countries, mortality is estimated to be around 10%–20% due to lack of access to the main drug, inhaled nitric oxide. Bosentan as an endothelin type A and B receptor antagonist and sildenafil as a phosphodiesterase inhibitor type 5 are effective in reducing pulmonary vascular resistance and pulmonary artery pressure (PAP). Materials and Methods: A double-blind clinical trial was conducted at the intensive care unit of Akbarabadi Hospital Tehran between October 2017 and September 2019. The efficacy, safety, and possible side effects of bosentan and sildenafil were evaluated in neonates suffering from PPHN. Echocardiographic findings, duration of oxygen dependency, invasive ventilation support requirement, duration of medication, short-term outcomes including blood pressure, white blood cell, and hemoglobin counts were compared between the two groups. Results: Bosentan is as effective as sildenafil in reducing PAP and improving cardiac output. The duration of treatment with bosentan was significantly shorter than that of sildenafil (P = 0.002). The time of oxygen demand was similar between both the groups, ranging from 15 to 17 days (P = 0.198). The need for invasive ventilation support was similar in both the groups (P = 0.989). Although PAP and the severity of tricuspid valve insufficiency were higher before treatment, the third echocardiographic findings such as pulmonic insufficiency (P = 0.194), tricuspid regurgitation (P = 0.368), and ejection fraction (P = 0.160) were similar in bosentan and sildenafil groups. The need for supportive inotropic drugs was similar in both the groups. There was no statistically significant difference in the mean of blood pressure, white blood cell, and hemoglobin counts between the two groups.Conclusion: Bosentan is effective in the treatment of PPHN in neonates and reduces it over a shorter period of time. It is more efficient in reducing PAP and decreases the severity of tricuspid valve insufficiency in a shorter time compared to sildenafil.

Background Developmental dislocation of the hip joint is among joint abnormalities and lack of its early diagnosis leads to irreversible complications and disabilities. Methods The current cross sectional study was conducted on 210 eighteen - month - old premature infants. Premature infants at term gestational age were examined by a neonatologist and underwent a sonographic scanning by a skilled radiologist. The results of the physical examination and ultrasound reports were collected and analyzed. Results In the clinical assessment, hip joint examination was diagnosed abnormal in 22 cases (10.4%) and joint dislocation was diagnosed by ultrasonographic examination in 17 patients (8.1%). In one high - risk case, despite normal clinical examination (0.48%), the dislocation was diagnosed by ultrasonographic evaluation. There was a significant relationship between hip dislocation rate, and reduced mean gestational age and birth weight (P < 0.05). The dislocation prevalence in the twins was significantly more than that of other infants (P = 0.001). In the current study, there was no statistically significant relationship between gender, family history, oligohydramnios, presentation, and type of delivery with joint dislocation (P > 0.05). In diagnosis of joint dislocation, clinical examination (the results of the Ortolani and the Barlow tests) had sensitivity of 94% and specificity of 97% compared with sonography; the positive and negative predictive values were 73% and 99%, respectively. Conclusions Clinical examination has high sensitivity and specificity for early diagnosis of developmental hip dislocation. If there are risk factors, ultrasonographic scanning is recommended despite normal physical examination, and ultrasound is not necessary in case of normal physical examination and the absence of risk factors.

Background: The present study aimed to assess the efficacy of omega-3 in treating ROP in premature infants. Methods: This randomized double-blinded controlled trial was performed on 160 premature infants with gestational age lower than 32 weeks and birth weight < 1500 grams who were at risk of ROP development (Tehran, Iran-2013). Children were randomly assigned to two groups. The intervention group received 300 mg omega-3 daily and the control group received sterile water as the placebo. The severity of ROP was defined according to the International Classification of ROP. Results: The frequency of ROP was 7.5% in the group received omega-3 and 20.0% in the placebo group with a significant difference (p = 0.021). Regarding the severity of ROP in the intervention group, ROP grade I was found in two patients and ROP grade II in four patients; while ROP grade I, II, and III were revealed in 6, 6, and 4 patients in placebo group indicating a significant difference between the two groups (p = 0.001). Using the multivariate logistic regression modeling with the presence of gender, gestational age, and birth weight, the use of omega-3 was associated with reduced risk for ROP (p = 0.045). Conclusion: The use of omega-3 supplement can be an appropriate treatment option for the treatment of ROP in premature infants.

The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups' amniotic fluid index5 cm and amniotic fluid index ≥5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index5 cm group [7(14.6%) versus 1(2.3%), p = .039, RR = 7.7 (95%CI 0.04-0.06) and 11(30.9%) versus 2(4.7%), p = .013, RR = 6.095 (95%CI = 1.26-29.31)]. In the subgroups of two categories of gestational ages of 26

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (

Background: Intraventricular hemorrhage (IVH) is a common complication seen in premature infants. Since the brain intraventricular hemorrhage in any degree of risk is an important factor in long-term neuropathology, the role of magnesium sulfate on cerebral hemorrhage requires further investigation. Therefore, this study aimed to investigate the effect of magnesium sulfate on intraventricular hemorrhage in infants of mothers with premature rupture of membranes. Methods: This study is a double blind clinical trial (IRCT: IRCT2016080729223N1) on 120 pregnant women with premature rupture of membranes at 34 weeks admitted to the hospital of Shahid Akbar Abadi that were selected based on the inclusion criteria and assigned to two groups (magnesium sulfate recipients and non-recipients). The significance level was set at p

AimsA dramatic increase in newborn infants with neonatal abstinence syndrome has been observed and these neonates are frequently treated with complex methadone dosing schemes to control their withdrawal symptoms. Despite its abundant use, hardly any data on the pharmacokinetics of methadone is available in preterm neonates. Therefore we investigated developmental pharmacokinetics of methadone and evaluated current dosing strategies and possible simplification in this vulnerable population.MethodsA single center open-label prospective study was performed to collect pharmacokinetic data after a single oral dose of methadone in preterm neonates. A population pharmacokinetic model was built to characterize developmental pharmacokinetics of methadone and to assess the effects of weight and age on clearance and volume of distribution. In addition, simulation techniques were applied to evaluate reported dosing scenarios, investigate methadone exposure levels and examine the feasibility of simplified dosing recommendations.ResultsIn total, 121 methadone concentrations were collected from 31 preterm neonates. The median weight and gestational age amounted 1.6 kg and 32 weeks, respectively. A one-compartment model with first order absorption and elimination kinetics best described the data for (R)- and (S)-methadone. Clearance was observed to be higher for the (R)-enantiomer as compared to the (S)-enantiomer (0.244 versus 0.167 L/h). Target exposures, based on simulations, can be maintained with a simplified dosing strategy during the first four days of treatment. It is therefore questionable if there is a need for the currently used more extended dosing regimen of methadone in neonates.conclusionsThis clinical investigation demonstrates that the clearance of methadone increases with advancing gestational age and higher clearance values and volumes of distribution can be observed for (R)-methadone as compared to (S)-methadone in preterm neonates. Simulations that account for developmental pharmacokinetics indicate that a simplified methadone dosing strategy can maintain target exposure to control withdrawal symptoms in preterm neonates.Disclosure(s)Nothing to disclose

Background Ghrelin is a pleiotropic hormone that regulates feeding and energy balance and stimulates growth hormone release. Ghrelin also exerts developmental and organizational effects during prenatal life. Objectives The aim of this study was to determine ghrelin levels in cord blood of small for gestational age (SGA) infants and its association with GH (growth hormone) and IGF-1 levels (insulin-like growth factor-1). Methods Cord blood sample was obtained from 31 SGA and 25 appropriate for gestational age (AGA) infants. Acylated ghrelin, GH, and IGF-1 levels were measured by enzyme-linked immunosorbent assay. Results No significant differences were observed in ghrelin and GH concentrations between SGA and AGA infants. However, IGF-1 levels were significantly lower in SGA infants. Cord blood ghrelin was negatively correlated with the infants’ birth weight (r = -0.33, P = 0.013); on the other hand, IGF-1 level was positively correlated with birth weight (r = 0.43, P = 0.002). Conclusions IGF-1 has the most significant effect on intrauterine growth. Acylated ghrelin is detectable in cord blood and correlated with birth weight, suggesting a role in intrauterine development, but its level is not affected by intrauterine growth retardation.

Intravascular large cell lymphoma (IVL) is a rare subtype of large cell lymphoma that is characterized by the proliferation of lymphoma cells within the lumina of small blood vessels, without an ob...

Intraventricular hemorrhage (IVH) is one of the most serious neurological morbidities in preterm infants. Several prenatal, intrapartum, and neonatal risk factors have been detected in different studies. However, maternal conditions that may render the neonates to IVH have been the subject of very few studies. Preterm infants with and without IVH were included in the study, and maternal obstetrics and general health clinical files were reviewed for any kind of morbidity. Data were then analyzed with statistical software to assess the association between maternal conditions and IVH. A total of 115 neonates with IVH and 120 infants without IVH were recruited. Among all maternal conditions, prolonged rupture of membrane (p = 0.00), laparoscopic surgery for infertility (p = 0.001), and in vitro fertilization (IVF) (p = 0.00) increased the risk of IVH in neonates significantly. IVF remained strongly associated with IVH even after controlling for confounding variables (odds ratio: 9.75; confidence interval: 2.66–35.75; p = 0.001). Based on our findings, prolonged rupture of membrane and IVF were maternal conditions that increased the risk of IVH. Laparoscopic surgery for infertility was also associated with an increased risk of IVH.

A deeper understanding of the variance of epidermal cell proliferation may eventually increase the reproducibility of diagnostic classification. A prospective study of 46 consecutive, unselected biopsies from benign (keratoacanthoma n=14), premalignant (actinic keratosis n=15 and Bowen disease n=10) and malignant (squamous cell carcinoma n=7) skin lesions was studied to assess the presence and extent of differences in expression of the proliferation marker Ki-67 using a monoclonal antibody directed against a c-DNA defined subsegment (MIB-1) and a noncross-linking, proprietary fixative BoonFix. MIB-1 was expressed in the adjacent, non-affected skin in a scattered to confluent linear pattern in the basal/suprabasal cell layer. In actinic keratosis, MIB-1 expression, in addition to basal/suprabasal layers, extended to mid-zones of the epidermis. An interesting feature in actinic keratosis as well as in Bowen disease was the expression of MIB-1 in the epithelium lining the hair follicles. In Bowen disease, MIB-1 was observed throughout the full thickness of the epidermis, unequivocally separating this entity from others under study. In invasive squamous cell carcinoma, MIB-1 expression was not consistent between and within cases. MIB-1 positivity was variably found in all layers of the epidermis, but showed a chaotic and haphazard pattern with total loss of polarity. Keratoacanthoma cases showed highly variable MIB-1 expression, ranging from no expression to expression in both basal/suprabasal and mid-zone layers of the epidermis. These results warrant further study of modulation of cell proliferation in actinic keratosis.