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Objective: Inadequate breastfeeding is the most important cause of neonatal dehydration hypernatremia (NDH). This study aimed to define the relationship between breastfeeding frequency and NDH. Methods: A total of 934 infants (574 isonatremic and 360 with NDH) were enrolled in this cross-sectional study at Ghaem Hospital, Mashhad, Iran, in 2014–2022, assigned into low feeding frequency (<8 times/day) and proper feeding frequency (≥8 times/day) groups, and compared for NDH intensity according to a researcher-made questionnaire. Results: The admission age (p =.001) and weight (t (931) = 1.864, p =.063), urination frequency (t (931) = −8.742, p =.001), defecation frequency (t (931) = −5.372, p =.001), serum sodium (t (931) = 13.541, p =.001), urea (t (931) = 9.721, p =.001), and creatinine levels (t (931) = 7.613, p =.001) showed significant differences between the two groups. Interestingly, 56.27% of infants with NDH and only 10.28% of isonatremic infants had low feeding frequencies. Conclusions: Low feeding frequency and duration were associated with weight loss and increased serum sodium levels. A group of infants who had a feeding frequency of less than eight times a day, a history of cesarean delivery, breast problems, and a lack of let-down reflex was associated with an increased incidence of low weight; higher levels of serum sodium, urea, and creatinine; and reduced frequency of urination and stool passage. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this large-scale, retrospective study was to identify the maternal and infantile factors influencing neonatal growth metrics within the 1st month of life. Materials and Methods: Data were collated from the Sina Electronic Health System between 2015 and 2018. The study employed the World Health Organization (WHO) Z-score system for categorizing neonatal growth and utilized logistic regression models to explore associations between maternal and infant characteristics and neonatal growth metrics. Results: The study comprised 137,548 neonates, with a slight male predominance (51%). An overwhelming 98% of infants were breastfed. The logistic regression analysis revealed male gender as a significant predictor for higher weight-for-age Z-score (WAZ) (odds ratio [OR] = 1.268, P < 0.001), height-for-age Z-score (HAZ) (OR = 1.316, P < 0.001), and weight-for-height Z-score (WHZ) scores (OR = 1.137, P = 0.015). In addition, vaginal delivery was strongly associated with higher WAZ (OR = 1.176, P < 0.001), HAZ (OR = 2.109, P < 0.001), and WHZ scores (OR = 1.176, P = 0.003). The influence of breastfeeding was particularly noteworthy, with significant associations with higher WAZ (OR = 1.934, P < 0.001), HAZ (OR = 5.435, P < 0.001), and WHZ scores (OR = 1.558, P = 0.008). Conclusions: Our robust analysis substantiates the significant influence of male gender, vaginal delivery, and breastfeeding on neonatal growth metrics, as evidenced by elevated WAZ, HAZ, and WHZ scores. The findings provide a compelling argument for the promotion of natural birthing methods and breastfeeding, and they highlight the role of gender in neonatal growth outcomes during the initial month of life. [ABSTRACT FROM AUTHOR]

Background: There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates. Materials and Methods: The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool. Results: The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth-minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short-term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates. Conclusions: Based on the results of the present study, emergency C-section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high-risk neonates through umbilical cord NRBC measurement immediately after delivery and special care. [ABSTRACT FROM AUTHOR]

Objective: Oxidative stress (OS) is due to a disturbance in the balance between the production of free radicals and antioxidant defense, resulting in a predominance of free radicals over endogenous anti-oxidant defenses. OS may have many causes. Pregnancy, and especially delivery, are associated with increased OS. The relationship between maternal and infant prooxidant-antioxidant balance (PAB) is unclear. Therefore, the aim of the present study was to compare PAB in mother and baby pairs. Material and Methods: This cross-sectional study was conducted in 104 mothers and normal term infants during 2017-2020. PAB was measured in healthy mothers before delivery and in umbilical cord samples after delivery. Data on the infant characteristics including age, gestational age, birth weight, Apgar score, and maternal history including the duration of mother's education, weight of the last month, and gravidity were collected using a researcher-made questionnaire. The cord and maternal PAB were compared by statistical methods. Results: In this study, the mean PAB of the neonates and mothers was 30.76 and 214.87 HK, respectively. The results revealed a moderate association between the PAB neonate and maternal PAB before delivery but it was not significant. Conclusion: Overall, the level of oxidants and antioxidants reduced during pregnancy and before delivery, and it was found that the relative incidence of neonatal PAB increases by increasing maternal PAB. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress is thought to be a major contributor to complications during pregnancy, for example preeclampsia. However, reports regarding prooxidant-antioxidant balance in uncomplicated pregnancy are inconsistent. In this study, we aimed to compare the levels of oxidative stress in non-pregnant women with apparently normal pregnant women during the first trimester and at delivery. Methods: An assay for the determination of prooxidant-antioxidant balance (PAB) was used in this study, in which the prooxidant burden and the antioxidant capacity were measured simultaneously in a single assay. The levels of oxidative stress were determined in 85 non-pregnant and 64 primigravid pregnant women. Results: Demographic data and biochemical indices did not differ significantly between the groups. Differences between PAB values were significant based on one-way ANOVA analysis (P

Objectives Precise and early diagnosis of neonatal asphyxia may improve outcomes. Recent studies aim to identify diagnostic biomarkers in neonates at risk for brain damage. The current study was designed to evaluate the diagnostic value of new biomarkers for neonatal asphyxia. Materials & Methods This prospective study was conducted with an available sampling of infants upper 35 weeks of gestational age, including neonates with asphyxia (case group) and healthy controls, 2014-2022, in Ghaem Hospital, Mashhad, Iran. Data collection was performed utilizing a researcher-made questionnaire, including maternal and neonatal characteristics, as well as clinical and laboratory evaluation. Serum umbilical cord levels of interleukin-6 (IL6), interleukin-1-beta (IL-1β), pro-oxidant-antioxidant balance (PAB), and heat shock protein-70 (HSP70), as well as nucleated red blood cells count (NRBC), were determined. Data were analyzed by t-test, Chi-square, receiver operating characteristic (ROC), and regression models. Results The differences in variables IL6, IL1β, PAB, NRBC/100WBC, and HSP70 were statistically significant between the two groups (in all cases, P<0.0001). In the diagnosis of asphyxia, the most sensitive marker (89%) was IL1β more than 2.39 pg/ml and HSP 70 upper than 0.23 ng/ml, while IL6 was higher than 9pg/ml, determined as the most specific marker (85%). Furthermore, a combination of HSP + PAB and IL6 + lL1b + PAB + NRBC/100WBC possesses the prediction power of 93.2% and 87.3%, respectively, for diagnosing asphyxia. Conclusion According to data analysis, the combination of new biochemical markers (NRBC count, IL6, IL1β, PAB, and HSP 70) could be a reliable marker for diagnosing infants with asphyxia. [ABSTRACT FROM AUTHOR]

Introduction: Nucleated red blood cell (NRBC) count can be used as a simple indicator for evaluation of the severity and primary outcomes of perinatal asphyxia. The current study has aimed to define the predictive value of NRBC count in the diagnosis and outcomes of preterm neonates with asphyxia. Materials and Methods: This cohort study was performed on 353 preterm (gestational age <37 weeks) neonates (168 asphyxia [47.6%] and 185 nonasphyxia [52.4%] neonates) from 2017 to 2021. The neonatal data were recorded. Denver II test was performed at 6, 12, 18, and 24-month follow-up visits. The children were then categorized into two groups of favorable and nonfavorable outcomes (death or developmental delay). Results: NRBC count and NRBC/100 white blood count (WBC) in asphyxia preterm neonates (30 ± 69.6 × 10²/mm³ and 9.6 ± 11.2) were significantly higher than nonasphyxia preterm neonates (32.3 ± 54.4 × 10²/mm³ and 7.6 ± 9) (P < 0.001). Furthermore, NRBC count and NRBC/100 WBC in preterm asphyxia neonates with unfavorable outcomes (29.2 ± 52.4 × 10²/mm³ and 32.17 ± 80.8 × 10²/mm³) were significantly higher than those with normal outcomes (15 ± 30.4 × 10²/mm³ and 10.14 ± 19.17 × 10²/mm³) (P < 0.001). NRBC count >370 had sensitivity and specificity of 69.5% and 57.3%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 63.2% and 63.6% in diagnosing asphyxia in preterm neonates. Furthermore, NRBC count >370 had sensitivity and specificity of 72.6% and 53.8%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 70.5% and 65.1% for the prognosis of asphyxia preterm neonates. Conclusions: According to our findings, NRBC/100 WBC >370 and total NRBC >8% are suitable sensitive predictors of the prognosis of preterm neonates with asphyxia. Evaluation of NRBC count and NRBC/100 WBC can help in the diagnosis of asphyxia and prognosing unfavorable outcomes of asphyxia in asphyxia preterm neonates. [ABSTRACT FROM AUTHOR]

Background:. Hemophagocytic lymphohistosis (HLH) is a life-threatening clinical syndrome that involves liver dysfunction and can range from mild dysfunction to severe fulminant insufficiency. Cholestasis, which is a frequent finding in many severe newborn illnesses, may also be a symptom of HLH. Therefore, HLH should be considered in the differential diagnosis of all cholestatic patients with cytopenia. In this report, we identified a case of HLH with cholestasis. The patient met at least seven out of the eight requirements of the HLH-2004 criteria. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils (PMNs), more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of HLH with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours. Case report: The patient was a 21-day-old infant with a birth weight of 3450 g. He developed fever and jaundice 10 days after a normal delivery, and he was referred to Sarakhs Hospital when he was 14 days old and hospitalized for 3 days. Later, he was sent to Ghaem Hospital and admitted to the Neonatal Intensive Care Unit. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. According to his mother, there was no history of any problems from birth, and the baby's jaundice started after the first week. Examinations showed abdominal distention and hepatosplenomegaly. Due to neonatal cholestasis and fever, he underwent a complete sepsis workup with vancomycin and cefotaxime. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils, more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein, and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of hemophagocytic lymphohistiocytosis (HLH) with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours. Conclusion:HLH is uncommon in the neonatal stage, and aberrant clinical and laboratory findings suggestive of HLH can be found in a variety of conditions. The severity of this condition makes it crucial to get a diagnosis as soon as possible. In the presence of additional variables, such as cytopenia and hyperferritinemia, HLH should be considered in the differential diagnosis of cholestasis in a neonate. [ABSTRACT FROM AUTHOR]