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Background and Objective: Neonatal thrombocytopenia (NTP) is one of the most common neonatal hematological disorders. The causes of NTP are very various, leading to large differences in the clinical profile of the affected neonates. Therefore, the aim of this study was to investigate the characteristics, clinical diagnoses and short-term outcomes of NTP in Bahrami Children's Hospital, Iran. Methods: This descriptive retrospective cross-sectional study was conducted on all neonates admitted to the neonatal intensive care unit (NICU) of Bahrami Children's Hospital in 2017-2019. The infants diagnosed with NTP, defined as a platelet count of <150000 on at least 2 occasions, were retrospectively evaluated. Data on patients' NTP and short-term outcomes were reported. Incomplete medical records were excluded from the study. Findings: Out of 2000 neonates, 210 patients were diagnosed with NTP with a prevalence of 10.5%. Totally, 60% and 71.4% of infants were premature and underweight, respectively. Moreover, 30 and 20.9% of infants had premature and severe NTP, respectively. The most common clinical diagnosis was sepsis (68.1%). The mean length of stay in NICU was 12.3±9.5 days. Additionally, 20.9% of infants had at least one episode of severe hemorrhage, received a platelet transfusion, and 10.4% of infants expired during their NICU stay. Conclusion: The prevalence of NTP was 10.5%. Despite the relatively high prevalence of preterm birth, low-birth weight and sepsis, the majority of our neonates recovered. Prospective studies are recommended to investigate the role of each predisposing factor in the development and outcome of NTP. [ABSTRACT FROM AUTHOR]

Background: Persistent pulmonary hypertension of the newborn (PPHN) is caused by the inability of the pulmonary arteries to dilate at birth, which leads to severe hypoxemia. Several risk factors have been identified in association with its occurrence and prognosis. The present study aimed to determine the incidence of PPHN, describe neonates’ characteristics, and evaluate the etiology, as well as mortality risk factors in newborns hospitalized due to PPHN at Bahrami Children’s Hospital, Tehran, Iran, from 2017 to 2020. Methods: A total of 49 neonates were included in the present study. The PPHN diagnosis was based on clinical criteria and echocardiography provided by neonatologists. Therefore, a complete history, physical examination, and laboratory data were gathered. Afterward, PPHN etiology was determined, and the patients were followed up for six months. Finally, PPHN prevalence was calculated and probable risk factors for its complications were investigated by using logistic regression analysis. Results: The findings revealed that the prevalence of PPHN was 3.5% in the center under study, and the mortality rate, as well as complete recovery, were 24.5% and 63%, respectively. It was also found that factors, such as male gender, abnormal Apgar score at birth, and cesarean delivery, were high in a percentage of PPHN patients; however, they were not associated with PPHN mortality and morbidity. The only variable that had a significant association with mortality and morbidity was an abnormal white blood cell count. Conclusion: The need for inotropic support was associated with poor outcomes. From the aspect of etiology, there exists higher mortality rates, complications, and poor prognosis among PPHN patients with underdevelopment, compared to the ones with maldevelopment. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is aimed at investigating and evaluating respiratory patterns between infants hospitalized with brief resolved unexplained event (BRUE) and the control group. Methods: A convenient sampling method was used to select 52 patients presented at an urban, tertiary, and teaching pediatric hospital fitting the American Academy of Pediatrics' criteria of a lower-risk BRUE from December 2019 to December 2020. A random probability sampling method was used to select 52 patients as a control group. A NINIX apnea monitoring device was used to record respiratory time patterns and analyzed with SPSS 25. Results: A total of 104 participants participated in the study. Our study found that inspiration time (0.31 ± 0.04), expiratory time (0.93 ± 0.14), respiratory rate (38.48 ± 4.38), body temperature (37.11 ± 0.20), and heart rate (137.90 ± 6.60) were not statistically different between both groups. Mean birth weight in the control group and BRUE were respectively (3.43 ± 0.39, 3.23 ± 0.35). Mean gestational age in the control and BRUE groups were respectively (38.94 ± 1.01, 39.0 ± 1.04). Mean postnatal age in the control and BRUE groups were respectively (17.19 ± 6.07, 17.32 ± 7.35). Birth weight (P = 0.08) was statistically significant between both groups. In one patient, we recorded breath arrest for more than 20 s. Conclusion: There were no significant differences in respiratory patterns between infants hospitalized with BRUE and the control group. Low birth weight and low APGAR score are possible risk factors for infants experiencing BRUE, and more investigations are required to establish underlying causes. [ABSTRACT FROM AUTHOR]

Limb bud first appears during the third week of gestation with the upper limb buds appearing a few days before the lower limb buds. Complete absence of one or more limbs, called Amelia, occurs prior to the eighth week of gestation. We report a case of Amelia in a twin gestation.

Background and Objective: Intraventricular hemorrhage (IVH) is a major cause of brain injury in preterm infants. Considering the high prevalence of IVH in preterm infants and the importance of determining the risk factors, this study was done to evaluate the prevalence of various grades of IVH and identify the different associated factors and short-term complications. Methods: In this retrospective study, the medical records of 54 preterm infants (26-37 weeks gestational age) admitted to the neonatal intensive care unit (NICU) of Bahrami Hospital, Tehran, Iran (2015-2018) were examined. Cranial ultrasonography was performed in all patients, and IVH was classified into 4 grades. A checklist was prepared and filled them out, and then the data were analyzed using SPSS-21. Findings: Out of all subjects, IVH was found in 11 infants (20.4%). The most frequent IVH grades were 1 and 2. The most common Apgar scores in the fifth minute was 6. The mean weight of infants and Apgar score in patients with IVH was significantly lower than that of those without IVH. In multivariate logistic regression analysis of factors affecting IVH, Apgar score was the only significant independent predictor of IVH, such that with each number increase in Apgar score, the risk of IVH decreased (up to 100%). Conclusion: Based on the results of this study, birth weight, gestational age and fifthminute Apgar score were associated with IVH. Prevention of preterm birth and other preventive measures can reduce the complications of this disease. [ABSTRACT FROM AUTHOR]

Background and Objective: Neonatal jaundice is a common condition among neonates in the first few days of life and is a leading cause of admission among neonates. The aim of this study was to investigate the most common risk factors associated with severe neonatal hyperbilirubinemia (NNH) and short-term complications of the exchange transfusion (ET). Methods: In this retrospective study, the medical records of newborns <28 days with severe hyperbilirubinemia who underwent ET during 2015-2018 were analyzed. Medical records and files were searched using the keyword "exchange transfusion". The clinical and demographic characteristics of the study population as well as the short-term complications of ET were descriptively analyzed. Findings: Totally, 74 newborns with the mean age of 5.6±3.4 days were included in the current study. The baseline mean peak total serum bilirubin (TSB) was 25.8±5.7 mg/dl. In neonates, the ABO incompatibility was the most frequent cause of severe hyperbilirubinemia requiring ET (54.1%), followed by sepsis (39.2%). Moreover, 57.7% of neonates developed complications secondary to ET. The most common complication was hyperglycemia (71.6%), followed by thrombocytopenia (48.6%). Conclusion: Hemolysis and sepsis are common causes of NNH; therefore, the extensive screening and identification of the at-risk population can help decrease the incidence of severe NNH. Frequent monitoring of blood sugar and screening of thrombocytopenia before and after ET procedures are necessary to reduce adverse events. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a generalized bacterial infection which occurs in the first month of life. Intraventricular hemorrhage is the most common intracerebral disorder which occurs in premature neonates. Mean Platelet Volume (MPV) is considered as a marker of intraventricular hemorrhage (IVH) in some studies. The aim of this study was to evaluate the impact of MPV on IVH and sepsis in neonates. Materials and methods: In this retrospective case-control study, 20 premature neonates with sepsis and 20 with sepsis and intraventricular hemorrhage were considered as case groups and 20 premature neonates without sepsis and IVH were regarded as control group. Demographic data as well as patients' data on IVH presence, IVH grading, mortality, platelet account, and MPVon the first and third days after birth were recorded using their medical files. After data collection, analysis was performed using SPSS (version 21) and running descriptive and analytical methods (T test, ANOVA and Chi square test). Results: In this study, 10 newborns (50%) in the sepsis group, 13 newborns (65%) in the IVH - sepsis group, and 10 newborns (50%) in the control group were male (P = 0.523). Mean ± standard deviation of gestational age and weight at birth were significantly lower in the IVH and sepsis group in comparison with the other two groups (P-value < 0.001). Considering platelet count on first day, no significant difference was observed among three groups; however, it was lower in the control group than the sepsis group as well as the IVH and sepsis group (P=0.004). Gender, birth weight, gestational age, onset of sepsis, and presence of respiratory distress syndrome (RDS) could not make significant changes in MPV three groups. Conclusion: The results showed that MPV on the first day was significantly higher in patients with sepsis or with sepsis and IVH. [ABSTRACT FROM AUTHOR]

Objective: To evaluate association between polymorphism rs1670533 in RNF212 gene with the risk of Down syndrome in young women. Materials and methods: In a case control study, one hundred pregnant women were evaluated in both group. The case group consisted pregnancy with diagnosis of Down syndrome in women younger than 35 years old. The control group consisted pregnancy with normal neonate. Fifty pregnant women in each group were allocated.one hundred blood samples were collected. Genomic DNA was extracted by salting - out method and polymorphism of rs1670533 were detected by PCR.PCR products were detected on 2% agarose gel electrophoresis. Results: The TTrs1670533 haplotype was present in 36% of pregnant women with Down syndrome versus 14% of normal pregnant women, (p = 0.003 e-12; CI 95%1.665-5.305, OR = 3.107); TC haplotype was present in 56% of normal pregnancy regarding of %16 of pregnancy with Down syndrome (p = 4.288 e = 12; CI 95%: 0.145-0.25; OR = 0.126). Conclusion: It seems that TTrs1670533 haplotype is a risk factor for pregnancy with Down syndrome in young women and TC haplotype has protective effect. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants' weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation. [ABSTRACT FROM AUTHOR]

Background: This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies (ART) to spontaneous pregnancies. Materials and Methods: In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student’s t test, chi square and logistic regression (p<0.05). Results: There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups (p<0.001). The ART group had significantly higher preterm labor and premature rupture of membranes (PROM) whereas pregnanc-induced hypertension (PIH) was higher in the spontaneous group (p=0.01). Newborn intensive care unit (NICU) admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome (RDS), NICU admission and Apgar score were independent predictors for neonatal complications. Conclusion: Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART. [ABSTRACT FROM AUTHOR]

Dicephalic parapagus tribrachius conjoined twin is a very rare condition. We present a case of 5-days-old male dicephalic parapagus conjoined twins. The conjoined twins were diagnosed in 4th month of pregnancy by ultrasonography. The pregnancy terminates at 36 weeks by cesarean section and triplets were born. The babies were male conjoined twins and another healthy male baby. Many congenital defects of interest can now be detected before birth. Sever form of this malformation precludes postpartum life. It is supposed that with advances in screening methods for prenatal diagnosis these cases are terminated in first or second trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intrauterine growth restriction (IUGR). To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR. Materials and methods: Twenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups. Results: NRBC count/100 white blood cells was significantly higher in the IUGR group (P value<0.001). pH measurements did not reveal any significant difference. Conclusion: Increased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention. [ABSTRACT FROM AUTHOR]

To determine the association between polymorphism of UGT1A1 gene and idiopathic hyperbilirubinemia in Iranian neonates. Fifty neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) more that 15mg/dl and 50 neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) less than 15mg/dl enrolled in this study. Thymine-adenine (TA) repeats in the promoter region of UGT1A1 gene investigated by means of polymerase- chain reaction (PCR) DNA sequencing. Demographic characteristics did not differ significantly between groups while STB was higher in case group (17.5±1.9 vs. 10.4±1.8, p value <0.001). Among one hundred neonates evaluated in this study, TA6/6, TA6/7 and TA7/7 genotypes found in 52%, 42% and 6%, totally. TA6/7 and TA7/7 genotypes observed in case group more than the control group (P<0.001). STB levels were significantly higher in cases with TA6/7 and TA7/7 genotype pattern (P<0.001). Heterozygous and variant homozygous genotypes of the promoter region of UGT1A1 gene in healthy Iranian neonates with idiopathic hyperbilirubinemia should be considered. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of paternal age on preterm births in Iranian neonates. Materials and methods: From January 2005 to January 2006, two hundred eighty one preterm neonates born in Mirza Kuchakkhan Hospital enrolled in this cross-sectional study. A structured questionnaire was applied for recording following data: birth weight, sex, gestational age, maternal age and paternal age. The study was limited to neonates whose maternal age was between 20 and 30 years to eliminate its confounding effect. Results: Near 50% of fathers were between 30-39 years old and more than half of neonates had gestational age between 35-37 weeks. There were no relation between either paternal age (p= 0.1) or birth weight (p=0.5) and neonatal gestational age. In women with parity one, there was not significant difference between gestational age among different paternal age levels ( p= 0.6) as well as women with parity two and three (p=0.2, p=0.3). Conclusion: Paternal age has no effect on gestational age and birth. [ABSTRACT FROM AUTHOR]

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10µg/kg/s.c. to neonates in group A and as 10µg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10µg/kg) was effective in treating neonatal septicemic neutropenia. [ABSTRACT FROM AUTHOR]

Objective: Spinal anesthesia causes hypotension which is a physiologic component during cesarean section. Ephedrine is used for prevention and treatment of maternal hypotension during spinal anesthesia. The aim of this study is to evaluate the effect of transient hypotension which is normalized with ephedrine on fetal outcome. Materials and methods: Eighty women with singleton pregnancies scheduled for elective cesarean section under spinal anesthesia were divided to two groups. The control group was women with normal BP, and case group were women with hypotension who received ephedrine. Two groups were compared for these variables: maternal BP and HR, nausea and vomiting, neonate Apgar and fetal cord blood gases. Results: No difference was found between two groups for variables of age, BMI, weight, height, mean BP, mean HR, serum volume, fetal Apgar in 1 and 5 min and fetal cord fetal blood gases. Dosage of oxytocin used was significantly different between two groups (P-value = 0.003). Conclusion: Transient hypotension which is treated by ephedrine does not have any effect on acid base situation of baby and treatment of hypotension with ephedrine in pregnant women is a safe procedure. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during caesarean delivery. Material and Methods: Total deliveries, caesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in four university hospital. The gestational age, the presenting part of the fetus, the type of incision, and maternal age and parity were recorded. Caesarean deliveries were divided into elective and emergency procedures. Fetal lacerations were grouped according to the location and the need for surgical intervention. Results: Of 19217 deliveries, 8840 women were delivered by caesarean birth (46%). Neonatal records documented 87 accidental fetal lacerations. Of these accidental lacerations, 16 needed surgical repair and 62 recovered by dressing. Head and neck was the most common site of laceration (64.1%). The overall rate of accidental fetal laceration per caesarean delivery was 0.88%. The rate of emergency caesarean was 45 (56.69%) and for elective procedures was 33 (42.4%). The risk for fetal accidental laceration was higher in foetuses who underwent emergency caesarean birth (P<0.001). Conclusion: Fetal accidental laceration may occur during caesarean delivery and its incidence is significantly higher during emergency caesarean delivery. The patient should be counselled about the occurrence of fetal laceration during caesarean delivery to avoid litigation. [ABSTRACT FROM AUTHOR]

Limb bud first appears during the third week of gestation with the upper limb buds appearing a few days before the lower limb buds. Complete absence of one or more limbs, called Amelia, occurs prior to the eighth week of gestation. We report a case of Amelia in a twin gestation. [ABSTRACT FROM AUTHOR]

Nowadays management of severe Rh alloimmunization consists of serial determination of middle cerebral artery peak systolic velocity, amniocentesis, cordocentesis, and in many instances intrauterine transfusion. We present a case of severe Rh alloimmunization who, for the first time in Iran, was delivered at term after several intrauterine transfusions.