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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]

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: Jaundice is the most common problem among neonates. Although neonatal jaundice is highly prevalent in Iran and the prevention and treatment of this disease is incredibly important, few studies have been conducted on the effect of probiotics in the prevention of hyperbilirubinemia in Iran so far. Considering the contradictory results in this regard, this study was conducted to investigate the effect of probiotics in preventing jaundice among neonates. Methods: The statistical population of this three-blinded clinical trial on the first of January 2021 consisted of 196 neonates who were divided into two groups of placebo and intervention. The neonates with a gestational age of more than 37 weeks, birth weight of more than 2,500 grams, and without risk factors for jaundice were included in the study after that the research objectives and procedures were explained to their parents and their informed consent was obtained. Patients were randomly divided into the intervention and placebo groups. The intervention group underwent treatment with probiotics (1010 Saccharomyces boulardii daily for 5 days), while the other group received treatment with a placebo. The level of bilirubin was measured with a skin bilirubin meter and, if necessary (i.e., bilirubin more than 15), a blood test was administered before the intervention and on the third and fifth days after the intervention. The effect of probiotics on jaundice was compared in the two groups. Results: Based on the study results, the level of forehead and chest bilirubin was not significantly different between the study groups before the intervention and 3 and 5 days after the intervention (P> 0.05). In cases that skin bilirubin levels were higher than 15 on the fifth day,the mean serum bilirubin level was obtained at 15.71±0.99 mg/dl and 17.42±1.17 mg/dl in the intervention and placebo group, respectively, which was statistically significant (P = 0.03). Conclusion The results of this study showed that the use of Saccharomyces boulardi decreased the level of serum bilirubin (P=0.03). [ABSTRACT FROM AUTHOR]

Background: Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers. Methods: In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns' conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test. Results: The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy. Conclusion: Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment. [ABSTRACT FROM AUTHOR]

Background: Severe hyperbilirubinemia is potentially neurotoxic and can lead to long-term complications in neonates. Exchange transfusion (ECT) is one of the most important treatments for hyperbilirubinemia. In this regard, the present study aimed to determine the characteristics of hyperbilirubinemic neonates who need ECT and their mothers. Methods: This cross-sectional study was performed on 380 infants born after 35 weeks of gestation who were 2-14 days old. The studied neonates had bilirubin levels higher than 17 mg/dl and underwent ECT in Ghaem Hospital in Mashhad, Iran during 2010-20. Moreover, it should be noted that the participants were selected using the convenience sampling method and the required data were collected using a checklist. This checklist was designed based on the neonatal examination, maternal (maternal age, parity), and neonatal status (age, gender, and weight) and serial laboratory tests before and after ECT (total bilirubin, hematocrit, and platelet). Finally, these variables were compared based on the cause of hyperbilirubinemia. Results: The mean levels of serum bilirubin were 28.5 mg/dl and 26.5 mg/dl in male and female infants (P=0.096), respectively. Furthermore, the mean levels of serum bilirubin in neonates born by cesarean section and normal vaginal delivery were 29.5 and 28.1 mg/dl, respectively (P=0.458). Based on the findings, 60% of the neonates suffered from weight loss and 22% had more than 3% daily weight loss. In the present study, the most prevalent risk factors among the studied neonates were RH incompatibility, ABO incompatibility, and G6PD deficiency, in that order. Conclusion: Overall, these findings suggest that normal vaginal delivery, repeated breastfeeding, prevention of severe weight loss, early detection of RH and ABO incompatibility, and G6PD deficiency, as well as appropriate management of hyperbilirubinemia, can reduce the need for ECT and alleviate complications of neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Introduction: The main reason for respiratory distress syndrome (RDS) is surfactant deficiency. One of the methods for surfactant administration is through a thin endotracheal catheter (TEC) during the spontaneous breathing of an infant. To identify the clinical effects of this method, we decided to compare the effect of surfactant administration through a TEC during spontaneous breathing through the intubation-surfactant-extubation (INSURE) method. Methodology: In a single-blind clinical trial, we randomly divided 40 premature infants with a gestational age of <32 weeks and birth weight of <1500 g suffering from RDS who needed surfactant administration, into the two groups of intervention (TEC) and control (INSURE). The treatment results were compared in the two groups in terms of the frequency and duration of mechanical ventilation requirement, duration of nasal continuous positive airway pressure (NCPAP) requirement, duration of infants' stay in neonatal intensive care unit, and side effects such as pulmonary hemorrhage, frequency and severity of intraventricular hemorrhage of the brain, and also death at 28 days of age. Results: The infants of both groups did not significantly differ in terms of gender, mode of delivery, Apgar score at 1 and 5 min, gestational age, and birth weight (P > 0.05). The mechanical ventilation requirement in the infants of the control group was significantly higher compared to the intervention group (P = 0.027). The duration of NCPAP requirement and duration of hospitalization in the groups did not significantly differ (P > 0.05). Conclusion: Based on our results, the TEC method decreases mechanical ventilation requirement, but NCPAP requirement and duration of stay did not differ from the normal method, therefore, TEC can be an acceptable alternative to INSURE. [ABSTRACT FROM AUTHOR]

Background: Perinatal asphyxia is an important cause of death, as well as permanent neurological and developmental complications. Diagnosing in time would lead to better prognosis and applying the most proper treatment. We sought to define the predictive values of serum concentrations of interleukin -1β (IL-1β) and interleukin 6 (IL-6) in newborns with perinatal asphyxia to see if there is a relation between the short-term neurological deficit and serum IL-1β and IL-6 concentrations. Methods: This was a prospective (case-control) study conducted between March 2006 and April 2013, at the Neonatal Intensive Care Unit, Mashhad, Iran. Serum IL-1β and IL-6 levels were measured at birth in 38 consecutive uninfected neonates with perinatal asphyxia (blood pH < 7.2, low Apgar score, signs of fetal distress) and 47 randomly selected healthy newborns. The results were compared between the groups, using Chi-Square, f-tests, and Mann-Whitney tests, as well as receiver operator characteristics (ROC) curves and regression models. Results: Serum IL-1β and IL-6 concentrations in the infants who developed perinatal asphyxia were significantly higher compared to values in the normal infants [16.88 vs 3.34 pg/mL for IL-1β, (P = 0.006), and 88.15 vs 6.74 pg/ mL for IL-6, (P < 0.001) respectively]. The sensitivity and specificity for the diagnosis of perinatal asphyxia using serum IL-6 were 80.5% and 81.6% respectively. The sensitivity and specificity using serum IL-1β were 71 % and 89.1 %, respectively. Conclusion: Evaluating serum IL-6 and 1β simultaneously, could improve the sensitivity and specificity of early diagnosis of the perinatal asphyxia.The most appropriate indicator of perinatal asphyxia is combined measurement of interleukin 1β and interleukin 6. [ABSTRACT FROM AUTHOR]

Background: In the recent decades, the prevalence of nosocomial infections in neonates has grown and almost 21% of preterm neonates experience these kinds of infections. Some factors were proposed to have a protective effect against neonatal infections through promoting the development of the immune system of the newborn. This study aimed to evaluate the efficacy of oral glutamine supplementation in management of neonatal sepsis. Methods: Neonates were randomly allocated to case and control groups. The infants in the case group received 0.3 g/kg/day glutamine, every eight hours from three days of age to 28 days. Hospital stay duration and occurrence of necrotizing enterocolitis (NEC) as well as sepsis were recorded for each patient. Data were analyzed using SPSS version 16. Results: In general, 105 neonates were enrolled in the study, 52 of who were allocated to the glutamine group and 53 neonates assigned to the control group. The results showed that 52 (49.5%) cases were male and 53 (50.6%) were female with mean gestational age of 30±2 weeks. Life threatening infections occurred more commonly in the control group (P=0.036). Six neonates (11.5 %) in the glutamine group and eight (15.1 %) in the control group developed clinical sepsis (P=0.592). NEC occurred only in the control group (P=0.118). Mean durations of hospital stay in the glutamine and placebo groups were 20±12 days and 26±18 days (P=0.065), respectively. Mean durations of oxygen therapy were 6±5 days and 16±11 days for the glutamine and control groups, respectively (P=0.039). Conclusion: Oral glutamine administration reduced life threatening infections and duration of receiving supplemental oxygen. [ABSTRACT FROM AUTHOR]

Jaundice is considered as a common clinical condition during infancy. Prevention of severe hyperbilirubinemia (jaundice) is safer and easier than current therapies, like phototherapy or blood exchange. In some animal studies, zinc was found effective in reducing jaundice. In this study we evaluated the effect of zinc sulfate on neonatal hyperbilirubinemia. Materials and Methods: This randomized, double-blind clinical trial was performed on healthy term (35 weeks of age and more) neonates. Eligible newborns were randomly allocated to two groups: group A (receiving zinc sulfate, n=57) and group B (receiving placebo, n=74). They were screened for indirect bilirubin by BiliCheck at the end of the first, third and seventh day of age. We evaluated various characteristics such as weight, clinical signs, maternal and neonatal histories, and laboratory results. Results: Mean bilirubin values of the 3rd and 7th day were determined as (12.9±3 vs. 12.6±2 mg/dl, p=0.473), and (12.4±3 vs. 12.4±4, p=0.989), respectively. The incidence of hyperbilirubinemia (Bil>15) among group A and group B was reported 26% and 22%, respectively. The rate of admission due to hyperbilirubinemia and phototherapy was significantly higher among the newborns in placebo group, (p=0.043). Weight gain between the 3rd and 7th day of infant's age was more significant in the zinc group, (p=0.039). Conclusion: The current study showed that the administration of zinc sulfate neither affected hyperbilirubinemia, nor delayed the jaundice appearance; although fewer admission and phototherapy duration were reported in the zinc group in comparison with the placebo group. Weight gain between the 3rd and 7th day was more significant in the zinc group. [ABSTRACT FROM AUTHOR]

Objective(s): Bacterial infection contributes substantially to neonatal morbidity and mortality. Early diagnosis of neonatal sepsis is difficult because clinical signs are nonspecific. We have evaluated serum IL-6, 8 and 10 as potential early diagnostic markers of neonatal infection and their relationship to mortality rate and poor prognosis. Materials and Methods: A total of 84 infants, aged ≥ 72 hr were enrolled in this prospective case-control trial. The case group (n=41) included babies with clinical and laboratory findings compatible with sepsis and/or positive blood or cerebrospinal fluid cultures. The control group (n=43) included healthy infants. IL-6, 8 and 10 were measured for all infants. Receiver-operating characteristic (ROC) curves were used for the determination of thresholds. Results: Statistically significant differences were observed between control and case groups for serum median level of IL-6, 8 and 10 (P<0.001). IL-6 cut-off values of 10.85 Pg/ml for discriminating between cases and controls and 78.2 Pg/ml for predicting mortality are suggested. IL-8 at a cut-off value of 60.05 Pg/ml was valuable for differentiation of definite versus indefinite infection. Conclusion: Evaluating the IL-6, 8 and 10 simultaneously, could improve the sensitivity and specificity of early diagnosis of the neonatal sepsis. Regarding our results, interleukin 6 had the greatest value for predicting infection and possible mortality, whereas IL-8 was valuable for diagnosing definitive infection. [ABSTRACT FROM AUTHOR]

Objective: Jaundice is the most common reason of newborn's admission to neonatal ward. Many Iranian families give traditional remedies like sugar water, camel's thorn and flixweed extracts to breast-fed babies for reducing jaundice. This study investigated the effect of traditional remedies on idiopathic neonatal jaundice. Methods: This prospective study has been performed on 336 babies with idiopathic jaundice in a four year period (2005-2009) at Ghaem hospital, Mashhad, Iran. The babies were divided into two groups. In case group (n=234) breast-fed babies received no remedy and in control group (n=102), traditional remedies were given additional to breast milk and the results recorded and compared. Findings: In the present study significant differences were observed between the two groups in age of admission (6.8±3.2 vs 9.2±3.7 day, P<0.001), serum bilirubin values (17.8 vs 21.3 mg/dl, P<0.001) and percent of weight loss (P<0.01). There were no significant differences between the two groups in birth weight, sex, gestational age and duration of hospitalization, age at jaundice remission, hematocrit value and maternal factors (age, gestational order, pregnancy and labor problems)(P>0.05). Conclusion: Traditional remedies (camel's thorn, flixweed and sugar water) cause more weight loss and delayed reexamination of newborns leading to increased hyperbilirubinemia. These remedies may raise pseudo confidence in parents, which postpones reexamination and follow up of the newborns. [ABSTRACT FROM AUTHOR]

Background: Perinatal asphyxia is a major cause of neurologic morbidity and mortality. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) count per 100 white blood cells (WBC) and absolute NRBC/mm3 in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. Methods: A prospective (case-control) study was undertaken between October 2006 and December 2008, in the Neonatal Intensive Care Unit, Ghaem Hospital, Mashhad, Iran. A total of 91 infants completed the study. Levels of nucleated red blood cell per 100 white blood cells and absolute nucleated red blood cell counts in venous blood were compared for 42 asphyxiated (case group) and 49 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. Results: The NRBC/100 WBC and absolute nucleated red blood cell levels in the blood of newborns in the control group were 3.87±5.06 and 58.21±87.57/mm3, respectively; whereas the corresponding values in the cases were 18.63±16.63 and 634.04±1002/mm3, respectively (P<0.001). A statistically signi cant negative correlation existed between nucleated red blood cell level and indicators of the severity of perinatal asphyxia, first minute Apgar score and blood pH (P<0.001), respectively. A positive correlation was demonstrated between these parameters and severity of asphyxia, acidosis, and poor outcome (P<0.05). Conclusions: The NRBC/100 WBC and/or absolute nucleated red blood cell are simple markers for assessment of severity and early outcomes of perinatal asphyxia. [ABSTRACT FROM AUTHOR]

Objective: Late-onset sepsis is responsible for high morbidity and mortality in newborn infants in the world and in particular in developing countries. In this study, we evaluated whether clinical characteristics, laboratory parameters and measurements of serum interleukin-8 (IL-8) are able to discriminate between late neonatal sepsis and normal baby. Methods: This was a prospective (case-control) study conducted between March 2007 and April 2008, at the neonatal intensive care unit, Ghaem Hospital, Mashhad, Iran. The study comprised 93 neonates ≥72 hours of life. The infants were categorized in two groups based on the clinical presentation, and biochemical markers including complete blood count, C-reactive protein (CRP) and blood culture: 1) Control group including 42 infants with routine screening and 2) Case group consisting of 38 infants with definitive infection (positive blood and/or cerebrospinal fluid culture) or clinical sepsis (clinical and laboratory signs of infection without positive blood or CSF culture). Receiver-operating characteristic curves were used for the determination of thresholds for the infection group versus healthy neonate group. Findings: Eighty infants were enrolled in this study. IL-8 and CRP decreased in order of definitive infection, clinical sepsis and healthy subjects respectively (P<0.001). Sensitivity, specificity, positive predictive value, negative predictive value for serum levels were 0.95, 0.1, 0.97, 0.1 for IL-8 and 0.83, 0.86, 0.83, 0.69 for CRP respectively (cut-off point for IL-8 >60pg/ml and for CRP>6mg/dl). Conclusion: IL-8 may be a valid and early predictive marker of neonatal infection. Also, IL-8 is associated with severity of infection. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-day-old premature-born boy who was admitted due to severe failure to thrive and diarrhea and generalized erythroderma and scaling. He was diagnosed with sepsis through positive blood culture for Staphylococcus aureus. The authors discuss the netherton syndrome (NS) as a rare hereditary autosomal recessive multisystem disorder which presents with generalized erythroderma at birth or soon after.

Introduction: Infections are one of the main causes of death during childhood. According to epidemiological studies in Iran, the incidence of neonatal sepsis was 1.8% in year 1995. Moreover, the incidence of neonatal meningitis was 0.2 to 0.4 in 1000 live births. The aim of this study was to determine the necessity of lumbar puncture (LP) for early neonatal sepsis. Methods: In a retrospective study, after obtaining the ethical approval, we evaluated the records of 1100 neonates younger than 7 days, who were admitted to the hospital in 2001-2007 with sepsis suspicion; all the subjects had undergone LP. Statistical analysis was performed using SPSS version 16. Nominal variables were compared by Chi-square or Fisher's exact test. Other parametric and non-parametric tests were carried out, as required. Results: In our study, 1100 neonates suspected of sepsis were evaluated. Overall, 28.3% and 71.7% of the subjects were older and younger than 3 days (male-female ratio of 1:5). In 115 neonates, sepsis was confirmed by positive blood culture and 21 neonates (2.1%) had positive cerebrospinal fluid (CFS), which was significantly associated with blood culture results. Conclusion: There was a significant relation between blood culture and CSF culture. With regard to the low incidence of positive CSF, LP should be performed for each case, based on clinical manifestations and the clinician's opinion. [ABSTRACT FROM AUTHOR]

Background: Perinatal asphyxia is an important cause of death, as well as permanent neurological and developmental complications. Diagnosing in time would lead to better prognosis and applying the most proper treatment. We sought to define the predictive values of serum concentrations of interleukin-1β (IL-1β) and interleukin-6 (IL-6) in newborns with perinatal asphyxia to see if there is a relation between the short-term neurological deficit and serum IL-1β and IL-6 concentrations., Methods: This was a prospective (case-control) study conducted between March 2006 and April 2013, at the Neonatal Intensive Care Unit, Mashhad, Iran. Serum IL-1β and IL-6 levels were measured at birth in 38 consecutive uninfected neonates with perinatal asphyxia (blood pH < 7.2, low Apgar score, signs of fetal distress) and 47 randomly selected healthy newborns. The results were compared between the groups, using Chi-Square, t-tests, and Mann-Whitney tests, as well as receiver operator characteristics (ROC) curves and regression models., Results: Serum IL-1β and IL-6 concentrations in the infants who developed perinatal asphyxia were significantly higher compared to values in the normal infants [16.88 vs  3.34 pg/mL for IL-1β, (P = 0.006), and 88.15 vs 6.74 pg/ mL for IL-6, (P < 0.001) respectively]. The sensitivity and  specificity for the diagnosis of perinatal asphyxia using serum IL-6 were 80.5% and 81.6% respectively. The sensitivity and specificity using serum IL-1β were 71% and 89.1%, respectively., Conclusion: Evaluating serum IL-6 and 1β simultaneously, could improve the sensitivity and specificity of early diagnosis of the perinatal  asphyxia. The most appropriate indicator of perinatal asphyxia is combined measurement of interleukin 1β and interleukin 6.