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Background and purpose: Pain is a destructive one and remains in the mind of the child suffering from it. Without considering the behavioral and physiologic responses of child against painful irritants, it is not possible kill pain only by observing the appearance. Hence the aim of this study was to determine the behavioral and physiological pain in neonates admitted in pediatric wards.
Materials and methods: This is a descriptive-cross sectional study. Sample size was estimated to be about 150, and this number of the subjects were selected in three and half months period. The data were recorded in check list prepared according to Âls, theory of development and lawrance’s Neonate-Ïnfant pain scale (NÏPS) the data were analyzed by ËPÏ 6 soft ware.
Results : 73.3 of the subjects under study had physiologic signs and flashing of face during the procesure. Âlso mean heart and respiratory rate during the procedure had significant increase compared to the previous ones. Âmong the behavioral signs, facial experssion (97.3%), crying (96%) and breathing patern changes (93.3%) scored the highest rate. Significant relationship was observed only between facial expression and kind of procedure (o.o25) (p<0.01).
Çonclusion: Having proper strategy to kill pain in reonates admitted in hospital needs a standard procedure and a team work function. Since neonate can’t express pain verbally, their physiologic behavioral response must be noticed. Referring to the findings of the research, among these signs, facial expression, increase in heart rate and number of breathing and change in pattern of respiration can be clue for studying the pain without need of any sophisticated instrument.

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Background and purpose: There are some debates with decision making for withdrawal/ withholding of life sustaining treatment in infants with adverse prognoses and incurable conditions. This study is conducted to review attitudes and practice of pediatrics and gynecology physicians in this field.
Materials and methods: This survey was conducted during 2009 in Sari and Babol. A total of 140 pediatricians, gynecologists and residents/fellows in these fields were recruited by census 106 doctors completed an anonymous questionnaire (response rate 75.7%).
Results: More than 70 percent of respondents disagreed and less than a quarter of them agreed with euthanasia. Thus far, none of the doctors prescribed drugs to expedite neonatal death. Withdrawal of life sustaining treatment in infants with adverse prognoses and incurable conditions was uncommon, and reported by one fifth of physicians in their diagnosis of infants with multiple congenital anomalies. Influential factors in their decision to withdraw life sustaining treatment in these infants were: the number of children, the insistence of hospital staff, the request from parents, the infant's sex, lack of hospital facilities, parental history of infertility and family income, respectively. Religious beliefs were effective for withdrawal/withholding of life sustaining treatment in the decision making process and was led to an agreement more with the approval of the law in the majority of cases.
Conclusion: This study revealed that attitude and sanctity of life, overcomes the attitude regarding to quality of life from most of the physicians. Law approval in this field is necessary.

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Background and purpose: Anogenital distance is an accepted indicator for endogenous or environmental effects of androgens on development of reproductive system in fetus and newborns. This study was done to determine the relationship between penile length and anogenital distance in Iranian newborns. Material and Methods: In this cross-sectional study stretched penile length (PL) and anogenital distance (AGD) were measured in 427 healthy male newborn infants born in a Teaching Hospital (in north of Iran). Other variables included the age of mothers, and weight, height, and head circumference of neonates. Normal distribution of variables was measured by Shapiro-Wilk and data was analyzed using Pearson Correlation tests Results: The mean of PL was 32.1±3.5 mm and the mean of AGD was 24.5±2.5mm. A weak correlation was observed between PL and AGD (r=0.097, p=0.046). Conclusion: The correlation between penile length and AGD showed that, AGD could be also used in assessing the genital system and even as a common indicator to assess the genital system in both sexes

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Background and purpose: Obstetricians and neonatologists have a major challenge in determining the viability of preterm newborns that has an important role in choosing the mode of delivery and evaluation of post-natal care. This study, evaluated the viability of preterm infants born in Ghaem Hospital in Mashhad Materials and methods: This descriptive–analytical study was performed between 2009-2013 in 1471 premature infants in Ghaem Hospital, Mashhad. The study population included all preterm infants born in delivery room and admitted to the Neonatal Intensive Care Unit (NICU). Neonatal data were collected for two groups (deceased and discharged alive as case and control group) including age, weight, Apgar scores at first and fifth minutes after birth, gestational age, mode of delivery, final diagnosis, blood cultures and type of congenital anomaly. Results: In our study approximately ten percent of neonates born at less than 25 weeks survived. While this rate was 69% in thirty- two weeks old. A high risk of neonatal death (85%) was observed in infants weighing 400-700 gr while this risk was 12.4% in newborns weighing 1500-1251 gr. The most common risk factors of death in premature infants were respiratory problems (35%), asphyxia (24%), congenital anomalies (16%), and infections (15%). Conclusion: This study showed that neonates with gestational age ≥27.5 weeks weighing ≥920 gr survived in our center. Respiratory problems, asphyxia, congenital anomalies, and infection were amongst the main predisposing causes of death in premature infants.

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Background and purpose: Kidneys are considered the general and final excretion route for many drugs as well as urinary and metabolic waste products. In this study, the influence of hydro-alcoholic extract of Angelica plant (Heracleum persicum) was investigated on the serum levels of renal functional factors, and serum electrolyte. Materials and methods: In this experimental study, 25 pregnant Wistar rats were randomly divided into a control, a sham group and three experimental groups (n=5 per group). The sham group received 0.1 ml of distilled water and the experimental groups received daily dosages of 100, 200 and 400 mg/kgBw hydro-alcoholic extract orally for 21 days (during pregnancy). After birth, 40 newborn male rats were divided into five groups (n=8 per group), and 25 days after birth blood samples were taken from the hearts and the serum concentration of all renal functional factors, sodium, potassium, and electrolyte levels were measured. Data was then analyzed in SPSS applying Tukey and ANOVA. Results: The serum level of creatinine and potassium increased significantly in the experimental group that received 400mg/kg extract compared to those of the other groups. Also, the concentration of blood urea nitrogen (BUN) increased significantly in all experimental groups compared to the control and sham groups. No significant differences were observed in the serum concentration of sodium among experimental, control and sham groups. Conclusion: Hydro-alcoholic extract of Angelica plant (Heracleum persicum) was found to interfere with kidney function during pregnancy, therefore, caution should be taken when it is consumed during pregnancy.

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Background and purpose: Sulfur is an essential element used in the amino acids cysteine and methionine. Sulfur toxicity occurs due to its high concentration and volatile compounds in the environment. In various stages of human life, sulfur contaminants cause a variety of disorders in different parts of the body including the immune system. The embryonic period is the most critical stage of life cycle, so, this study investigated the effects of sulfur intoxication in pregnant rats on serum levels of immunoglobulin in their neonates.

Materials and methods: In this experimental study, 36 adult female Wistar rats were divided into three groups: a control, experimental group I with mild poisoning and experimental group II with severe intoxication. Before and during pregnancy the experimental groups I and II received a daily dose of 500mg/kg.bw sodium sulfide dissolved in drinking water for 15 and 30 days, respectively. Blood samples were taken from male and female newborns, 40 days after birth, and the serum levels of IgG and IgM were measured using nephelometric technique. Data was analyzed in SPSS ver. 17.

Results: The results indicated a significant increase in serum levels of immunoglobulin IgG and IgM in male and female neonates with severe maternal toxicity compared to the control group (P < 0.05). On the other hand, there was no significant difference in the concentration of immunoglobulins in female newborns of all groups compared to the corresponding male group. (P>0.05)

Conclusion: Sulfur contaminants or their metabolites can cross the placental barrier during pregnancy and increase serum levels of IgG and IgM in neonates through changes in the function of fetal immune system. Furthermore, these alterations are believed to be gender independent.

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Background and purpose: Hypoglycemia is an important problem in newborns which requires early diagnosis and treatment. Laboratory testing of blood glucose level and glucometer readings are used to detect hypoglycemia but sometimes the results are given late. This study aimed at evaluating the accuracy of glucometer in detection of hypoglycemia in newborns at neonate intensive care unit (NICU), 2014-2015. Materials and methods: A diagnostic study was performed in which 408 blood samples (glucometer capillary and venous derived samples) were obtained from 204 neonates in NICU within two hours after birth. Blood glucose concentrations were measured by glucose oxidase and photometric analysis. The mean values for blood glucose level, correlation coefficient, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Data analysis was performed in SPSS V.19. Results: The mean neonatal weight was 2915 ± 840 gr. In our study, 92 neonates were females and 112 were males. In laboratory testing the prevalence of hypoglycemia was found to be 21.6% (CI 95% 15.9-27.3%). Mean values of blood glucose level (86.4 ± 60.9 mg/dl) with glucometer was significantly higher than that of laboratory level (77.8 ± 69.1 mg/dl), (P<0.001). At cutoff point of 40 mg/dL blood glucose level the diagnostic indices of glucometer were as follows: sensitivity 95.6%, specificity 45.5%, PPV 86.4%, and NPV 74.1%. According to ROC curve, 49 mg/dl was obtained as the glucometer cutoff point and the prevalence of hypoglycemia was found to be 15.2% (CI 95% 10.2-20.2%). Conclusion: Glucometer was found to have appropriate sensitivity and NPV in detecting neonatal hypoglycemia, therefore, it is recommended in screening of neonatal hypoglycemia without any side effects.

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Background and purpose: Futile medical care is referred to any medical intervention or activity that bring no benefit to patients. The aim of this study was to evaluate the frequency of futile treatment and its cost in neonates with a probable diagnosis of inherited metabolic disorder.
Materials and methods: In this cross-sectional study, hospitalization records of all admitted neonates in Children's Medical Center, Tehran were evaluated between 2013 and 2016. Demographic characteristics of the patients, duration of hospitalization, diagnostic and therapeutic management, and costs were investigated.
Results: In the period studied, 1668 neonates were hospitalized of whom 20 (1.2%) died in neonatal intensive care unite with a probable diagnosis of inherited metabolic disorder. Six (30%) cases had deceased siblings. The total duration of hospitalization was 290 day-patient ranging from 20 hours to 37 days. The costs of hospitalization and medical treatments were calculated. Despite disagreement of eight (40%) parents with any futile treatments, the medical team discontinued the futile care in only one case who received palliative care. In other patients futile treatment continued before death.
Conclusion: Futile medical treatments in neonates with inherited metabolic disorders are not uncommon. Lack of a comprehensive guideline about this issue leads to continuation of futile medical care.

 

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 Background and purpose: Infants with persistent pulmonary hypertension (PPHN) are readmitted to hospital three times more than other infants or die after discharge. The disease imposes a high cost on families and health systems. In this study, for the first time, the prevalence of PPHN and associated factors were investigated in mature neonates born in southeast of Iran.
Materials and methods: In this cross-sectional study, the clinical records of 1859 infants born in Kerman Afzalipour Hospital, 2020 were reviewed. Infants hospitalized from delivery, congenital heart disease, other differential diagnoses of PPHN, and evidence of genetic diseases were excluded from the study. Then, mature infants with clinical evidence of PPHN underwent Doppler echocardiography to confirm the final diagnosis. Information about pregnancy, childbirth, infant gender, birth, 1-minute and 5-minute Apgar scores, and advanced respiratory support were also obtained. Data were analyzed by SPSS V25.
Results: Out of 229 neonates meeting the inclusion criteria, 31 (11.9%) had PPHN. Signification relationship was observed between frequency of PPHN and cesarean delivery and 5-minute minute Apgar score (P<0.05). But, no significant association was found between developing PPHN and other maternal or neonatal factors (P>0.05). The mean parameters of PPHN, including tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitation rate, mean pulmonary artery pressure, and pulmonary artery diameter were significantly higher in infants delivered by cesarean section than those born by normal vaginal delivery group (P<0.05).
Conclusion: Further multicenter studies with larger sample size over a longer period of time are suggested in southeast of Iran to elicit clear explanations on the association between PPHN and maternal, fetal, and neonatal factors.
 

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Background and Purpose: Infant mortality is one of the most important health indicators for any country, and understanding the causes and timing of infant deaths can aid in health and hygiene planning. Respiratory diseases are a leading cause of infant mortality, particularly among premature infants. This study was conducted to investigate the status of respiratory care for infants in neonatal intensive care units (NICUs) in hospitals in Mazandaran province.
Materials and Methods: In this descriptive, retrospective study, information related to infants hospitalized during the year 1400 (2021-2022) in the NICUs of hospitals under the Mazandaran University of Medical Sciences was extracted from the Iman system and from patients' medical records. This system, launched in 1397 (2018-2019) under the supervision of the Infant Health Department, a subsidiary of the Deputy of Health of the Ministry of Health, Treatment, and Medical Education, has been verified for accuracy through the use of trained personnel and repeated validation processes. As of 1399 (2020-2021), its data are considered reliable. The study population included all infants hospitalized in the NICUs of hospitals affiliated with Mazandaran University of Medical Sciences. Given the availability of data for all infants hospitalized in the province's hospitals, there was no need for sampling. Therefore, all infants hospitalized in the NICUs during 1400 (2021-2022) were included in the study by census, amounting to 2,531 infants, according to the Iman system. The inclusion criteria were infants hospitalized in the NICUs, while the presence of major congenital anomalies at birth was an exclusion criterion. In this study, intubation was categorized as invasive ventilation, while other methods were classified as non-invasive ventilation. For the statistical analysis, parametric tests were used to test the study hypotheses after confirming the normality of the data. All data analyses were performed using SPSS software version 26.
Results: The gestational age of mothers ranged from 22 to 41 weeks, with a median and interquartile range of 37.0 (34.0-39.0) weeks. Of the 2,531 infants hospitalized in the NICUs during 1400 (2021-2022), 1,505 (59.5%) were boys and the rest were girls. Of all infants requiring respiratory support, 248 (9.8%) underwent invasive ventilation, while 579 (22.9%) underwent non-invasive ventilation. Pneumothorax was reported in 42 (1.7%) of the infants. A total of 112 (4.4%) infant deaths were reported. This mortality rate was 89 (21.5%) for infants under 32 weeks and 23 (1.1%) for infants over 32 weeks.
Conclusion: The findings of this study showed that, while the overall mortality rate of infants hospitalized in the NICUs was low, the mortality rate for very premature infants (under 32 weeks) was higher than that of developed countries and warrants further attention and investigation into the contributing factors. Additionally, about one-tenth of the hospitalized infants were transferred to other hospitals due to a need for more advanced equipment. Providing these hospitals with the necessary resources, including invasive ventilation devices, could potentially reduce infant mortality. The most common causes of death in NICU infants were respiratory distress syndrome, prematurity, and congenital malformations, respectively.

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Background and purpose: Due to specific metabolic changes during pregnancy, identifying pregnancy risks and timely intervention can improve the health of the mother and baby. The best results for preventing gestational diabetes are achieved through lifestyle measures early in pregnancy. Today, abnormal fasting plasma glucose (FBS) is routinely measured in early pregnancy, but its association with pregnancy outcomes is ambiguous. This study aims to investigate the incidence of gestational diabetes mellitus and other pregnancy outcomes in women with FBS levels in the first trimester of pregnancy.
Materials and methods: This prospective descriptive study was conducted on 230 women with singleton pregnancies at the clinic of Imam Khomeini Hospital in Sari in 2022. After obtaining informed consent, blood samples were collected from pregnant women in the first trimester of pregnancy, and FBS levels were recorded. Additionally, between the 24th and 28th weeks of pregnancy, women underwent a re-examination based on the results of the 75g glucose tolerance test (OGTT). Based on FBS levels, women were divided into two groups: normal (92-100 mg/dL) and abnormal (101-126 mg/dL). All mothers were followed up during pregnancy, and on average, 2 days after giving birth, the pregnancy outcomes of both the mother and the baby were recorded. Data were analyzed using SPSS version 22 software.
Results: The mean and standard deviation of mothers' age in the mothers of the normal FBS group were 31.05 ± 5.61 years, and in the mothers of the abnormal FBS group, it was 32.46 ± 6.24 years. The number of pregnancies in 64% (n=80) and 51.4% (n=54) of mothers was less than or equal to two pregnancies, and the number of deliveries was less than or equal to 2 births in 75.2% (n=94) and 66.7% (n=70) respectively. The most common underlying disease was hypothyroidism, which was present in 20% of mothers with normal FBS and 21% of mothers with abnormal FBS. The results showed that in weeks 24 to 28 of pregnancy, 56.5% (n=130) of mothers had impaired oral glucose tolerance tests, which was statistically significant (P=0.048). The relationship between stillbirth (P=0.593), IUGR fetus (P=0.392), blood pressure disorders related to pregnancy (P=0.904), neonatal hypoglycemia (P=1), liquid ammonia level in the 28th week of pregnancy (P=0.915) and the 36th week of pregnancy (P=0.537), and the Apgar score of the first minute (P=0.514) and the fifth minute (P=0.296) were not significant with abnormal FBS in the first pregnancy. There was a substantial relationship between impaired OGTT and first-pregnancy FBS, and 69.5% of mothers with first-pregnancy FBS in the range of 101-126 mg/dL had impaired OGTT (P<0.0001). Also, the type of cesarean delivery (P=0.037) insulin intake (P=0.031), and gestational age less than 37 weeks at the time of delivery (P=0.047), had a significant relationship with the first FBS of pregnancy.
Conclusion: The results showed that FBS in the first trimester is related to gestational diabetes and pregnancy outcomes and can be used as a simple and low-cost screening test to identify pregnancies at risk of GDM and some adverse pregnancy outcomes, including the type of delivery. Insulin and gestational age should be assessed at the time of delivery.