Iranian Neonates Research Articles

Anthropometric indices growth references (length, Weight and Head Circumferences) of children aged 0–24 months in North-East of Iran by GAMLSS

BackgroundGrowth references play a crucial role in the screening, evaluation, and surveillance of children, aiding in the early identification of the requirement for diverse growth-promoting interventions. Variations in human growth across distinct ethnic cohorts arise from genetic disparities, lifestyle variances, nutritional diversity, and diverse social and environmental contexts. Consequently, the selection of growth references markedly influences the prevalence of developmental disorders and nutritional imbalances in children. The study aims to assess the growth percentile of children in the north-east of Iran and establish population-specific reference charts for length, weight, and head circumference spanning from birth to 24 months.MethodsThis cross-sectional population-based research conducted in the north-east of Iran, from 2016 to 2023. The Data extracted from the electronic health records of Mashhad University of Medical Sciences. All apparently healthy children aged from birth to 24 months who were measured at least once by health staff at the ages of birth,1,2,4,6,7,9,12,15,18,24 months were included. The target population of the study were 479,089 children (96.21%), encompassing 233,565 girls (48.75%) and 245,524 boys (51.25%). Gender-specific percentile curves for length, weight, and head circumference concerning age, as well as weight concerning length, were derived using the GAMLSS approach.ResultsFrom the anthropometric information of 479,089 children (245,524 boys and 233,565 girls), growth charts were constructed. In comparison to the standard WHO chart, Iranian neonates displayed lower weight across all percentiles during the first month after birth, exhibited decreased head circumference at the 3rd percentile, and boys showed reduced length across all percentiles. After this age, Iranian children demonstrated increased weight, length, and head circumference.ConclusionsThis research introduces the inaugural large-scale endeavor for indigenous reference charts. Through the noted distinctions from the international reference, the utilization of this novel resource offers the potential to enhance the surveillance of children’s growth within the area. Moreover, by accurately assessing growth anomalies such as underweight, stunting, and wasting, it expands the domain of impactful policies in this sphere. Simultaneously, it enables the exploration of the secular trend of children’s growth in the forthcoming years.

Age-specific reference intervals for liver function tests in healthy neonates, infants, and young children in Iran.

The reference intervals (RIs) for liver function tests (LFTs) were determined in Iranian children for the first time. A total of 344 healthy pediatrics aged 3 days to 30 months old were recruited. Serum levels of ALT, AST, ALP, direct bilirubin, and total bilirubin were measured. RIs were determined using CLSI Ep28-A3 guidelines. All analytes demonstrated age-specific differences except AST. ALT and ALP demonstrated significantly elevated levels in infants 0 to <5 months relative to the remainder of the age range. Direct and total bilirubin demonstrated markedly elevated levels in early life with mean of 0.28 mg/dL and 1.64 mg/dL observed for direct and total bilirubin, respectively, decreasing by ~50% in the adjacent partition. These novel data will help improve the clinical interpretation of biochemical test results in young Iranian neonates and children and can be of value to clinical laboratories with similar populations.

Prevalence of gram-negative bacteria and their antibiotic resistance in neonatal sepsis in Iran: a systematic review and meta-analysis

BackgroundNeonatal sepsis, particularly gram-negative (GN) bacteria-induced, is a significant cause of morbidity and mortality in newborns. Healthcare professionals find this issue challenging because of antibiotic resistance. This study aims to combine findings to identify the prevalence of GN bacteria and their antibiotic resistance in Iranian neonates with sepsis.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed through international databases, including (PubMed/MEDLINE, EMBASE, Scopus, and Web of Science), Iranian local databases (Magiran, Iranmedex, Irandoc, Scimed, and SID), and the first 100 records of Google Scholar. Analytical cross-sectional study checklist from the Joanna Briggs Institute (JBI) was used for the quality assessment of included studies. Comprehensive Meta-Analysis Software Version 2 was used to conduct the meta-analysis. The between-study heterogeneity was investigated by I2 statistics.ResultsThe prevalence of GN bacteria was estimated to be 53.6% [95% CI: 45.9– 61.1: P = 0.362] in Iranian neonates with sepsis, based on 31 studies with a sample size of 104,566. klebsiella pneumoniae (K.pneumonia) (23.2% [95% CI: 17.5–30.0, P < 0.001]) followed by Escherichia coli (E.coli) (13.5% [95% CI: 9.4–18.9, P < 0.001]) were more prevalent among GN bacteria. The highest resistance in K.pneumoniae was observed in Cefixime (80.6%, [95% CI: 56.3–93.1, P = 0.018]). E.coli showed greater resistance to Ampicillin (61.8%, [95% CI: 44.2–76.5, P = 0.188]. The prevalence of GN bacteria in Iranian neonates with sepsis has a decreasing trend based on the year, as shown by a meta-regression model (P < 0.0004).ConclusionGN pathogens, particularly K.pneumoniae, and E.coli, are the leading cause of neonatal sepsis in Iran. GN bacteria showed the highest resistance to Third-generation cephalosporin and Aminoglycosides.

Clinical Significance of OATP2 Gene Variants in Iranian Neonates with Hyperbilirubinemia

Clinical Significance of OATP2 Gene Variants in Iranian Neonates with Hyperbilirubinemia

Factors Affecting Prevalence of Urinary Tract Infection in Neonates with Unexplained Hyperbilirubinemia: A Systematic Review and Meta-Analysis Study in Iran.

Background:The prevalence and risk factors of urinary tract infection (UTI) in neonates with unexplained hyperbilirubinemia are not studied thoroughly. Since the prevalence of UTI is highly variable in different areas and countries, this study aimed to review the existing data of Iranian neonates with UTI presented with unexplained hyperbilirubinemia.Methods:This study is a meta-analysis of Iranian newborns with unexplained hyperbilirubinemia. We identified all studies indexed in international (Web of Science, PubMed, Scopus, Google Scholar) and national (Science Information Database, Magiran) databases from 2000–2018. Search terms included: Urinary Tract Infections OR UTI AND urine OR culture OR microbio, jaundice OR icter OR hyperbili, AND Iran.Results:Overall, 4210 neonates from 17 studies were included. The pooled prevalence of UTI in neonates with unexplained hyperbilirubinemia was 6.81% (95% CI: 4.86–8.77). Considering the subgroups analyses; the prevalence of UTI was higher in the prolonged vs. not-prolonged state (8.34% vs. 4.00%), low birth weight vs. normal birth weight (7.81% vs. 4.51%), and exclusive vs. non-exclusive breastfeeding (8.84% vs. 4.72%). Male gender and low birth weight increased the risk of UTI about two times compared to the female gender and normal birth weight, respectively. The results of the analyses in neonates with unconjugated hyperbilirubinemia also showed the above-mentioned subgroup differences.Conclusion:Due to considerable prevalence of UTI in neonates with unexplained hyperbilirubinemia and risk factors in this age group, investigation for UTI is essential for the workup in this situation.

Genetic Association of UGT1A1 Promoter Variants (c.-3279T>G and c.-3156G>A) with Neonatal Hyperbili-rubinemia in an Iranian Population

Background: Several studies have reported that two promoter variants (c.-3279T>G and c.-3156G>A) in UDP-glucuronosyltransferase (UGT1A1) gene may contribute to neonatal hyperbilirubinemia. However, these variants have not been investigated in Iranian neonates. This cross-sectional study aimed to determine if the UGT1A1 promoter variants are significant risk factors associated with neonatal hyperbilirubinemia. Methods: A total of 178 unrelated neonates, including newborns with neonatal jaundice (n=95) and healthy controls (n=83), were included in this study. Each individual was genotyped by the PCR-RFLP and COP-PCR at nucleotides -3279 and -3156, respectively, using fresh blood DNA. Logistic regression analyses were performed to assess the association of UGT1A1 promoter variants with the presence of significant hyperbilirubinemia. Anthropometric indices and clinical variables were also compared between the different genotype groups. Results: Allele and genotype analysis of the c.-3279T>G and c.-3156G>A variants showed no significant association with the risk of neonatal hyperbilirubinemia neither in the crude nor after adjustment for gestational age, gender, and birth weight in different genetic models (P>0.05). However, in haplotype-association analysis, only one haplotype (A-T) was found to be associated with the risk of neonatal hyperbilirubinemia (OR=0.19, 95% CI; [0.18–0.20], P=0.001). Conclusion: This study failed to demonstrate that c.-3279T>G and c.-3156G>A variants alone might contribute to the risk of neonatal hyperbilirubinemia in Iranian neonates. However, the A-T haplotype may play a significant role in increasing the risk of hyperbilirubinemia.

The prevalence of prolonged jaundice due to breast milk jaundice in hospitalized newborn; a study among Iranian neonates

Introduction: Breast milk jaundice is considered as the most common cause for neonatal jaundice; however, its epidemiological aspects in some population remain unclear. Objectives: The present study aimed to assess the prevalence of breast milk jaundice and its main determinant among a group of neonates in western Iran. Patients and Methods: This cross-sectional study was conducted on 413 neonates hospitalized due to prolonged jaundice in Besat hospital in Hamadan, Iran. The study information was collected by reviewing the hospital’s recorded files. Results: In total, 413 neonates hospitalized were assessed in this study. The main reason for appearing jaundice included; 72.4% of cases of jaundice were due to breast milk, urinary tract infection in 4.2% of cases, glucose-6-phosphate dehydrogenase deficiency (G6PD) in 5.8% of cases, hypothyroidism in 1.2% of cases. Out of 299 neonates suffering from breast milk jaundice, 126 (42.1%) were male, and 173 (57.9%) were female with the overall average age of 16.68 ± 2.14 days. Jaundice appeared at less than two days of age in 29.4% of neonates, between 15 to 20 days of age in 64.9%, and more than 20 days of age in 5.7% of cases. Conclusion: Breast milk jaundice is considered as the most common reason for neonatal jaundice in our population, which affects more than two-thirds of our neonates. Additionally, the peak age of this phenomenon is between 15 and 20 days. The appearing breast milk jaundice is independent of gender, age, and birth weight or baseline total serum bilirubin level.

Prevalence of Congenital Cytomegalovirus Infection Among Hospitalized Neonates in Tehran, Iran

Background: Cytomegalovirus (CMV) can vertically transmit from infected mothers to fetuses and causes congenital infection in newborns. Unfortunately, there have been limited data available on the prevalence of congenital CMV (cCMV) infection among Iranian neonates at higher risk of infection. Objectives: The current study aimed to assess the prevalence of cCMV infection among hospitalized neonates in Tehran, Iran, and investigate the diagnostic values of CMV polymerase chain reaction (PCR) on Guthrie cards in comparison to those reported for urine specimens. Methods: This cross-sectional study was carried out on the hospitalized neonates with 3 weeks of age. The urine specimens and Guthrie cards were taken from each eligible newborn. Total nucleic acid was extracted from the samples and tested by PCR for the presence of CMV deoxyribonucleic acid. The cCMV infection was confirmed in the newborns, and the infected neonates underwent further evaluation. Results: Out of 224 newborns, CMV infection was identified in 11 neonates (4.9%). There were no factors in association with cCMV infection. The sensitivity and specificity of dried blood spot (DBS) samples for the identification of newborns with cCMV infection were 90% and 99%, respectively. Conclusions: A significant number of hospitalized neonates in the present study were infected with cCMV infection. The results of the current study revealed that Guthrie cards had adequate sensitivity for the identification of CMV infection in the hospitalized newborns. Since symptomatic newborns with cCMV infection have a higher chance for the development of early- or late-onset sequelae of infection, it is recommended to diagnose and treat this group of newborns.

The Therapeutic Effect of Zinc Sulfate in Iranian Neonates With Hyperbilirubinemia: A Systematic Review and Meta-Analysis

Background: Physiologic jaundice in neonates usually occurs during the first week of life. The main cause of this condition is increased serum bilirubin due to heme catabolism. Objectives: This systematic review and meta-analysis study aimed to investigate the therapeutic effect of zinc sulfate in Iranian newborns with hyperbilirubinemia. Methods: This review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The databases of ISI, Cochrane Library, Google Scholar, PubMed, and Scopus were independently searched by two researchers using MeSH keywords. We included the studies published in different regions of Iran from 2015-2018. The obtained data were analyzed using the meta-analysis technique and STATA. To determine the heterogeneity across the studies, the Q and I square (I2) indices were used. Results: A total of 40 articles were collected from which 5 studies with adequate quality entered the systematic review process. The collected results were assessed in the intervention (zinc sulfate recipients) and control (without zinc sulfate treatment) groups. After the first day of consumption, total serum bilirubin level decreased 4.46 mg/dL (I2=61.9, P=0.049) and 4.08 mg/dL (I2=72.9, P=0.011) in the intervention and comparison groups, respectively. In the second and third days, the mean values of decreases in serum bilirubin reached 7.64 mg/dL and 6.66 mg/dL in the intervention and comparison groups, respectively. From the third day onward, serum bilirubin dropped by 8.46 and 7.08 mg/dL in intervention and control groups, respectively. Meta-regression analysis data based on the sample size and year of the study indicated a significant growing trend in using zinc sulfate by increasing years and sample size. Conclusions: Zinc sulfate is a safe and effective medication in reducing bilirubin level and its usage has increased in recent years. Therefore, this supplement could be used for the treatment of neonatal hyperbilirubinemia.

Phenylketonuria screening in Iranian newborns: a systematic review and meta-analysis

BackgroundPhenylketonuria (PKU), which is characterized by a deficiency of phenylalanine hydroxylase activity, is an autosomal recessive disorder of phenylalanine (Phe) metabolism. Newborn screening is the main population-based public health screening program that allows successful identification and treatment of PKU with low-Phe diet. The aim of this study was to evaluate the epidemiology of PKU screening in Iranian newborns.MethodsThe present study was designed based on MOOSE protocol and reporting was done in accordance with the PRISMA guidelines. The protocol of this systematic review was published in PROSPERO before it was performed (CRD42020162626). A comprehensive search was done in 10/10/2019 to find related literature on international online databases Web of Science, Scopus, EMBASE, Science Direct, PubMed/Medline, EBSCO, CINAHL, Cochrane Library, national online databases and the Google Scholar search engine. Heterogeneity among studies was assessed by I2 index and Q test. All meta-analyses were performed using Comprehensive Meta-Analysis Software ver. 2. P < 0.05 was considered significant.ResultFinally, 18 studies with 3,339,327 Iranian neonates were included. The prevalence of suspected hyperphenylalaninemia (HPA) was estimated to be 45.6/100,000 (95% CI: 23.9–87.1). The prevalence of suspected HPA in girls and boys infants in Iran was estimated to be 38.0/100,000 (95% CI: 15.1-95.5) and 43.3/100,000 (95% CI: 16.2-116.2), respectively. The prevalence of PKU was estimated to be 16.5/100,000 (95% CI: 12.9–21.2). The prevalence of PKU in girls and boys infants was estimated to be 13.3/100,000 (95% CI: 7.5–15.8) and 10.9/100,000 (95% CI: 7.5–15.8), respectively. The prevalence of mild to moderate HPA was estimated 9.7/100,000 (95% CI: 5.1–18.4) and the prevalence of classical PKU was estimated 4.4/100,000 (95% CI: 2.5–7.8). Sensitivity analysis for all meta-analysis with the omission of one study showed that overall estimation is still robust.ConclusionThe results of this meta-analysis showed that PKU is prevalent in Iranian neonates. It should be considered that for PKU there is a highly effective dietary treatment which can prevent the clinical symptoms of PKU if initiated early after detection by newborn screening.

Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards

Cytomegalovirus (CMV) constitutes the most common viral cause of congenital infections in newborns worldwide. There are a significant number of asymptomatic newborns with congenital CMV infection in Iran, which may develop long-term sequelae of infection. Unfortunately, limited data exsists from Iran on the rate of congenital CMV infection among neonates. The current study was aimed to investigate the prevalence of congenital CMV infection among Iranian neonates by testing Guthrie cards. Guthrie cards were collected from infants within 2 weeks of life, and total DNA was extracted from samples by thermal shock and evaluated for CMV DNA using nested-PCR assay. CMV infection in newborns was confirmed through a commercial CMV PCR kit. Infected infants underwent further evaluation at the hospital. CMV infection was identified in four of 1174 infants (0.34%) which is approximately 3 cases per 1000 live births. Infected infants were asymptomatic at birth and had a normal hearing status similar to other children. There were no factors in relation with CMV infection among newborns. According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our population, educating and effective counseling by obstetricians/ gynecologists to the pregnant women are recommended.

The Nomogram of Clitoral Length and Width in Iranian Term and Preterm Neonates.

Background and Objectives: Clitoromegaly is an important parameter in the evaluation of ambiguous genitalia in neonates, but the normative data for clitoral size in newborns have racial/ethnic differences. The present study aimed to determine clitoral length (CL) and clitoral width (CW) values and establish cutoff measurement to define clitoromegaly in both term and preterm Iranian neonates for the first time.Methods: A total number of 580 female newborn infants delivered at 28–42 weeks of gestation were enrolled in the study, and their CL and CW were measured on the first 72 h of birth. Data about birth weight (BW), body length (BL), and head circumference (HC) of newborns; mothers' age; and gestational age (GA) were recorded, too. Results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Backward stepwise regression analysis was used for prediction of CL and CW.Results: Among 580 Iranian female newborns studied, 187 were term neonates and the other 393 newborns were preterm. Mean ± SD values of CL were 6.11 ± 0.39 mm in term infants and 5.45 ± 0.64 mm in preterm infants (P < 0.001). Mean ± SD values of CW were 4.22 ± 0.43 in term infants and 3.68 ± 0.53 in preterm infants (P < 0.001). Regression analysis showed that CL was correlated with GA considered by last menstrual period, BL, BW, and HC; and CW was associated with GA, BL, and BW.Conclusion: This study suggests normative values (mean + 1, 2, and 3 SD) of CL and CW according to GA, which can be used as a reference for Middle East's newborns, especially Iranian newborn babies.

Umbilical Cord Blood Lipid Profile in Healthy Neonates in Iran

Background: Coronary heart diseases (CAD) and their risk factors are among the major causes of death in Iran. Since these risk factors begin to develop early in life, it is vital to diagnose those newborns at high risk of CAD. Objectives: The present study investigated the umbilical cord blood lipid profile of term and preterm neonates. Methods: In this cross-sectional study, the lipid profiles of 292 neonates, of which 276 were term and 16 preterm, were examined at a teaching hospital. Results: The lipid profile results of total cholesterol, triglycerides, high density lipoprotein, and low density lipoprotein were 69.8, 34.9, 23.6, and 31.5 in term neonates and 80.5, 25.5, 25.1, and 38 in preterm neonates, respectively. Conclusions: According to the current paper, the lipid profiles of eastern Iranian neonates were similar to those reported in global studies. Moreover, except for triglycerides in the female neonates, lipid profiles were significantly higher among the male neonates.

Umbilical Cord Blood Lipid Profile in Healthy Neonates in Iran

Background: Coronary heart diseases (CAD) and their risk factors are among the major causes of death in Iran. Since these risk factors begin to develop early in life, it is vital to diagnose those newborns at high risk of CAD. Objectives: The present study investigated the umbilical cord blood lipid profile of term and preterm neonates. Methods: In this cross-sectional study, the lipid profiles of 292 neonates, of which 276 were term and 16 preterm, were examined at a teaching hospital. Results: The lipid profile results of total cholesterol, triglycerides, high density lipoprotein, and low density lipoprotein were 69.8, 34.9, 23.6, and 31.5 in term neonates and 80.5, 25.5, 25.1, and 38 in preterm neonates, respectively. Conclusions: According to the current paper, the lipid profiles of eastern Iranian neonates were similar to those reported in global studies. Moreover, except for triglycerides in the female neonates, lipid profiles were significantly higher among the male neonates.

Cutaneous Lesions in Iranian Neonates and Their Relationships with Maternal-Neonatal Factors: A Prospective Cross-Sectional Study.

Cutaneous lesions are common in the neonatal period and mostly physiological, transient, and self-limited; uncommonly, they are pathological and require treatment and cooperation between neonatologists and dermatologists. Particular conditions, like prematurity, can influence the onset, type, and evolution of cutaneous manifestations. Of the several articles in the literature about skin findings in newborns, only a few were performed in Iran. We aimed to investigate dermatological findings in a sample of neonates within the first three days of life and to evaluate the association between skin lesions and neonatal- or maternal-related variables. A total of 1202 newborns, hospitalized in the Department of Pediatrics of Imam Sajjad Hospital of Ramsar and Shahid Rajaee Hospital of Tonekabon, Iran, for two years, were examined. All skin findings were recorded, and information on neonatal and maternal variables was collected and analyzed to detect statistically significant associations. Skin lesions were present in 958 newborns (79.8%). The prevalence of milia, erythema toxicum, salmon patch, and Mongolian spots were 45.2%, 43%, 37.3%, and 37%, respectively. Natural vaginal delivery, use of medication, term gestation, and maternal disease were associated with a higher incidence of cutaneous lesions in neonates. Milia, erythema toxicum, Mongolian spots, and genital hyperpigmentation were seen more frequently in the male gender. Conversely, skin desquamation was seen more frequently in females. Among maternal diseases, gestational diabetes mellitus, urinary tract infection, preeclampsia, hypertension, psychiatric disorders, and uterine infection were associated with a higher prevalence of cutaneous lesions. Neonatal cutaneous lesions are a common source of concern in parents and inexperienced physicians. Therefore, prompt recognition of neonatal cutaneous lesions is essential in order to avoid unnecessary diagnostic and therapeutic procedures.

Etiology and therapeutic management of neonatal jaundice in Iran: a systematic review and meta-analysis.

Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients. We searched the databases of PubMed, Web of Sciences, Scopus and Google Scholar for English articles published since inception until May 2019. A search was also done for Persian articles in Magiran and Scientific Information Database. Studies were evaluated based on predefined criteria by two reviewers. Data analysis was performed by STATA software. A total of 33 articles were finally included. The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows: ABO blood groups incompatibility, 16.9% [95% confidence interval (CI) 10.9-22.8]; Rh blood group incompatibility, 4% (95% CI 2.5-5.5); ABO and Rh blood groups incompatibility, 3.6% (95% CI 0-7.7); glucose-6-phosphate dehydrogenase (G6PD) deficiency, 6.3% (95% CI 5.1-7.5); infection, 6.6% (95% CI 5.2-8.1); hypothyroidism, 4.2% (95% CI 0.1-8.3); infant of diabetic mother: 2.3% (95% CI 0.1-4.5); unknown, 50.7% (95% CI 33.4-68); cephalohematoma, 0.6% (95% CI 0.3-0.9). Regarding treatment of icterus, seven and eight articles were found on phototherapy and exchange transfusion, respectively. In five studies, all patients underwent phototherapy, but rate of exchange transfusion use was between 6.6% and 50.9%. According to the results, unknown factors were the most common causes of icterus in Iranian neonates, followed by ABO blood groups incompatibility, infections and G6PD deficiency. By the way, phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.

Clinical Characteristics and Report of Seven Iranian Neonates Born to Mothers with Covid-19

The outbreak of Covid-19 infection is an actual public health challenge. Iran is fighting hard against the virus outbreak. Although at first it seemed that the disease does not affect infants and the neonates, But the population of affected infants and neonates appears to be increasing. This article is written to share some of the experiences about encountering with neonates born to mothers with covid-19. It describes the maternal, perinatal and neonatal aspects of the disease in seven Iranian cases. It also explains the outcome of delivery and follow up of mothers and their neonates after they discharged from hospital. According to our vague and incomplete knowledge about this novel disease and also hazardous side effects of its specific drugs which are not fully evaluated in neonatal population, in this article we just emphasize on routine and supportive care and avoiding unconventional therapy. In this case series we manage our patients according to their disease such as pneumonia, transient tachypnea of neonates or respiratory distress syndrome by using antibiotics, total parenteral nutrition and supplementary oxygen therapy with the preference of non-invasive methods. We didn’t use any novel treatment for Covid-19 disease. We also carefully considered isolation and personal protection issues.

Association of Cord Blood Zinc Level and Birth Weight in a Sample of Iranian Neonates.

Background:In addition to its short-term effects, low birth weight increases the risk of noncommunicable diseases (NCDs) in adult life. The quality of maternal diet including the macronutrient intake is very important in this regard. This study aims to evaluate the possible associations between maternal zinc and neonatal anthropometric measures.Method:This cross-sectional study was conducted on 226 pairs of mothers-neonates in Isfahan, Iran. Maternal characteristics including the history of the disease, age, preconceptional weight, weight gain during pregnancy, as well as, anthropometric characteristics of neonates such as weight, height, length, and circumferences of head, belly, chest, and thigh were documented. Cord blood zinc was measured by atomic absorption spectrophotometer in three groups of neonates depending on their weights.Results:The gestational age of neonates was 35 to 38 weeks with a mean weight of 3.13 ± 0.42 kg. The mean of zinc concentration was 0.81 ± 0.18 and it was higher in neonates with appropriate weight than in those with high or low birth weight (0.82 ± 0.18, 0.75 ± 0.19, and 0.65 ± 0.12 ng/ml, respectively). Bivariate correlation analysis showed significant weak correlation between cord blood zinc and neonatal weight (r = 0.16, P = 0.04).Conclusions:The cord blood zinc concentration of normal-weight neonates was higher than others. Our findings suggest that maternal zinc may influence neonatal birth weight, and it should be considered in the primordial prevention of NCDs.

Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis

Background: Neonatal mortality rate is an important health index. The present study was conducted to determine the mortality rate and its causes in neonatal intensive care units (NICUS) in Iran. Methods: Online search was done without time limit until June 2018 in several databases, such as PubMed, Web of Science (ISI), Scopus, Magiran, Barakat Knowledge Network System, SID, Iranian National Library, Regional Information Center for Science and Technology (RICST), Google Scholar search engine, and Iranian journals. The articles were qualitatively assessed after evaluating the inclusion and exclusion criteria. The Cochran's Q test and I2 index were used to determine the heterogeneity between studies. Meta-analysis was done based on a random effects model using Comprehensive Meta-Analysis Software (version 2). Results: Thirty-one eligible studies were analyzed. The mortality rate in 24,995 neonates admitted to NICUs in Iran was estimated to be 11.40% (95% CI: 9.10-14.20). The lowest mortality rate reported as 7.70% (95% CI: 6.01-9.82) was related to the Center of Iran, and the highest mortality rate was reported as 19.26% (95% CI: 15.82-23.24) in the west of Iran. In this regard, the difference was statistically significant (P<0.001). The most common causes of mortality in NICUs in Iran were prematurity (44.14% [95% CI: 31.95-57.08]), respiratory distress syndrome (RDS) (31.93% [95% CI: 22.83-42.66]), congenital malformation (16.09% [95% CI: 12.85-19.95]), septicemia (12.66% [95% CI: 8.87-17.75]), and asphyxia (7.58% [95% CI: 4.63-12.19]). Conclusion: The most common causes of mortality in Iranian neonates were prematurity, RDS, and congenital anomalies. We also found the mortality rate to be acceptable (11.4%). To reduce the mortality rate, we recommend performing prenatal screening tests and genetic counseling. In addition, maternal care during pregnancy should be improved to reduce premature delivery.

Congenital toxoplasmosis among Iranian neonates: a systematic review and meta-analysis.

Toxoplasmosis is a serious zoonotic disease that can lead to abortion and congenital disorders and has a widespread global distribution in humans and animals. The objective of this review was to investigate the incidence of toxoplasmosis in Iranian neonates in order to obtain a comprehensive assessment of the overall situation of the disease for use in developing future interventions. Original studies investigating the incidence of Toxoplasma gondii infections in Iranian neonates were systematically searched in a number of English-language and Persian-language electronic databases. The search process resulted in the inclusion of a total of 11 studies in the systematic review, 10 of which were entered into the meta-analysis. The reviewed articles included 2,230 Iranian neonates investigated through January 1, 2018. Based on the retrieved studies, the overall weighted incidence rates of toxoplasmosis in the Iranian neonatal population and neonates with suspected congenital toxoplasmosis were estimated to be 0.64% (95% confidence interval [CI], 0.31 to 1.09) and 4.10% (95% CI, 2.68 to 5.77), respectively, using a fixed-effects model. The findings of the reviewed studies demonstrate that the incidence of toxoplasmosis is high in Iranian neonates. Accordingly, it can be concluded that toxoplasmosis is a serious public health concern that has been ignored by the Ministry of Health. Therefore, it is essential to perform further studies, in addition to implementing screening and detection programs, using standardized methods to estimate the incidence of toxoplasmosis in Iran and to determine its associated risk factors.