Introduction:Fournier’s gangrene is an infective necrotizing fasciitis of external genital and perineal region. Hematologic malignancies and immunocompromised status are predisposing factors. Simultaneous occurrence of Fournier’s gangrene and congenital leukemia in neonates is extremely rare.Case Presentation:We present a case of Fournier’s gangrene in a 4-day-old female infant with a necrotic lesion in perineum and no history of trauma or other predisposing condition. Focusing on high blast percentage in blood cell count she was affected by acute myeloid leukemia (M4 type). Pseudomonas aeruginosa was isolated from the blood and wound culture. She was treated with broad spectrum antibiotics and supportive care. The parents refused chemotherapy and the patient was discharged from hospital. Bleeding and DIC was the cause of death in a local hospital few days later.Conclusions:High index of suspicion is essential for diagnosis and appropriate treatment. Congenital leukemia should be considered in the differential diagnosis of a newborn with clinical features of sepsis and necrotizing fasciitis.

Background:The heel-lancing procedure is a common tissue damaging procedure routinely performed in premature neonates and causes pain. Therefore, efforts should be made to relieve this pain. Objectives: This study aimed to assess the effect of kangaroo mother care (KMC) for a brief duration of 15 minutes on pain intensity of heel lance in preterm newborns admitted to neonatal intensive care units. Patients and Methods:In this clinical trial with crossover design, 64 vitally stable preterm neonates between 30-36 weeks of gestational age, who needed at least two heel lances, were randomly allocated to two groups. In group A, neonates received KMC 15 minutes before, during, and two minutes after the first heel lancing procedure. In group B, neonates were kept in prone position in incubator 15 minutes before lancing. For second heel lancing, the neonates in group A were put in incubator and group B received KMC. Premature Infant Pain Profile (PIPP) was scored during and within two minutes after finishing the procedure in both conditions. Results: The mean score of pain intensity during the intervention was significantly lower in the KMC position (P < 0/000). Mean score of pain intensity at two minutes after intervention was also significantly lower in the KMC position (P < 0/000). Conclusions: KMC before and during heel lancing is a natural, easy to use, and cost-effective method to decrease pain in premature neonates. It is consistent with modern strategy of family-centered care in neonatal units.

Objective Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition with high mortality and morbidity rates in neonatal intensive care unit (NICU) admitted neonates due to severe hypoxemia. The aim of this study was to evaluate red cell distribution width (RDW) as a biomarker of hypoxemia and determine the optimal cutoff point of RDW for identifying neonates with PPHN. Study Design All PPHN diagnosed, NICU admitted term infants with hypoxemia after birth from May 2014 to September 2016 were enrolled as case control and healthy term infants with nonhemolytic jaundice who were admitted for phototherapy on the second or third day of birth were the control group. Blood samples were collected. Multiple logistic regression modeling was used to examine the association between PPHN and RDW. Results Receiver-operating characteristics (ROC) curve analysis was used to determine the optimal cutoff point of RDW for identifying neonates with PPHN. RDW was higher in the PPHN group compared with the control group (p < 0.001). Significant predictors of PPHN were mother's underlying disease (p = 0.01) and RDW (p < 0.001). The optimal RDW cut point for prediction of PPHN by the ROC curve analysis was 17.9 (sensitivity = 85.71%). RDW's area under the curve was 0.9197 (p < 0.001). Conclusion RDW may be a simple, valuable, accessible marker for predicting PPHN before performing echocardiography in hypoxemic NICU admitted neonates.

Background: Neonatal sepsis is a serious problem in neonatal intensive care units, as it causes high rates of morbidity and mortality. Objectives: The purpose of this study is to evaluate various etiologic agents, antimicrobial susceptibility, clinical manifestations and the mortality rate in an intensive care unit in Kashan, Iran. Patients and Methods: One hundred and four neonates with documented early onset sepsis in a 2 year period from 2006 to 2008 were enrolled in this descriptive study. The results of blood cultures and antimicrobial susceptibility and clinical manifestations and outcome were collected in questionnaires and subsequently analyzed. Results: We evaluated 104 cases including 63 (61%) males and 41 (39%) females. The most common clinical presentations were respiratory distress in 28 (26.9%), poor feeding in 18 (17.3%), lethargy in 15 (14.5%), fever in 15 (14.5%) and jaundice in 13 cases (12.5%). The most common organisms isolated from blood cultures were Flavobacterium (43.3%), Pseudomonas (17.3%) and coagulase positive Staphylococcus (17.3%). All Flavobacterium were resistant to Ampicillin and 100% were susceptible to Amikacin. Conclusions: The most common isolated organism from blood cultures was Flavobacterium. Water was causative source of Flavobacterium. Later on we found that an outbreak had occurred during our study and these results may not be seen in an ordinary situation.