IRANIAN JOURNAL OF NEONATOLOGY
Year:2018 | Volume:9 | Issue:2|Papers Count:13

Background: Stabilization of the conditions of infants is essential to the neurodevelopmental interventions in neonatal intensive care units (NICUs). Premature infants are born before the third trimester of pregnancy is completed, which disrupts the evolutionary process associated with brain development in neonates. Given the importance of the position of preterm infants and limited findings on nursing education in NICUs, the present study aimed to conduct a training intervention to improve the performance of nurses to properly implement the evolutionary positions of premature infants in the NICU. We also investigated the impact of instructions on the evolutionary status of preterm infants on the clinical practices in the NICUs of the hospitals affiliated to Iran University of Medical Sciences. Methods: This quasi-experimental study was conducted on 85 NICU nurses selected via convenience sampling. Performance of the nurses in implementing the evolutionary supportive status on the preterm infants admitted to the NICU was assessed and compared using a neonatal assessment tool before, one week, and two months after the intervention. Results: Analysis of the demographic data indicated that the majority of the NICU nurses had a master’ s degree (98. 8%), most of whom were aged more than 30 years (48. 2%). Nurses constituted the majority of the participants (97. 6%), who had the highest work experience (5-10 years) (42. 4%). A significant difference was observed in the performance scores of nurses in the evolutionary support status of premature infants before, one week, and two months after the training (P>0. 001). Conclusion: According to the results, training on the emergency support status of premature infants had a positive effect on the nursing performance in NICUs.

Background: between mother and her neonatal reflects the quality of maternal emotional feelings and behaviors toward her baby. This attachment emerges in behaviors, which indicate the mother’ s attention and care. Self-compassion is the extension of compassion to oneself in instances of perceived inadequacy, failure, or general suffering. Regarding this, the aim of the present study was to determine the relationship between maternal-neonatal attachment and self-compassion in postnatal period. Methods: This cross-sectional study was conducted on 335 primiparous women, referring to health care centers in Mashhad city in 2014. The study population was selected using the cluster and convenience sampling methods. The research tools were maternal/neonatal demographic form, self-compassion scale, and neonatal-maternal attachment questionnaire. The data were analyzed by Pearson correlation coefficient and linear regression model in SPSS software (version 22). Results: The results of the Pearson correlation coefficient test showed a positive correlation between the total score of maternal-neonatal attachment and self-compassion in postpartum period (r=0. 22, P=0. 012). Accordingly, as the score of self-compassion increased, the maternal-neonatal attachment score also enhanced. Conclusion: As the findings indicated, there was a correlation between self-compassion and maternal-neonatal attachment in postnatal period. Therefore, the provision of caregivers with education regarding psychological problems by community health midwives during postnatal period can be effective in the early diagnosis and identification of such disorders.

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as an alternative to nasal continuous positive airway pressure (nCPAP) therapy in the management of preterm neonates with respiratory distress due to ease of administration and patient comfort. However, limited evidence is available addressing its risks and benefits. To study the efficacy and safety of HHHFNC in comparison to nCPAP for the facilitation of extubation in preterm neonates (born at 27-34 weeks of gestation) with respiratory distress. Methods: A prospective observational study was conducted, where 64 neonates were assigned either to nCPAP (n=34) or HHHFNC (n=30) groups post-extubation. The primary outcome was treatment failure (defined by pre-specified criteria) requiring a higher modality of respiratory support within 72 hours after extubation. Results: Treatment failure was seen in 36. 7% of neonates assigned to the HHHFNC group compared to 14. 7% in the nCPAP group (P=0. 043). The incidence and severity of nasal trauma were higher in the nCPAP group compared to the HHHFNC group (nCPAP: 58. 6% vs. HHHFNC: 15. 7%; P=0. 001). No significant difference was observed between the two groups in terms of other outcomes such as days on primary non-invasive ventilation (NIV), days of total NIV, duration of hospitalization, days to reach full enteral feeding, weight gain at discharge, incidence and severity of nasal trauma, incidence of pneumothorax, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, and death. Conclusion: Though a gentler modality with less incidence of nasal trauma, HHHFNC does not appear to be as effective as nCPAP in the management of preterms with respiratory distress.

Background: Congenital anomaly is a disturbance in fetal growth and development during pregnancy and is one of the main causes of morbidity and mortality in the first year of life. In addition, this anomaly causes a large waste of heath care resources. We aimed to determine the prevalence and proportion rates of different congenital anomalies in Iran via a systematic review and meta-analysis. Methods: The present study was performed to estimate the prevalence and proportion rates of different anomalies in Iran via a systematic review and meta-analysis. Therefore, all the studies performed in Iran between 2000 and 2016 were evaluated. For this purpose, Medlib, Scopus, Web of Science, PubMed, Cochrane Library, Science Direct, Google Scholar, Irandoc, Magiran, IranMedex, and SID databases were searched by two different expert individuals independently. For the qualification survey of the papers, the Strengthening the Reporting of Observational Studies in Epidemiology checklist was applied. Then, the extracted data were entered into STATA (ver. 11. 1) and analysed using statistical tests of stability and random effects models in meta-regression, a tool used in meta-analysis. The 95% confidence intervals were calculated by I-square models. Meta regression was introduced to explore the heterogeneities among studies. Results: Overall, 36 papers with a total sample size of 909, 961 neonates were analysed. The total prevalence rate for congenital anomalies was 18/1000 live births, 23. 2/1000 and 18/1000 for boys and girls, respectively. Moreover, 55. 8% of all congenital anomalies pertained to boys. The greatest prevalence and proportion rates of congenital anomalies belonged to musculoskeletal disorders followed by urogenital anomalies (9. 3/1000 [34%] and 5. 7/1000 [20%], respectively), and the lowest figures belonged to chromosomal and respiratory system anomalies (0. 8/1000 [6%] and 0. 3/1000 [2%], respectively). Conclusion: According to the findings of this meta-analysis, the prevalence of congenital anomalies is notably high in Iran and annually imposes huge visible and non-visible expenses on individuals, societies, and heath care systems. Therefore, preparation of tools and centres for the early diagnosis and prevention of birth defects and rehabilitation of those with congenital anomalies throughout Iran are essential.

Palliative care is a series of actions aiming to offer support to parents and their infants in order to improve their quality of life. Despite optimal outcomes, the provision of palliative care for infants and achieving these outcomes may be hardly feasible. The present study aimed to investigate the barriers to palliative care and gain insight into the solutions. Accordingly, the obstacles were identified and classified into three categories of parent-related barriers (parental request for continuing treatment, cultural background, and religious beliefs), barriers concerning healthcare providers (attitude toward palliative care, death, and life values, religious beliefs, knowledge and skills in palliative care, and ethical distress), and barriers within the healthcare system (unclear policies regarding the implementation of palliative care, inadequate support from caretakers, lack of educational programs, insufficient personnel, unprepared environment, lack of technological requirements, and lack of access to consultants). Each category was discussed, and relevant solutions were provided.

Background: Most of the nurses have accepted family-centered care (FCC) as a standard model of care; however, they meet difficulties using this model. The aim of this study was to explore the perception of Neonatal Intensive Care Unit (NICU) nurses about the implementation of FCC. Methods: This qualitative study was carried out on 11 in-service NICU nurses with at least three years of work experience using an interpretative phenomenological approach. The study setting was three separate NICUs of three teaching hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran. Data collection was performed through semi-structured interviews and field notes. The data were analyzed using the seven-stage Diekelmann, Allen, and Tanner approach. Results: One of the important themes emerging in this study was “ Walking on an insecure foundation” that included three subthemes of “ Inappropriate base” , “ A pathway with no lines” and “ Unequal encounter” . The nurses described a lack of facilities, inadequate space, and staff’ s specific instruction in encouraging parents’ engagement, as well as high work pressure due to short staffing as factors that affected their ability to provide an ideal FCC. Conclusion: As the findings indicated, the lack of essential substructures and absence of a systematic program to engage parents in the care process of their infants have resulted in different operations by the nurses and discontinuous FCC implementation in NICUs. Officials and policy-makers should consider basic requirements, adequate workforce, and explicit guidelines to contextualize and guarantee the continuity of FCC.

Background: Premature rupture of membrane (PROM) refers to the rupture of fetal membranes at least 1 hour before the onset of labor pain. We aimed to determine the predictive value of maternal serum level of procalcitonin in the early diagnosis of chorioamnionitis in mothers with preterm (PPROM). Methods: In this prospective cohort study, 48 patients with PPROM were selected due to limited financial resources and in accordance with previous similar articles. The study was carried out in Kosar ward of Motahhari Hospital of Urmia, Iran. The inclusion criteria were leaking amniotic fluid, positive nitrazine and fern tests, gestational age of 28-33 weeks, and lack of fetal tachycardia. The exclusion criteria were chronic vascular and congenital heart diseases as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs). To analyze the data, we used descriptive statistics, Chi-square test (OR), independent t-test, and Pearson in SPSS, version 19. Results: The present study was conducted on 48 pregnant women and their neonates. About 39. 6% of the mothers were pathologically infected with chorioamnionitis, while 60. 4% of the patients were not infected with the disease. Moreover, 68. 8% of the neonates had a five-minute Apgar score of ≥ 7. There was a significant correlation between the mothers’ infection with histopathologic chorioamnionitis and neonatal hospitalization in neonatal intensive care unit (P<0. 001). Conclusion: According to the results, there was a significant correlation between the inflammatory indices of erythrocyte sedimentation rate, C-reactive protein, and white blood cell during the delivery time and histopathologic chorioamnionitis.

Background: Fetal growth restriction is defined as the failure of the fetus to achieve its full growth potential. The present study aimed to investigate the application of first trimester screening in the prediction of small for gestational age (SGA). Methods: This cohort study was conducted on the consecutive and unselected women with singleton pregnancies undergoing routine first-trimester examinations in a health center affiliated to Neyshabur University of Medical Sciences in Razavi Khorasan Iran during February 2014-March 2016. Subjects received a first-trimester visit by a physician, which included the entry of basic maternal characteristics, medical history, measurement of maternal weight and height, ultrasound examination for fetal anatomy, and measurement of crown-rump length to assess gestational age. Results: SGA was significantly correlated with maternal age, parity, and body mass index. Furthermore, a significant association was observed between SGA and smoking habits in the mothers. Conclusion: According to the results, first trimester screening was a useful method for the prediction of SGA.

Background: Congenital hypothyroidism (CH) is a prevalent disorder, which is associated with several other congenital anomalies, especially cardiac diseases. The present study aimed to determine the prevalence of congenital heart disease (CHD) in the neonates with CH. Methods: This cross-sectional study was conducted on two groups of 79 subjects to compare the type and frequency of congenital cardiac anomalies between the neonates with the confirmed diagnosis of CH (TSH≥ 10 mlU/ml) and healthy infants. The study was performed in Kowsar Clinic affiliated to Arak University of Medical Sciences, Iran. Level of thyroid-stimulating hormone (TSH) was measured within days 3-7 of birth using the samples collected from the soles of the neonates. In addition, all the subjects were evaluated for the presence of CHD using echocardiography before day 30 of life. Results: In total, 79 neonates were enrolled in the study. The case group consisted of 34 females (43. 04%) and 45 males (53. 96%), and the control group consisted of 43 females (54. 43%) and 36 males (45. 57%). The groups were matched in terms of age and gender. Cardiac involvement was only detected in the case group (CH infants) with the prevalence of 22. 7%. Among the non-cyanotic malformations observed in the case group, one infant had ventricular septal defect (1. 3%), eight infants had atrial septal defect (10. 1%), three infants had patent ductus arteriosus (3. 8%), three neonates had endocardial cushion defect (3. 8%), two neonates had pulmonary stenosis (2. 5%), and one infant had dilated cardiomyopathy (1. 3%). Moreover, six neonates were diagnosed with Down syndrome. All the infants with endocardial cushion defect (n=3) had Down syndrome, and no significant association was observed between TSH and thyroxine (T4) in the presence of CHD. Conclusion: According to the results, the high prevalence of cardiac malformations in the neonates with CH necessitated cardiac examinations using echocardiography.

Pregnancy in the women aged less than 20 years is an important public health issue, especially in developing countries. In Iran, limited studies have focused on the effects of maternal age on gestational and neonatal outcomes to demonstrate the pregnancy outcomes in young women. The present study aimed to investigate the maternal and neonatal complications in the pregnant women aged less than 20 years. In this cross-sectional study, variables such as maternal age, neonatal birth weight, head circumference at birth, one-and five-minute Apgar scores, gestational age, low birth weight, intrauterine growth restriction (IUGR), neonatal mortality, fetal death, preterm labor and cesarean section, maternal mortality, anemia, and preeclampsia were assessed in all the subjects. Mean age of the studied women was 18. 79± 1. 27 years, and low birth weight was reported in 17. 6% of the neonates. One-and five-minute Apgar scores of <7 were observed in 8. 1% and 4. 5% of the neonates, respectively. In addition, IUGR, neonatal mortality, fetal death, preterm labor, maternal anemia, and preeclampsia were reported in 4. 1%, 1. 7%, 1. 4%, 24. 6%, and 3. 4% of the subjects, respectively. Cesarean delivery was performed in 51. 8% of the mothers, and no maternal mortality was reported. Rate of fetal death was higher and one-minute Apgar score was lower in the neonates of the mothers aged less than 18 years compared to those aged 18-20 years (P=0. 001). Moreover, neonatal mortality and low one-and five-minute Apgar scores were higher in our study compared to the previous studies. It is recommended that educational programs be planned about the maternal and neonatal complications in the pregnant women aged less than 20 years. Considering the high rate of neonatal mortality and low Apgar scores at birth in our subjects, better prenatal care and accurate resuscitation must be implemented, especially in the pregnant women aged less than 18 years.

Background: No comprehensive definition of SBF leads to failure in identification of ineffective breast-feeding and clinical problems, which will end up in early hospitalization of the infants. The study tried to describe the factors affecting SBF by Walker and Avant approach. The quantitative, qualitative, and mixed papers using different approaches in nursing, midwifery, nutrition and medical literature from 1995 to 2017 were reviewed by the researchers using keywords “ successful breast-feeding, ” “ infant, ” and “ SBF concept analysis, ” in databases of Cinahel, PubMed, Scopus, Medline and Google Scholar. Methods: We used Walker and Avant approach in the analysis of the factors affecting successful breast-feeding. Searching for “ successful breast-feeding” and “ infant” triggered the initial study. Ultimately, 84 sources were selected as the sample of the study. Later, data was classified according to characteristics, effective factors, incidences, consequences, and empirical referents connected with successful breast-feeding. Results: As an interactive process, four main characteristics of SBF were holding the infant while breast-feeding, the method of placing the breast in the infant’ s mouth, sucking, and milk transmission from mother to the infant. Furthermore, some incidents related to SBF were “ posture of the infant while breast-feeding, ” “ breast physiology and anatomy, ” and “ infant’ s mouth physiology and anatomy. ” The aftermaths included “ infant’ s behavior when being full, ” “ letting go of the breast, ” “ not responding to sucking reflex, ” “ apparently calm infants, ” and “ lack of pain and discomfort in the breast. ” Conclusion: The results showed that determining the characteristics, events, and aftermaths of SBF is absolutely essential and important for both clinical and nursing intentions. Indeed, accurate estimation of the concept of SBF ends in identification of the related problems and proposing strategies for solving them.

Background: Cleidocranial dysplasia (CCD) is a rare inherited skeletal dysplasia, with an incidence of 1 case per 1000, 000 individuals. It is a form of predominantly autosomal dominant inheritance and is associated with a mutation in runt related transcription factor-2 gene mapped on chromosome 6p21. This disease primarily affects the bones formed by intramembranous ossification and is characterized by the aplasia or hypoplasia of the clavicles, delayed closure of fontanelles, open skull sutures, supernumerary teeth, wide pubic symphysis, and short stature. The phenotypic spectrum can range from individuals with minor dental anomalies to severe manifestations, like syringomyelia. The early diagnosis of CCD may be difficult because the craniofacial abnormalities become obvious usually during adolescence. Case report: Herein, we reported a rare case of a neonate with features of classical CCD coupled with a positive family history extending over three generations. This report aimed to create awareness among the paediatricians regarding CCD and highlight the importance of the early diagnosis of this rare disorder to prevent the associated complications. Conclusion: Though the diagnosis of CCD in neonatal period is a challenge, the clinical features along with the characteristic family history and radiographic findings, help to establish the diagnosis with confidence.

Background: Barakat syndrome is a rare autosomal dominant disorder characterized by hypoparathyroidism, sensorineural deafness, and renal disease, collectively known as HDR syndrome. This disease is caused by the mutation of GATA3 gene located on chromosome 10p15. GATA3 is involved in the embryonic development of kidneys, inner ears, parathyroid glands, and central nervous systems. Case report: Herein, we presented a 20-month-old female with seizure and microcephaly, congenital left kidney dysplasia, hypoparathyroidism, and bilateral sensorineural deafness. Her laboratory tests were consistent with hypoparathyroidism, and the chromosomal study revealed a deletion in chromosome 10. The patient was diagnosed as a case of Barakat syndrome based on her clinical and laboratory tests. The microarray-based comparative genomic hybridization study of the patient was compatible with the monosomy of 10p15. 3p13 and trisomy of 12p13. 33p13. 33. Conclusion: It is important to be aware of rare inherited conditions like Barakat syndrome (HDR syndrome) in a patient with abnormal presentations, such as seizure, neurodevelopmental delay, kidney defects associated with hearing loss, and clinical abnormalities associated with hypoparathyroidism.