Introduction: Acute renal failure (ARF) is a common problem among the admitted neonates in Intensive Care Units. In most of the patients, ARF accompanies with a predisposing factor such as sepsis, heart failure, perinatal asphyxia or prematurity. Due to the relatively high prevalence of ARF in neonates, the present study emphasizes on the fact that misdiagnosis and under treatment of ARF can lead to adverse complications. So, our objective is to find the frequency and etiology of renal failure among the admitted newborns in a NICU.Materials and Methods: In this study, the profiles of 2400 admitted newborns in the NICU of Bahman 22nd Hospital of Mashhad over a period of 5 years were reviewed. There were 50 newborns with the inclusion criteria of renal failure. Patients’ serum creatinin and urine volumes were measured and compared with a standard table. Finally, the data was analyzed by SPSS, setting a significance level of P£0.05.Results: The prevalence rate of ARF was found to be 2.1% with a rate of 2.3% among the male neonates and that of 1.8% among the females which was not significantly different (P=0.093). Concerning the type of renal failure, 18 neonates (36%) were diagnosed as renal ARF, 31 neonates (62%) as pre-renal ARF and 1 neonate (2%) as post-renal ARF. In this study, the most common causes of ARF were dehydration (28%), respiratory distress syndrome (18%), Icterous and poor feeding (16%), asphyxia (16%) and Infections (14%), respectively.Conclusion: Pre-renal factors, especially dehydration and poor feeding are the most common causes of acute renal failure in newborns.

Background: Acinetobacter baumannii is one of the most important pathogen in hospital acquired infections especially in intensive care units (ICUs). This opportunistic pathogen can be easily isolated from water, soil, and hospital facilities. A.baumannii as a nosocomial opportunistic pathogen is resistant to wide range of antibiotics. The aim of this study was to determine frequency and resistance patterns of A.baumannii isolated ICUs of Isfahan Hospitals.Methods: During one year period (2012-2013), 350 specimens were collected from ICUs of Isfahan hospitals. The specimens were characterized as A .baumannii by conventional phenotypic and biochemical tests.The isolates were confirmed by PCR for OXA_51 like gene. Susceptibility of isolates was determined by standard disk diffusion method according to CLSI.Findings: From 350 specimens, 43 isolates was Acinetobacter baumannii .The antimicrobial patterns of isolates showed that 53.5% of isolates were resistant to amikacin, 83.7% to tetracyclin, 86% to ceftazidime, 90.7% to trimetoprim sulfametoxazol, 93% to imipenem, cefepime, meropenem, ampicillin -Sulbactam. All isolates were resistant to ciprofloxacin. Our findings showed that all of Acinetobacter, isolated from the ICU of Isfahan hospitals were MDR.Conclusion: This study showed a high resistant of A.baumannii to a wide range of antimicrobial agent. It is necessary to adopt appropriate strategies to control the spread of the bacteria in care unit centers and wards.

Background: Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients.Objectives: The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU.Materials and Methods: This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient’s reports and documents were used. Information saturation was determined as an interview termination criterion.Results: Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications).Conclusions: Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

Aim: This paper reviews various positions for neonates admitted to Neonatal Intensive Care Unit (NICU), describes benefits and disadvantages of each position and suggests a clinical guideline to improve development. .Background: It has been known that development of active muscle tone begins at 36 weeks gestation, when the baby achieves a postural state known as physiological flexion. Premature babies suffer from low muscle tone because they have missed out on some or all of the substantial stages of muscle tone development in the uterus. Without appropriate intervention these babies may experience head flattening and cranial molding. Without support, gravity causes preterm babies shoulders and hips flatten onto the bed, often called ‘frog leg position’ and ‘W arm position’. This can result in inappropriate or delayed development and mobility challenges including the inability to crawl, stand, walk and problem in fine motor skills such as hand-mouth co-ordination.Method: In this literature review, papers published during the last 15 years, were searched out through search engines and data bases: Science Direct, Google Scholar, Ebsco, Pub Med, Ovid, Proquest based on which 16 papers about neonatal positioning during nursing care were selected. Also, three neonatal textbook were used. .Result: One of the earliest neurodevelopmental strategies in the NICU is therapeutic positioning. Positioning of premature infant is an essential neonatal nursing care. These positions are supine, prone, side-lying, and head up tilted position. Many studies have shown that a variety of outcomes can be affected by different body positioning of premature infants. Every position has its own advantages and disadvantages, so each infant should be individually assessed and positioned according to condition, preferences and behavioral cues. Position changes should be slow and steady, so that the infant doesn’t become distressed and dislodgement of invasive and monitoring equipment can be avoided. Whenever possible, an infant should be touched gently and talked to before changing their position.Conclusion: It is necessary to ensure that preterm and sick neonates receive individualized positioning appropriate for their musculoskeletal development in order to minimize complications. Infants receiving developmentally supportive care have been demonstrated better medical outcomes including shorter duration of mechanical ventilation and supplemental oxygen support, earlier oral feeding, and shorter hospitalization.