ORIGINAL_ARTICLE
Clinical Outcomes of Snuggle up Position Using Positioning Aids for Preterm (27-32 Weeks) Infants
ABSTRACTBackground: Preterm birth, if not actively managed with developmental supportive care, can significantly contribute to neurodevelopmental compromise. Use of appropriate positioning aids helps with mimicking the intrauterine environment and facilitating neuromuscular development. Herein, we aimed to determine the effectiveness of snuggle up positioning aids on clinical outcomes of preterm (<32weeks) infants.Methods: This randomized controlled trial was performed at a tertiary neonatal intensive care unit (NICU) to investigate the effect of snuggle up position using positioning aids (vs. standard care) on heart rate, respiratory rate, oxygen saturation, duration of ventilation, weight gain, and duration of NICU stay.Results: There was a significant difference in respiratory rate, oxygen saturation, stability of the cardiorespiratory system in preterm infants (SCRIP) score, and weight gain between the intervention and control groups (P<0.05). However, there was no significant difference in temperature, heart rate, and duration of ventilation between the two groups (P>0.05).Conclusion: Use of snuggle up position with positioning aids increased stability of physiological parameters and weight gain and reduced duration of NICU stay. Thus, the use of positioning aids for preterm infants is recommended to facilitate their growth and clinical outcomes.
https://ijn.mums.ac.ir/article_8515_6769fc9e01236912fdfba47ec6fcbbc6.pdf
2017-03-01
1
6
10.22038/ijn.2016.7709
Keywords: Clinical outcomes
Physiological Parameters
preterm infants
Snuggle up positioning
Yashoda
Sathish
yashodamanipal@yahoo.co.in
1
Manipal College of Nursing Manipal University, Manipal, India
AUTHOR
Leslie
Edward Lewis
2
Department of Paediatrics, Kasturbha Hospital and Kasturbha Medical College, , Manipal, India
AUTHOR
Judith
Angelitta Noronha
3
Manipal College of Nursing Manipal University, Manipal, India
LEAD_AUTHOR
Anice
George
anice.george@manipal.edu
4
Manipal College of Nursing Manipal University, Manipal, India
AUTHOR
Baby
Snayak
5
Manipal College of Nursing Manipal University, Manipal, India
AUTHOR
Mamatha
S Pai
6
Manipal College of Nursing Manipal University, Manipal, India
AUTHOR
Ramesh
Bhat
ramesh.bhat@manipal.edu
7
Department of Paediatrics, Kasturbha Hospital and Kasturbha Medical College, , Manipal, India
AUTHOR
Jayashree
Purkayastha
jayashreepurkayashta@yahoo.com
8
Department of Paediatrics, Kasturbha Hospital and Kasturbha Medical College, , Manipal, India
AUTHOR
References
1
1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet; 2012; 379(9832):2151-2161.
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2. Bylund B., Cervin T, Finnström O, Gäddlin P, Kernell A, Leijon I, et al. Morbidity and neurological function of very low birthweight infants from the newborn period to 4y of age. A prospective study from the south-east region of Sweden. Acta Paediatrica;. 1998; 87(7): 758–763. doi: 10.1111/j.1651-2227. .tb01743.x
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3. Vaucher YE. Bronchopulmonary dysplasia: an enduring challenge. Paediatric reviews Rev. 2002; 23(10):349-358.
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4. Bregman J. Developmental outcome in very low birth weight infants. Current status and future trends. Pediatr Clin North Am. 1998; 45(3): 673-690.
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5. Altimier, L, Philips RM. The neonatal integrative developmental care model: seven neuro protective core measures for family-centered developmental care. Newborn & Infant Nursing Reviews. 2013; 13(1): 9-22.
6
6. Beck S, Daniel W, Say Lale S, Betran AP, Mario M, Jennifer HR, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bulletin World Health Organization. 2010; 88(1):31-38.
7
7. Halverson, Kristia. "The effects of positioning on premature infant development". Michigan: (2010). Pediatrics CATs. 2010. Paper 5. http://commons .pacificu.edu/otpeds/5,
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8. Fox RE, Viscardi RM, Taciak VL, Niknafs H, Cinoman MI.Viscardi RM, Taciak VL, Niknafs H, Cinoman MI. Effect of position on pulmonary mechanics in healthy preterm newborn infants. J Perinatol. 1993; 13(3):205–211.
9
9. Waitzman, KA. The importance of positioning the near-term infant for sleep, play, and development. Newborn& Infant Nursing Reviews. 2007; 7(2): 76-81.
10
10. Coughlin M, Gibbins S, Hoath S. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. . Journal of Advanced Nursing. 2009; 65(10):2239-2248. doi:10.1111/j.1365-2648.2009.05052.x.
11
11. Faul F, Edgar E, Buchner, A, Georg Lang, AG. Statistical power analyses using G*Power 3.1: Tests tests for correlation and regression analyses. Behavior Research Methods. 2009; 41(4): 1149-1160.
12
12. Jenni OG, von Siebenthal K, Wolf M, Keel M, Duc G, Bucher HUOskar J, Kurt S, Martin W, Matthias K, Gabriel D, Hans B. Effect of nursing in the head elevated tilt position (15 degrees) on the incidence of bradycardia and hypoxemic episodes in preterm infants. PedriatricsPediatrics. 1997; 100 (4):622-5.
13
13. Joana brigs Institute. Positioning of preterm infants for optimal physiological development. Best Pract. 2010; ice 14(18) 2010;:1-4. available at: www joannabriggs. edu.au
14
14. Kihara H, Nakamura T. Nested and swaddled positioning support in the prone position facilitates sleep and heart rate stability in very low birth weight infants. Research and Reports in
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Neonatol.ogy 2013; 3:11-14.
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15. Beckmann CA. Use of neonatal boundaries to improve outcomes. Journal of Holistic Nursing;. 1997; 15(1):54–67.
17
ORIGINAL_ARTICLE
The Effect of Psychological Intervention on Mother-Infant Bonding and Breastfeeding
ABSTRACT Background: The emotional bond that a mother feels towards her infant is critical to their social, emotional, and cognitive development. This concept has a major influence on an infant’s future health, and growth, so the assessment of parental-fetal attachment and related factors is of great importance. This study aimed to examine the effect of psychological intervention on attachment and persistency of lactation.Methods: This clinical trial was carried out on 71 pregnant women who visited Milad and Vali-Asr hospitals in Tehran, Iran. The subjects were selected by convenience sampling method and randomly divided into control (n=36) and intervention (n=35) groups. In the intervention group, the subjects received three sessions of supportive group psychotherapy supplemented by training packages. Avant’s mother-infant attachment behavior questionnaire, Maternal Attachment Inventory, 28-item General Health Questionnaire, and the short form of the Coopersmith Self-Esteem Inventory were used to evaluate attachment behaviors and related factors. Attachment of mothers was examined at six different times. Statistical data was analyzed using independent t-test, Fisher’s exact test.Results: The findings indicated that the intervention group had increased attachment and breastfeeding persistency (P˂0.001). Regression test also showed that maternal attachment was significantly influenced by psychological interventions, self-esteem, and depression (P˂0.001).Conclusion: According to the results, psychological interventions are suggested during pregnancy to increase attachment and breastfeeding persistency, and thereby, improve mental health of both mother and newborn.
https://ijn.mums.ac.ir/article_8516_db3aa241fd88b6c6e3e753aa1af4f247.pdf
2017-03-01
7
15
10.22038/ijn.2017.16673.1191
Keywords: Bonding
Lactation
Supportive psychotherapy
Mamak
Shariat
shariat@tums.ac.ir
1
Department of Pediatrics, Maternal Pediatric Health Specialist, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Vali ASR Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
AUTHOR
Nasrin
Abedinia
nasrin.abedinia@yahoo.com
2
Clinical Psychologist, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Vali Asr Hospital, Iranian Research Centers of HIV/AIDS Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
LEAD_AUTHOR
References
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2. Nematbakhsh F, Kordi M, Sahebi A, Esmaeeli H. The effect of mother–infant skin to skin contact on mother’s attachment. Quart J Fundament Ment Health. 2007; 8(33-34):25-32 (Persian).
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3. Saastad E, Ahlborg T, Froen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health. 2008; 53(4):345-52.
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4. Verhults JM. Relational problem. In: Sadok BA, Sadok VA, editors. Comprehensive text book of psychiatry. 7th ed. Philadelphia: Williams and Wilkins; 2000. P. 1888.
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5. Edwards LD. Adaptation to parenthood. In: Lowdermilk BP, Perry SE, Cashion MC, editors. Maternity nursing. 5th ed. St. Lois: Mosby; 1999. P. 450.
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6. Furman L, Breastmilk K. Breastmilk and skin-to-skin kangaroo care for premature infants. Avoiding bonding failure. Acta Pdiatricts. 2000; 89(11):1280-3.
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7. Lundington-Hoe SM, Anderson GC, Simpson S, Hollingsead A, Argote LA, Rey H. Brith-related fatigue in 34-36-week preterm neonates: rapid recovery with very early kangaroo (skin-to-skin) care. J Gynocol Neonatal Nurs. 1999; 28(1):94-103.
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8. Prodromidis M, Field T, Arendt R, Singer L, Yando R, Bendell D. Mothers touching newborns: a comparison of rooming– in versus minimal contact. Birth. 1995; 22(4):196-200.
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9. Curry MA. Maternal attachment behavior mother´s self concept: the effect of skin-to-skin contact. Nurs Res. 1982; 31(2):73-8.
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10. Messmer PR, Rodriguez S, Adams J, Well-Gentry J, Washburn K, Zabaleta I, et al. Effect of kangaroo care on sleep time for neonates. Pediatr Nurs. 1997; 23(4):408-14.
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11. Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981; 30(5):281–4.
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12. Shieh C, Kravitz M, Wang HH. What do we know about maternal-fetal attachment? Kaohsiung J Med Sci. 2001; 17(9):448–54.
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13. Sandbrook SP, Adamson-Macedo EN. Maternal-fetal attachment: searching for a new definition. Neuro Endorcinol Lett. 2004; 25(1):169–82.
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14. Alhusen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs. 2008; 37(3):315-28.
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15. Solchany JE. Promoting maternal mental health during pregnancy. 1st ed. Theory. Practice & Intervention. Seattle: NCAST Publications; 2001. P. 289-95.
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16. Pillitteri A. Maternal & child health nursing: care of the childbearing & childrearing family. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. P. 201-26.
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17. Facello DC. Maternal/fetal attachment: associations among family relationships, maternal health practices, and antenatal attachment. Michigan: ProQuest; 2008.
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18. Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud. 2009; 46(5):708-15.
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19. Shiremadar2. Shiraz Health Center. Available at: URL: http://shc.sums.ac.ir/shiremadar2.htm; 2015.
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20. Toosi M, Akbarzadeh M, Zare N, Sharif F. Effect of attachment training on anxiety and attachment behaviors of first-time mothers. J Hayat. 2011; 17(3):69-79 (Persian).
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21. Hoseini VM, Nejhad FJ, Soltanifar A. Impact of maternal attachment style on mother to infant attachment. Qom Univ Med Sci J. 2011; 5(3):87-92 (Persian).
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22. Noorbala AA, Mohammad K. The validation of general health questionnaire- 28 as a psychiatric screening tool. Hakim Res J. 2009; 11(4):47-53 (Persian).
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23. Taghavi SM. The normalization of general health questionnaire for Shiraz University students (GHQ-28). Daneshvar Raftar. 2008; 15(28):1-12 (Persian).
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24. Basiratniea S. Self Questionnaire of Qoper Esteem. New Ideas in the Field of Consulting. Family Counselor. Available at: URL: http://www.basiratnia2007.blogfa.com/8610.aspx; 2005.
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25. Akbarzadeh M, Toosi M, Zare N, Sharif F. Effect of learning attachment behaviors on anxiety and maternal fetal attachment in first pregnant women. Evid Based Care 2011; 1(1):21-34 (Persian).
26
26. Kim JS, Cho KJ. The effect of mother-fetus interaction promotion program of talking and tactile stimulation on maternal-fetal attachment. Korean J Child Health Nurs. 2004; 10(2):153-64.
27
27. Abasi E, Tafazoli M, Esmaeili H. The effect of foetal movement counting on primipara maternal foetal attachment. J Mazandaran Univ Med Sci. 2010; 20(77):53-60 (Persian).
28
28. Nagata M, Nagai Y, Sobajima H, Ando T, Honjo S. Depression in mother and maternal attachment--results from a follow-up study at 1years postpartum. Psychopathology. 2003; 36(3):142-51.
29
29. Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud. 2009; 46(5):708–15.
30
Torshizi M. Different dimensions of maternal-fetal attachment behaviors and associated factors in pregnant women referred to health centers of Birjand, Iran, 2012. Iran J Obstet Gynecol Infertil. 2013; 16(72):13-21 (Persian). 31. Lefkovics E, Baji I, Rigó J. Impact of maternal depression on pregnancies and on early attachment. Infant Ment Health J. 2014; 35(4):354-65. 32. Tharner A, Luijk MP, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Jaddoe VW, Hofman A, et al. Maternal lifetime history of depression and depressive symptoms in the prenatal and early postnatal period do not predict infant-mother attachment quality in a large, population-based Dutch cohort study. Attach Hum Dev. 2012; 14(1):63-81. 33. Perry DF, Ettinger AK, Mendelson T, Le HN. Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants. Infant Behav Dev. 2011; 34(2):339-50. 34. Cinar N, Köse D, Altinkaynak S. The relationship between maternal attachment, perceived social support and breast-feeding sufficiency. J Coll Physicians Surg Pak. 2015; 25(4):271-5. 35. Ozlüses E, Celebioglu A. Educating fathers to improve breastfeeding rates and paternal-infant attachment. Indian Pediatr. 2014; 51(8):654-7.
31
ORIGINAL_ARTICLE
Survival of Premature and Low Birth Weight Infants: A Multicenter, Prospective, Cohort Study in Iran
ABSTRACTBackground: The survival rate of preterm and low-birth-weight (LBW) infants depends on various factors such as birth weight, gestational age, and quality of care. The present study aimed at evaluating the survival rate of preterm and LBW infants, predictive factors, and the risk of mortality in three training hospitals of Mashhad and Tabriz cities.Methods: This prospective, cohort study was conducted during six months from 2013 to 2014. Infants with birth weight ≤1500 g or gestational age ≤32 weeks were enrolled. Their information was gathered by using data collection forms and clinical risk index for infants (CRIB II) was calculated for each participant. Infants were followed up until discharge from the hospital and their outcomes were determined. Kaplan-Meier and Log rock tests were used for survival analysis. Cox regression was also applied in order to find out the factors associated with infants’ survival.Results: Among the 338 followed up infants, 97 (28.7%) died and 241 (71.3%) remained alive. The median of preterm and LBW infants’ overall survival rate was 76 days (CI: 60.4-91.5). Multivariate Cox regression analysis indicated that three factors of birth weight, base excess, and fifth minute Apgar score had a significant relationship with the survival rate of infants (P<0.05).Conclusion: The survival rate of preterm and low-weight infants was acceptable in this study (71%). Birth weight, fifth minute Apgar score, and base excess were important items that affected infants’ survival and could be considered in predicting it in neonatal intensive care units.
https://ijn.mums.ac.ir/article_8517_19357468164533cf496626e6b33ddb42.pdf
2017-03-01
16
22
10.22038/ijn.2017.17586.1203
Keywords: Low birth weight
NICU
premature infant
Survival
Fatemeh
Ghorbani
ghorbanif@tbzmed.ac.ir
1
Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Mohammad
Heidarzadeh
heidarzade_2013@yahoo.com
2
Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Saeed
Dastgiri
saeed.dastgiri@gmail.com
3
Tabriz Health Services Management Centre, Tabriz, Iran
AUTHOR
Marziyeh
Ghazi
marziyeh.ghazi@gmail.com
4
Mashhad Omolbanin Hospital, Mashhad, Iran
AUTHOR
Mahni
Rahkar Farshi
rahkarfarshim@tbzmed.ac.ir
5
Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
References
1
1. Verklan MT, Walden M. Core curriculum for neonatal intensive care nursing. New York: Elsevier Health Sciences; 2014.
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2. Hashemian Nejad N, Pejhan A, Rakhshani MH, Hoseini BL. The incidence of low birth weight (LBW) and small-for-gestational age (SGA) and its related factors in neonates, Sabzevar, Iran. Int J Pediatr. 2014; 2(4.2):73-8.
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3. Platt M. Outcomes in preterm infants. Public Health. 2014; 128(5):399-403.
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4. Kliegman RM. Nelson textbook of pediatrics. Philadelphia: Sunders; 2011.
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5. Lau C, Ambalavanan N, Chakraborty H, Wingate MS, Carlo WA. Extremely low birth weight and infant mortality rates in the United States. Pediatrics. 2013; 131(5):855-60.
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6. Rüegger C, Hegglin M, Adams M, Bucher H. Population based trends in mortality, morbidity and treatment for very preterm-and very low birth weight infants over 12 years. BMC Pediatr. 2012; 12(1):17.
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7. Vakrilova V. Scoring systems for assessing illness severity and predicting outcome in very low birth weight infants. Akush Ginekol. 2011; 50(1):37-41.
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8. Basu S, Rathore P, Bhatia BD. Predictors of mortality in very low birth weight neonates in india. Singapore Med J. 2008; 49(7):556-60.
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9. Khani S, Mohamadpour RA, Ghaffari Saravi V, Abdollahi F, Sabaghi R, Bavand M. 200 and governmental hospitals in Sari by survival analysis technique during 2005-7. J Mazandaran Univ Med Sci. 2008; 17(62):54-62.
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10. Alleman BW, Bell EF, Smith B, Ambalavanan N,
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Laughon MM, Stoll BJ, et al. Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics. 2013; 132(1):e175-84.
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11. Sritipsukho S, Suarod T, Sritipsukho P. Survival and outcome of very low birth weight infants born in a university hospital with level II NICU. J Med Assoc Thai. 2007; 90(7):1323-9.
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12. Selected finding of the 2011 national population and housing Census. Statistical Centre of Iran ISY. Available at: URL: http://unstats.un.org/unsd/demographic/sources/census/wphc/Iran/Iran-2011-Census-Results.pdf; 2011.
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13. Rezaeian A, Boskabadi H, Mazlom SR. Factors associated with perinatal mortality in preterm infants in NICU Ghaem Hospital, Mashhad. J North Khorasan Univ Med Sci. 2012; 4(3):349-60.
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14. Medlock S, Ravelli AC, Tamminga P, Mol BW, Abu-Hanna A. Prediction of mortality in very premature infants: a systematic review of prediction models. PloS One. 2011; 9(6):e23441.
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15. Zanjani AP, Gharib MH, Kamrani MA. The evaluation of predicting mortality risk of premature infants with very low birthweight by CRIB score. J Gorgan Univ Med Sci. 2009; 10(4):40-3.
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16. Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, et al. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol. 2016; 215(1):103.e1-14.
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17. Costeloe K, Hennessy E, Haider S, Stacey F, Marlow N, Draper ES. Short-term outcomes after extreme preterm birth in England: comparison of 2 birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012; 345:e7976.
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18. Navaei F, Aliabady B, Moghtaderi J, Moghtaderi M, Kelishadi R. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran. World J Pediatr. 2010; 6(3):228-32.
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19. Velaphi SC, Mokhachane M, Mphahlele RM, Beckh-Arnold E, Kuwanda ML, Cooper PA. Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital. S Afr Med J. 2005; 95(7):504-9.
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20. Mohamed EM, Soliman AM, El-Asheer OM. Predictors of mortality among neonates admitted to neonatal intensive care unit in pediatric Assiut University Hospital, Egypt. J Am Sci. 2011; 7(6):606-11.
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21. Babaee H, Jafrasteh A. The evaluation of CRIBII scoring system in predicting mortality in preterm
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newborns. Yafteh. 2015; 16(4):27-35 (Persian).
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22. Rastogi PK, Sreenivas V, Kumar N. Validation of CRIB II for prediction of mortality in premature babies. Indian Paediatr. 2010; 47(2):145-7.
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23. Locatelli A, Roncaglia N, Andreotti C, Doria V, Doni D, Pezzullo JC, et al. Factors affecting survival in infants weighing 750g or less. Eur J Obstet Gynecol Reprod Biol. 2005; 123(1):52-5.
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24. Mori R, Shiraishi J, Negishi H, Fujimura M. Predictive value of Apgar score in infants with very low birthweight. Acta Paediatr. 2008; 97(6):720-3.
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25. Vincer MJ, Armson BA, Allen VM, Allen AC, Stinson DA, Whyte R, et al. An algorithm for predicting neonatal mortality in threatened very preterm birth. J Obstet Gynaecol Can. 2015; 37(11):958-65.
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26. Ravelli AC, Schaaf JM, Mol BW, Tamminga P, Eskes M, van der Post JA, et al. Antenatal prediction of neonatal mortality in very premature infants. Eur J Obstet Gynecol Reprod Biol. 2014; 176:126-31.
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27. Fallahi M, Joudaki N, Bandpey HM. Evaluation of
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causes of neonatal mortality in Shohadaye Tajrish hospital, during years 2004-2007. Pajoohandeh. 2009; 14(1):43-6. (Persian)
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28. Olischar M, Messerschmidt A, Repa A, Klebermasz-Schrehof K, Weber M, Pollak A, et al. The early prediction of neonatal morbidity and mortality in singleton small for gestational age infants with a birthweight
32
ORIGINAL_ARTICLE
An Active Teaching Approach for Fetal and Maternal Assessment in Delivery Room: A Randomized Clinical Trial
ABSTRACTBackground: A modern teaching method has been used for educating the midwifery students. Regarding the importance of accuracy and speed among the midwifery students, especially in the stressful condition of childbirth, this study aimed to investigate the effect of time management and precaution techniques on the midwifery student's clinical performance in the labour ward.Methods: This study was conducted on 40 midwifery students during November 2015-March 2016. The participants were randomly assigned into the control and experimental groups that were trained using the traditional method and time management techniques, respectively. The subjects’ clinical performance regarding the fetal heart rate monitoring, contraction check, and physical examination was assessed using a checklist during the intervention and four months after the intervention. The data analysis was performed using the independent and paired t-tests through the SPSS version 14. P-value less than 0.05 was considered statistically significant.Results: According to the results of the present study, there was no significant difference between the two groups regarding the speed of performing the examined clinical care before the intervention. However, following the intervention, there was a significant difference between the two groups in this regard (P=0.010). Additionally, the paired t-test revealed a statistically significant difference in the speed of performing the clinical care between the two groups after the intervention (P=0.018).Conclusion: As the findings of the present study indicated, the time management technique could improve the speed in the midwifery students. Therefore, this technique as a modern method is recommended to be employed in the emergency wards such as the labour and delivery wards.
https://ijn.mums.ac.ir/article_8518_d5246a1e00793ef4a36329cf9ae1dbeb.pdf
2017-03-01
23
26
10.22038/ijn.2017.16744.1193
Keywords: Delivery
fetal
Labour
Maternal
Midwifery
Time management
Shahla
Mohamadirizi
1
School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Parvin
Bahadoran
2
School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Soheila
Mohamadirizi
3
School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
LEAD_AUTHOR
References
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6. Fathi M, Shafiean M, Gharibi F. Clinical education stressors from the perspective of students of nursing, midwifery, and operating room: a study in Kurdistan university of medical sciences. Iran J Med Educ. 2012; 11(7):675-84.
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7. Mohamadiriz S, Khani B, Mohamadirizi S. Role playing approach vs. traditional method about neonatal admission skills among midwifery students. Int J Pediatr. 2015; 3(5.2):965-70.
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8. Hossein KM, Fatemeh D, Fatemeh OS, Katri VJ, Tahereh B. Teaching style in clinical nursing education: a qualitative study of Iranian nursing
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teachers’ experiences. Nurse Educ Pract. 2010; 10(1):8-12.
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9. Mohamadirizi S, Fahami F, Bahadoran P, Ehsanpour S. The effect of four-phase teaching method on midwifery students’ emotional intelligence in managing the childbirth. J Educ Health Promot. 2015; 4:47.
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10. Mohammadi Rizi S, Mohammadi Rizi S, Mohammadi Rizi M. The effectiveness of the 4-stage approach compared to traditional clinical teaching among midwifery student's about delivery management skills. J Clin Nurs Midwifery. 2015; 4(3):32-9.
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13. Orde S, Celenza A, Pinder M. A randomized trial comparing a 4stage to 2 stage teaching technique for laryngeal mask insertion. Resuscitation. 2010; 81(12):1687-91.
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14. Jenko M, Frangez M, Manohin A. Four-stage teaching technique and chest compression performance of medical students compared to conventional technique. Croat Med J. 2012; 53(5):486–95.
16
15. Abraham A, Cheng TL, Wright JL, Addlestone I, Huang Z, Greenberg L. Assessing an educational intervention to improve physician violence screening skills. Pediatrics. 2001; 107(5):e68.
17
16. Foronda C, Gattamorta K, Snowden K, Bauman EB. Use of virtual clinical simulation to improve communication skills of baccalaureate nursing students: a pilot study. Nurse Educ Today. 2014; 34(6):e53–7.
18
ORIGINAL_ARTICLE
Effect of Vitamin D Supplementation during Pregnancy on Birth Weight: A Case-Control Study
ABSTRACTBackground: Previous studies revealed that maternal serum level of vitamin D can influence neonatal outcomes. In this controlled trial, we evaluated the effect of vitamin D supplementation during pregnancy on birth weight.Methods: In this interventional study, we enrolled 67 pregnant women (gestation: 10 weeks), who referred to Seyyedal Shohada Hospital during two years (from January 2014) with vitamin D less than 30 ng/ml. From gestational age of 14-24 weeks, vitamin D (50,000 IU/week) was administered to the patients, and its level was measured again in the 24th week of gestation. At this time, patients with vitamin D more than 30 ng/ml served as the intervention group, while the remaining patients were excluded (n=55 patients). In the control group, the level of vitamin D was measured at the time of delivery.Results: The mean vitamin D level in the intervention group was 43.04±20.09 ng/ml. The baseline patient characteristics such as gravidity, parity, and the number of deliveries were not significantly different between the two groups. However, the two groups were significantly different regarding neonates’ characteristics such as birth weight, height, and headcircumference.Conclusion: Our findings showed that administrating vitamin D during pregnancy increases the mean values of neonatal weight, head circumference, and height.
https://ijn.mums.ac.ir/article_8519_f8c807803fb4891ceb6dc83a34a33e2a.pdf
2017-03-01
27
30
10.22038/ijn.2017.16142.1182
Keywords: Birth weight
pregnancy
Vitamin D
Parisa
Elmee
1
Department of Obstetrics and Gynecology, Seyyed-al Shohada Hospital, Zahedan, Iran
AUTHOR
Seyyed
Shahrokh Taghavi
2
Department of Cardiology, Seyyed-al Shohada Hospital, Zahedan, Iran
AUTHOR
References
1
1. Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005; 81(5):1060-4.
2
2. Wang J, Yang F, Mao M, Liu DH, Yang HM, Yang SF. High prevalence of vitamin D and calcium deficiency among pregnant women and their newborns in Chengdu, China. World J Pediatr. 2010; 6(3):265-7.
3
3. Dawodu A, Wagner CL. Mother-child vitamin D deficiency: an international perspective. Arch Dis Child.
4
2007; 92(9):737-40.
5
4. Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila). 2007; 46(1):42-4.
6
5. Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Mäkitie O, et al. Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab. 2010; 95(4):1749-57.
7
6. Kazemi A, Sharifi F, Jafari N, Mousavinasab N. High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. J Womens Health. 2009; 18(6):835-9.
8
7. Specker BL. Does vitamin D during pregnancy impact offspring growth and bone? Proc Nutr Soc. 2012; 71(1):38–45.
9
8. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics. 2012; 129(3):485–93.
10
9. Walker VP, Zhang X, Rastegar I, Liu PT, Hollis BW, Adams JS, et al. Cord blood vitamin D status impacts innate immune responses. J Clin Endocrinol Metab. 2011; 96(6):1835–43.
11
10. Bodnar LM, Simhan HN. Vitamin D may be a link to black-white disparities in adverse birth outcomes. Obstet Gynecol Surv. 2010; 65(4):273–84.
12
11. Hollis BW, Pittard WB 3rd. Evaluation of the total fetomaternal vitamin D relationships at term: evidence for racial differences. J Clin Endocrinol Metab. 1984; 59(4):652–7.
13
12. Roth DE. Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials. J Perinatol. 2011; 31(7):449–59.
14
13. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011.
15
14. De-Regil LM, Palacios C, Ansary A, Kulier R, Pena-Rosas JP. Vitamin D supplementation for women
16
during pregnancy. Cochrane Database Syst Rev. 2012; 2:CD008873.
17
15. Thorne-Lyman A, Fawzi WW. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2012; 26(Suppl 1):75–90. 16. Khalessi N, Kalani M, Araghi M, Farahani Z. The relationship between maternal vitamin D deficiency and low birth weight neonates. J Fam Reprod Health. 2015; 9(3):113-7. 17. Hashemipour S, Ziaee A, Javadi A, Movahed F, Elmizadeh K, Javadi EH, et al. Effect of treatment of vitamin D deficiency and insufficiency during pregnancy on fetal growth indices and maternal weight gain: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2014; 172:15-9. 18. Sabour H, Hossein-Nezhad A, Maghbooli Z, Madani F, Mir E, Larijani B. Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: a cross-sectional study. Gynecol Endocrinol. 2006; 22(10):585-9. 19. Gernand AD, Simhan HN, Klebanoff MA, Bodnar LM. Maternal serum 25-hydroxyvitamin D and measures of newborn and placental weight in a U.S. multicenter cohort study. J Clin Endocrinol Metab. 2013; 98(1):398-404.
18
20. Pérez-López FR, Pasupuleti V, Mezones-Holguin E, Benites-Zapata VA, Thota P, Deshpande A, et al. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2015; 103(5):1278-88.e4.
19
21. Galthen-Sørensen M, Andersen LB, Sperling L, Christesen HT. Maternal 25-hydroxyvitamin D level and fetal bone growth assessed by ultrasound: a systematic review. Ultrasound Obstet Gynecol. 2014; 44(6):633-40.
20
22. Roth DE, Al Mahmud A, Raqib R, Akhtar E, Perumal N, Pezzack B, et al. Randomized placebo-controlled trial of high-dose prenatal third-trimester vitamin D3 supplementation in Bangladesh: the AViDD trial. Nutr J. 2013; 12:47.
21
23. Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Mansouri A, Najafi M, Khodabande F. The effect of vitamin D and calcium plus vitamin D during pregnancy on pregnancy and birth outcomes: a randomized controlled trial. J Caring Sci. 2015; 4(1):35–44.
22
ORIGINAL_ARTICLE
Mothers' Challenges after Infants' Discharge from Neonatal Intensive Care Unit: A Qualitative Study
ABSTRACTBackground: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant's condition and care for it after discharge from neonatal intensive care unit (NICU).Methods: A qualitative design was used to explain mothers' challenges after their infant's discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant's discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis.Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers.Conclusion: Mothers have difficulty in meeting their infants' basic needs after discharge. Supporting these mothers can enable them promote their infant's health.
https://ijn.mums.ac.ir/article_8520_7fe55687c5964fa0107bbc4074f00267.pdf
2017-03-01
31
36
10.22038/ijn.2017.15546.1174
Keywords: Challenges
Discharge
Home care
Mother's
NICU
Qualitative study
Zeinab
Hemati
z_hemati@nm.mui.ac.ir
1
Nursing and midwifery care research center, faculty of nursing and midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Mahboobeh
Namnabati
2
Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Fariba
Taleghani
taleghani@nm.mui.ac.ir
3
Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Alireza
Sadeghnia
4
Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
References
1
1. Hockenbery MJ, Wilson D. Wong's nursing care of infants and children. 2011, 9th Edition, Elsevier Mosby, Missouri.
2
2. Leifer G. Maternity Nursing: an introductory text, 10 Th Edition, Saunders, 2008.
3
3. Mok E, Loung SF. Nurses as providers of support for mothers of premature infant. Journal of Clinical
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Nursing 2006, 15(6):726-34.
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4. Malusky S, Donze A. Neutral head positioning in premature infants for interventricular haemorrhage prevention: an evidence-based review. Neonatal Netw 2011; 30(6): 381-96.
6
5. Keshavars M, Eskandari N, Jahdi F, Ashaieri H, Hoseini F, Kalani M. The effect of holy Quran recitation on physiological responses of premature infant. Koomesh journal of semnan university of medical science 2010; 3(35):169-178.
7
6. Alaei Karahroudi F, Jafari Mianaei S, Rasouli M, Zayeri F (2013). Evaluating the effectiveness ofParent Empowerment (COPE) program on participation of mothers of preterm infants hospitalized in NICUs of hospitals affiliated to Isfahan University of Medical Sciences and Health Services, 2009-2010. Journal of Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences2013; 23 (81):33-40.
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7. Megan M, Spencer S, Alicia JS, Lex WD, Katherine JL, Lucy L, and et al. Long-term benefits of home-based preventive care for preterm infants: a randomized trial. Journal of Pediatrics2012; 103:1094-1101.
9
8. Akbarbegloo M, Valizadeh L, Asadollahi M. Mothers and nurses’ viewpoint on importance and amount of nursing supports for parents with hospitalized premature infants in neonatal intensive care unit. Iranian Journal of Critical Care Nursing2009; 2(2); 71-74.
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9. Aliabadi T, Bastani F, Haghani H. Effect of mothers’ participation in preterm infants care in NICU on readmission rates. Journal of Faculty of Nursing and Midwifery Tehran University of Medical Sciences2011; 17(2): 71-7.
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10. Wheeler B. Health promotion of the newborn and family. In: Hockenbery MJ, Wilson D (editors). Wong's Essentials pediatric nursing: Canada: Mosby, 2009.
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11. Nicolaou M, Rosewell R, Marlow N, Glazebrook C. Mothers' experiences of interacting with their premature infants. Journal of Reproductive and Infant Psychology2009; 27(2): 182-94.
13
12. Brinchmann BS, Forde R, Nortvedt P. What matters to the parents? a qualitative study of parents' experiences with life-and-death decisions concerning their premature infants. Nursing Ethics 2002; 9(4): 388-404.
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13. McGrath JM. Strategies to support the transition to home. J Pediatric Neonatal Nurse 2012; 26(1):8-9.
15
14. Griffin JB, Pickler RH. Hospital-to-home transition of mothers of preterm infants. MCN Am J Maternal Child Nursing 2011; 36(4):252-7.
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15. Green B. Personal constructs psychology and content analysis. Personal Construct Theory &Practice 2004; 1: 82-91.
17
16. Griffin T, Abraham M. Transition to home from the newborn intensive care unit: Applying the principles of family-centered care to the discharge process. The Journal of perinatal & neonatal nursing 2006;
18
20(3):243-249.
19
17. Smith V, Young S, Pursley D, McCormick M, Zupancic J. Are families prepared for discharge from the NICU & quest? Journal of Perinatology 2009; 29(9):623-9.
20
18. Sneath N. Discharge teaching in the NICU: are parents prepared? An integrative review of parents' perceptions. Neonatal Network. The Journal of Neonatal Nursing 2009; 28(4):237-46.
21
19. Valizadeh S, Penjvini S. Mothers' experiences of breastfeeding premature infants after discharge from NICU; a qualitative study. Indian journal of applied research2014; 4(1):374-378.
22
20. Flacking R, ewald U, nygvist K H, strrin B. trustful bonds: A key to becoming a mother and to reciprocal breast feeding. Stories of mothers of very preterm infants at a neonatal unit. Social science & medicine2006; 62:70-80.
23
21. Ross ES, Browne JV. Developmental progression of feeding skills: an approach to supporting feeding in preterm infants. Seminars in fetal & Neonatal 2002; 7:469–475.
24
22. Nyqvist KH, Engvall G. Parents as their infant's primary caregivers in a neonatal intensive care unit. Journal Pediatric Nursing 2009; 24(2):153-163.
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23. Raffray M, Osorio S, Ochoa SC, Semenic S. Barriers and facilitators to preparing families with premature infants for discharge home from the neonatal unit. Perceptions of health care providers. Investigation & Education Enfermeria2014; 32(3): 379-392.
26
24. Arockiasamy V, Holsti L, Albersheim S. Fathers’ experiences in the neonatal intensive care unit: a search for control. Pediatrics Journal 2008; 121(2): 215-222.
27
25. Verma RP, Sridhar S, Spitzer AR. Continuing care of NICU graduates. Clinical Pediatric 2003; 42(4):299-315. 26. Lopez GL, Anderson KH, Feutchinger J. Transition of premature infants from hospital to home life. Neonatal Network2012; 31(4):207-14.
28
27. Valizadeh L, Namnabati M, Zamanzadeh V, Badiee Z. Factors affecting infant's transition from neonatal intensive care unit to home: A qualitative study. Iran Journal Nurse Midwifery Research 2013; 18(1): 71–78.
29
ORIGINAL_ARTICLE
Severe Persistant Cyanosis in a Newborn Due to Prominent Eustachian Valve
ABSTRACTThe valves of right horn of systemic venous sinus are prominent structures within the right atrium during early embryonic period. Involution of these structures may not be complete, resulting in a spectrum of anatomical presentations such as cyanosis. A full-term male neonate referred to our hospital for precise evaluation of severe cyanosis on the first day of life. Echocardiographic examination revealed right-to-left interatrial shunting through patent foramen ovale due to prominent eustachian valve with normal estimated right heart pressures from peak tricuspid regurgitation velocity. He was maintained with supplemental oxygen and a PDE-5 inhibitor (sildenafil) and subsequently improvement in oxygen saturation was achieved. The patient was discharged after 2 weeks of treatment. In conclusion; the embryologic remmants of the sinus venosus rarely may lead to right-to-left shunting resulting in severe cyanosis. Pulmonary vasodilators such as sildenafil may improve oxygen saturation in these patients even in case of normal right heart pressures.
https://ijn.mums.ac.ir/article_8521_239c6773df221aa66f0db52f67fede85.pdf
2017-03-01
37
39
10.22038/ijn.2017.16289.1184
Cyanosis
Chiari network
Eustachian valve
Newborn
Sildenafil
Vehbi
Dogan
vdogan86@yahoo.com
1
Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
LEAD_AUTHOR
İlker
Ertuğrul
ilkerer.ertugrul@gmail.com
2
Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
AUTHOR
Şeyma
Kayalı
ak-seyma@yahoo.com
3
Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
AUTHOR
Ece
Koyuncu
ece_koyuncu@hotmail.com
4
Pediatric Cardiology and Neonatology, Ankara, Turkey
AUTHOR
Utku
Arman Örün
5
Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
AUTHOR
Selmin
Karademir
selminkarademir@yahoo.com
6
Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
AUTHOR
References
1
1. Bendadi F, van Tijn DA, Pistorius L, Freund MW. Chiari’s network as a cause of fetal and neonatal pathology. Pediatr Cardiol. 2012; 33:188–91
2
2. Yasuda K, Iwashima S, Sugiura H, Ohki S, Seguchi M. Intermittent cyanosis due to prominent eustachian valve in a newborn infant. The Journal of Maternal-Fetal & Neonatal Medicine. 2009; 22:9, 812-5
3
3. Ko HS, Chen MR, Lin YC. A huge Chiari network presenting with persistent cyanosis in a neonate. Pediatr Cardiol. 2011;32:239–40
4
4. Qureshi AU, Latiff HA, Sivalingam S. Persistent valve of systemic venous sinus: a cause of neonatal cyanosis. Cardiology in Young. 2014;24:756–9
5
5. Farrow KN, Groh BS, Schumacker PT, Lakshmi-nrusimhaS, Czech L, Gugino SF, Russel JA, Steinhorn RH. Hyperoxia increases phosphodiesterase 5 expression and activity in ovine fetal pulmonary artery smooth muscle cells. Circ Res. 2008;102:226–33.
6
6. Porta FM, Steinhorn RH. Pulmonary vasodilator therapy in the NICU: Inhaled nitric oxide, sildenafil, and other pulmonary vasodilating agents. Clin Perinatol 2012; 39: 149–64.
7
ORIGINAL_ARTICLE
New Insights on Genetic Features of Neu-Laxova Syndrome
ABSTRACTBackground: This study aimed to present a rare case of Neu-Laxova syndrome (NLS) and review the newly revealed genetic features of the disease in hopes to find a way for early interventions.Case report: Female newborn with NLS was born at 30 weeks of gestation to consanguineous parents. The last prenatal ultrasound imaging revealed severe intrauterine growth restriction and microcephaly without polyhydramnios. The newborn had significant dysmorphic features, such as microcephaly, slanted forehead, protruding eye, flattened nose, micrognathia, cleft palate, ichthyosis skin, edematous hands and feet and flexion contractures of the joints. Moreover, she had the usual female karyotype. Results of plain x-ray imaging demonstrated microcephaly, kyphosis, and arthrogryposis.Conclusion: According to the results of this study, NLS is a severe serine deficiency disorder. Given the confirmation of the possibility of diagnosing NLS early in gestation by several studies, it is suggested that early maternal supplementation with serine and glycine be used in families at risk of this disease or those who are diagnosed in early gestation with NLS in order to decrease the severity and fatality of the disease.
https://ijn.mums.ac.ir/article_8522_00698c01b31716311e1ba95d15f0f1d9.pdf
2017-03-01
40
42
10.22038/ijn.2017.17273.1199
Deficiency
Microcephaly
Serine
Elaheh
Amini
el88_amini@yahoo.com
1
Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Negin
Azadi
mahduni@icloud.com
2
Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Mahdi
Sheikh
mahdisheikh@gmail.com
3
Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
References
1
1. Ozcan D, Derbent M, Seckin D, Bikmaz YE, Agildere M, De Sandre-Giovannoli A, et al. A collodion baby with facial dysmorphism, limb anomalies, pachygyria and genital hypoplasia: a mild form of NLS or a new entity? Ann Dermatol. 2013; 25(4):483-8.
2
2. Shaheen R, Rahbeeni Z, Alhashem A, Faqeih E, Zhao Q, Xiong Y, et al. Neu-Laxova syndrome, an inborn error of
3
serine metabolism, is caused by mutations in PHGDH. Am J Hum Genet. 2014; 94(6):898-904.
4
3. Acuna-Hidalgo R, Schanze D, Kariminejad A, Nordgren A, Kariminejad MH, Conner P, et al. Neu-Laxova syndrome is a heterogeneous metabolic disorder caused by defects in enzymes of the L-serine biosynthesis pathway. Am J Hum Genet. 2014; 95(3):285-93.
5
4. Laxova R, Ohara PT, Timothy JA. A further example of a lethal autosomal recessive condition in sibs. J Ment Defic Res. 1972; 16(2):139-43.
6
5. Jaeken J, Detheux M, Van Maldergem L, Foulon M, Carchon H, Van Schaftingen E. 3-Phosphoglycerate dehydrogenase deficiency: an inborn error of serine biosynthesis. Arch Dis Child. 1996; 74(6):542-5.
7
6. Hart CE, Race V, Achouri Y, Wiame E, Sharrard M, Olpin SE, et al. Phosphoserine aminotransferase deficiency: a novel disorder of the serine biosynthesis pathway. Am J Hum Genet. 2007; 80(5):931-7.
8
7. Jaeken J, Detheux M, Fryns JP, Collet JF, Alliet P, Van Schaftingen E. Phosphoserine phosphatase deficiency in a patient with Williams syndrome. J Med Genet. 1997; 34(7):594-6.
9
8. Vincent JB, Jamil T, Rafiq MA, Anwar Z, Ayaz M, Hameed A, et al. Phosphoserine phosphatase (PSPH) gene mutation in an intellectual disability family from Pakistan. Clin Genet. 2015; 87(3):296-8.
10
9. Horn D, Muller D, Thiele H, Kunze J. Extreme microcephaly, severe growth and mental retardation, flexion contractures, and ichthyotic skin in two brothers: a new syndrome or mild form of NLS? Clin Dysmorphol. 1997; 6(4):323-8.
11
10. Shivarajan MA, Suresh S, Jagadeesh S, Lata S, Bhat L. Second trimester diagnosis of Neu Laxova syndrome. Prenat Diagn. 2003; 23(1):21-4.
12