Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Early Nasal Intermittent Positive Pressure Ventilation (NIPPV) versus Nasal Continuous Positive Airway Pressure (NCPAP) for Respiratory Distress Syndrome (RDS) in Infants of 28-36 weeks gestational age: a Randomized Controlled Trial
1
8
EN
Tisha
Ann Skariah
0000- 0002-5567-6407
Department of Respiratory Therapy, School of Allied Health Science, MAHE, Manipal, Udupi, Karnataka, India
tisha_skariah@hotmail.com
Leslie
Edward Lewis
0000-0002-3467-6821
Department of Paediatrics, Kasturba Medical College, MAHE, Manipal, Udupi, Karnataka, India
leslielewis1@gmail.com
10.22038/ijn.2018.32566.1454
<strong><em>Background:</em></strong> Early nasal continuous positive airway pressure (NCPAP) has emerged as a primary modality of respiratory support for preterm infants withrespiratory distress syndrome (RDS). However, 30%-40% of these newborns need subsequent mechanical ventilation. Nasal intermittent positive pressure ventilation (NIPPV) is a promising alternative to NCPAP, especially in post-extubation settings, apnea of prematurity, or NCPAP failure as the primary mode of respiratory support in RDS. Application of these two methods in neonates with RDS needs further studies. <br /> <strong><em>Methods:</em></strong> This open-label randomized clinical trial (RCT) was stratified by gestational age (i.e., 28-32 and 33-36 weeks). The sample included 78 infants divided into the two groups of 37 NIPPV and 41 CPAP. We compared the effect of ventilator delivered asynchronous NIPPV with NCPAP in reducing the need for invasive ventilation within 48 h of non-invasive support in infants of 28-36 weeks with RDS [onset of distress within ≤ 6 h of life with a fraction of inspired oxygen (FiO2) ≥ 0.25 compatible with chest radiograph]. The FiO2 > 0.3 and/or Downes score ≥ 4 were the indications for surfactant therapy administered by endotracheal tube. The infants were extubated and returned to their initial assigned mode of support within 60 min. The primary outcome was considered as failure of the allocated mode within 48 h.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> According to our findings, the two groups showed no significant difference in terms of failure rates with 5 (13.5%) and 6 (15%) failed NIPPV and NCPAP cases (P=0.8). There was a trend toward less surfactant therapy in NIPPV [12 (32.4%) vs. 22 (53.7%), P=0.06], and lower Downes score in the first 12 h. The hazard ratio (HR; adjusted for gestation, surfactant therapy, and birth weight) for failure in NIPPV was similar to that of NCPAP (HR=1.03) at 95% confidence interval. No difference in air leaks or abdominal distension was noted between the two groups.<br /> <strong><em>Conclusion:</em></strong> Early NIPPV may not have a benefit, compared to NCPAP as a primary mode of respiratory support for infants with RDS.
asynchronous,nasal continuous positive airway pressure,Nasal intermittent positive pressure ventilation,Non-invasive Ventilation,respiratory distress syndrome
https://ijn.mums.ac.ir/article_12000.html
https://ijn.mums.ac.ir/article_12000_22f166decb7be3d1afaf0847888ff782.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial
9
16
EN
Majid
Mohammadizadeh
0000-0002-4140-0348
Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
m_mohammadizadeh@med.mui.ac.ir
Zohreh
Badiei
0000-0002-9251-3828
Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
badiei@med.mui.ac.ir
Roya
Choopani
0000-0002-5452-4948
Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
dr.choopani@yahoo.com
Marzie
Khalili
Tehran University of Medical Sciences, Tehran, Iran
marmar.kh98@gmail.com
10.22038/ijn.2019.32951.1466
<strong><em>Background:</em></strong> Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns.<br /> <strong><em>Methods:</em></strong> This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO<sub>2</sub> and 5 cm H<sub>2</sub>O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (P<0.001). Numbers of NCPAP weaning attempts, the need for mechanical ventilation, duration of oxygenation, and hospital stay in the two groups were not significantly different.<br /> <strong><em>Conclusion:</em></strong> There was no difference between sudden complete and gradual weaning from NCPAP in terms of treatment success and complications. The selection of the appropriate technique may depend on available equipment and treatment costs.
Continuous positive airway pressure (CPAP),Gradual weaning,Preterm,Sudden weaning
https://ijn.mums.ac.ir/article_13089.html
https://ijn.mums.ac.ir/article_13089_7116c7cc30c511ad7845c1c676c2ce72.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Standardization and Validation of Non-invasive Monitoring of End Tidal Carbon Dioxide in Neonates via Nasal Cannula: An Observational Study
17
21
EN
Varun R
Nayak
0000-0003-2206-0461
Department of Respiratory Therapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
varunr838@gmail.com
Tisha
Ann Skariah
0000- 0002-5567-6407
Department of Respiratory Therapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
tisha_skariah@hotmail.com
Leslie
Lewis
0000-0002-3467-6821
Head of Neonatal Intensive Care Unit, Kasturba Hospital Manipal, Karnataka, India
leslielewis1@gmail.com
10.22038/ijn.2018.32704.1460
<strong><em>Background:</em></strong> Carbon dioxide (CO<sub>2</sub>) is a by-product of cellular metabolism, which could be considered as a reflection of metabolism, circulation, and ventilation. Arterial blood gas analysis (ABG) is the gold standard of monitoring for CO<sub>2</sub>. However, is an expensive method leading to blood loss and iatrogenic anemia. In addition, each sample is only a snapshot view of the sampling moment. End-tidal CO<sub>2</sub> (ETCO<sub>2</sub>) measurement gives a non-invasive and continuous monitoring of exhaled CO<sub>2</sub>. Therefore, this study aimed to validate the non-invasive CO<sub>2</sub> measurement performed by nasal cannula and evaluate the correlation with partial pressure of arterial CO<sub>2</sub> (PaCO<sub>2</sub> ) in neonates.<br /> <strong><em>Methods:</em></strong> This single-center observational study was conducted in the Neonatal Intensive Care Unit (NICU), Kasturba Hospital, Manipal, India. PaCO<sub>2</sub> was reported on routine ABG within a 15-minute interval of ABG sampling. Moreover, partial pressure of end-tidal carbon dioxide (PetCO<sub>2</sub>) was noted at continuous 30-sec intervals (i.e., 30, 60, 90, ..., 180) up to 3 minutes. The values of PaCO<sub>2</sub> and PetCO<sub>2</sub> were found to be correlated with Pearson correlation and were shown by scattered plot. Regression analysis was used to get the prediction equation and the variance.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> A total of 70 samples were taken in the initial phase to study the correlation between PaCO<sub>2</sub> and measured PetCO<sub>2</sub>. Pearson correlation showed a moderate positive correlation (r= 0.589) between PetCO<sub>2</sub> and measured PaCO<sub>2</sub>. Regression analysis demonstrated a variance of 33.8% between the measured PetCO<sub>2</sub> and PaCO<sub>2</sub>, which was statistically significant (P<0.001). A prediction equation was obtained for PaCO<sub>2</sub>. In the final phase, 20 samples were recruited to standardize and validate the prediction equation. The PaCO<sub>2</sub> was calculated using the predicted equation and a new prediction equation was obtained.<br /> <strong><em>Conclusion:</em></strong> According to the findings of this study, there is a good correlation (r=0.681) between the non-invasively measured PetCO<sub>2</sub> and PaCO<sub>2</sub>.
correlation,ETCO2,Nasal cannula,Neonates,Non-invasive,PaCO2
https://ijn.mums.ac.ir/article_12001.html
https://ijn.mums.ac.ir/article_12001_a89ac55369fc50ba9cfefd53969c367b.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Comparison of Effectiveness of Two Polyethylene Covers on Body Temperature and Oxygen Saturation of Neonates Transferring to NICUs
22
29
EN
Naiire
Salmani
0000-0001-8193-6246
Faculty of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
n.salmani@ssu.ac.ir
Zahra
Dehghan
Intensive Care Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
nasimdehghan63@yahoo.com
Zahra
Mandegari
Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
mandegar.zahra@yahoo.com
Azita
Aryaee
Faculty of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
aryaee.azita@gmail.com
Shima
Dehghan
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
mahadiat@yahoo.com
10.22038/ijn.2019.32906.1464
<strong><em>Background:</em></strong> The sudden exposure of premature newborns to a cold and dry environment can lead to hypothermia. This study aimed at comparing the effectiveness of two polyethylene covers on the body temperature and oxygen saturation of premature neonates.<br /> <strong><em>Methods:</em></strong> This experimental study was conducted on 72 premature newborns in the neonatal intensive care unit (NICU) of Shahid Sadoughi Hospital in Yazd, Iran. The study subjects were randomly assigned into three groups, including the neonates with polyethylene head cap, polyethylene body bag, and routine care. The data were collected using a thermometer and a pulse oximeter. The data analysis was performed through descriptive statistics, Chi-square test, analysis of variance (ANOVA), repeated measures ANOVA, and Tukey test using SPSS (version 18) software.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> There was a significant difference in the mean body temperature of control and intervention groups immediately after their NICU admission and 1 h later. Other significant differences were found in the mean of oxygen saturation belonging to the control group and the hat group upon admission and 1 h later. Also, the mean scores of oxygen saturation belonging to the control group were compared with those of the bag group, and the differences were significantly different 1 h after the admission.<br /> <strong><em>Conclusion:</em></strong> In the light of these findings, the application of both polyethylene head cap and body bag can maintain the body temperature and oxygen saturation in the premature neonates transferring to the NICU. In particular, the head cap seems to better improve than oxygen saturation.
Newborn,Oxygen saturation,Premature,Temperature,Transfer
https://ijn.mums.ac.ir/article_13087.html
https://ijn.mums.ac.ir/article_13087_c79626ce62ea2072e701fcac029043f7.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Comparison of the Effects of Supine and Prone Positions on Oxygen Saturation and Vital Signs in Premature Infants: A Crossover Clinical Trial
30
36
EN
Hamid
Torabian
0000-0002-6563-486X
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
torabian.pedmastermu@gmail.com
Saeed
Alinejad
0000-0002-7861-4155
Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
s.alinejad@arakmu.ac.ir
Akram
Bayati
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
a.bayati@arakmu.ac.ir
Fatemeh
Rafiei
Department of Biostatistics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
f.rafiei87@yahoo.com
Sharareh
Khosravi
0000-0002-9506-3500
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
khosravi@arakmu.ac.ir
10.22038/ijn.2019.32928.1465
<strong><em>Background:</em></strong> Positioning of premature newborns significantly affects their health status. However, the most suitable position remains controversial. The current study aimed to compare the effect of supine and prone positions on oxygen saturation and vital signs in premature newborns.<br /> <strong><em>Methods:</em></strong> In this crossover clinical trial, a total of 22 newborns admitted to the Neonatal Intensive Care Unit (NICU) of Amir Kabir Hospital in Arak, Iran, were selected through purposive sampling technique, and then randomly assigned into groups 1 and 2. Newborns in group 1 were first placed in a prone position (i.e., the first period for 3 h), and then in a supine position (i.e., the second period for an additional 3 h). The reverse procedure was applied to the intervention group 2. Heart rate, respiratory rate, and oxygen saturation were measured and recorded every 15 min.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> The mean oxygen saturation in the prone position (96.164±0.148) was higher than in the supine position (90.479±0.513; P=0.0001). The mean heart rate in the prone position (138.24±1.87 beats/min) was lower than that in the supine position (147.48±1.597 beats/min; P=0.0001). The mean respiratory rate in the prone position (40.430±0.504 breaths/min) was lower than that in the supine position (46.773±0.685 breaths/min; P=0.0001).<br /> <strong><em>Conclusion:</em></strong> The current study demonstrated that the prone position put the newborn admitted to NICU in a more stable condition. However, the selection of the best position must be made based on the newborn’s health status and situation.
Oxygen saturation,Position,Premature Newborn,Vital signs
https://ijn.mums.ac.ir/article_13088.html
https://ijn.mums.ac.ir/article_13088_b0f194d8cac9eeb84b09a2e25cd4df2d.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Effect of Caffeine and Aminophylline on Apnea of Prematurity
37
41
EN
Morteza
Habibi
0000-0002-9384-7176
Kosar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
drmhabibi@yahoo.com
Abolfazl
Mahyar
Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
abolfazl473@yahoo.com
Sanam
Nikdehghan
Kosar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
sanamnikdehghan@gmail.com
10.22038/ijn.2019.33041.1468
<strong><em>Background:</em></strong> The most common type of apnea among premature newborns is idiopathic apnea of prematurity. Recurrent apnea can lead to hypoxemia and central nervous system damage. Although caffeine and theophylline are the most commonly prescribed drugs in this field, there is disagreement about which medicine is preferred. The purpose of this study was to compare the therapeutic effect and side effects of caffeine and aminophylline in the treatment of idiopathic apnea of prematurity.<br /> <strong><em>Methods:</em></strong> This randomized clinical trial study was conducted on 67 premature neonates with the definite diagnosis of idiopathic apnea of prematurity. In this regard, subjects were divided into two groups, namely aminophylline recipient group (n=31) and caffeine recipient group (n=36). The two groups were compared regarding the frequency of recurrent apnea and side effects of drugs.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> Regarding gender distribution, 15 (48.4%) patients in the aminophylline recipient group, and subjects in the 20 (55.6%) caffeine recipient group were male. After the treatment, apnea recurred only in one case (0.1%) of aminophylline recipient group. Moreover, 7 patients (58.3%) in the aminophylline recipient group and 5 cases (41%) in the caffeine recipient group suffered from gastrointestinal side effects (P=0.3).<br /> <strong><em>Conclusion:</em></strong> The obtained results of the present study revealed that there was no significant difference between the two groups.
Aminophylline,Apnea,Caffeine,Prematurity
https://ijn.mums.ac.ir/article_13090.html
https://ijn.mums.ac.ir/article_13090_3384ecd42ebfbaf61695d6b47cd22df8.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Volume-guaranteed Ventilation Versus Pressure-controlled Ventilation in Preterm Infants with Respiratory Distress Syndrome: A Randomized Controlled Trial
42
46
EN
Gokul
Krishna
0000-0002-3648-8891
Department of Respiratory Therapy, School of Allied Health Sciences, Manipal, Udupi P.O, Karnataka, India
gokulrescare@gmail.com
Tisha
Ann Skariah
0000- 0002-5567-6407
Department of Respiratory Therapy, School of Allied Health Sciences, Manipal, Udupi P.O, Karnataka, India
tisha.skariah@manipal.edu
Leslie
Lewis Edward
0000-0002-3467-6821
Head of Neonatal Intensive Care Unit, Department of Paediatrics, Kasturba Medical College,Manipal, Udupi P.O, Karnataka, India
leslielewis1@gmail.com
10.22038/ijn.2018.33533.1490
<strong><em>Background:</em></strong> This study was targeted toward comparing volume-guaranteed (VG) ventilation with conventional pressure-controlled (PC) ventilation in preterm infants with respiratory distress syndrome (RDS) in terms of the facilitation of weaning and extubation and occurrence of complications, such as pneumothorax, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC).<br /> <strong><em>Methods:</em></strong> This single-center randomized controlled trial was conducted on neonates who were mechanically ventilated in the Neonatal Intensive Care Unit of Kasturba Hospital Manipal Udupi, Karnataka, India. Infants with the gestational age (GA) of 27-34 weeks with RDS requiring mechanical ventilation in the first week of life were randomized to receive either SIMV-PC or SIMV-VG ventilation. Infants were stratified into two GA groups of 27-30 and 31-34 weeks. Sealed opaque envelope was used to randomize the infants into two treatment modalities. Sample size was calculated as 120 and 60 in each treatment group.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> A total of 115 neonates were enrolled. The mean GA and birth weight of the treatment groups were 31±2.3 weeks and 1230±374 g, respectively, and 70% of them received antenatal steroids. As the primary outcome variable, the total duration of ventilation was 8 h (range: 3-17) (median and IQR) in the SIMV-PC group and 6 h (range: 3-13) in the SIMV-VG group (P=0.366). Stratified analysis of neonates with the GA of > 31-34 weeks showed a significant difference between the VG and PC ventilation groups regarding the duration of ventilation.<br /> <strong><em>Conclusion:</em></strong> There was a decrease in the duration of ventilation in VG ventilation, compared to that in PC ventilation at a higher GA. The leak was the major issue with VG ventilation in the lower GA group.
RDS,SIMV-PC,SIMV-VG
https://ijn.mums.ac.ir/article_12054.html
https://ijn.mums.ac.ir/article_12054_667083a7a187dba16130afa51decd507.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Thrombocytopenia during the First Week of Life among Neonates with Down Syndrome: Data from Multihospital Healthcare Systems
47
49
EN
Shahin
Mafinezhad
0000-0003-3600-3943
Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
shahinmaf@yahoo.com
Hasan
Boskabadi
0000-0003-4022-5426
Department of Pediatrics, Mashhad University of Medical Sciences (MUMS), Iran
boskabadih@mums.ac.ir
Ghasem
Bayani
0000-0001-8395-7470
Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
bayani.ghasem@yahoo.com
Hojatollah
Ehteshammanesh
Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
ehteshamhojat46@gmail.com
10.22038/ijn.2019.31995.1444
Background: A fault in chromosome distribution during cell division leads to aneuploidy, which can be associated with thrombocytopenia. Various hematological abnormalities have been reported among neonates with Down syndrome (DS). Neutrophilia, thrombocytopenia and polycythemia were the most common hematological abnormalities observed among neonates with Down syndrome. In particular, thrombocytopenia below 150×109/L was found approximately in two-third of DS and 6% of counts below 50,000 was detected during the first week of life.The exact mechanism remains unknown, but is thought to be due to decreased platelet production from chronic fetal hypoxia. fetal hypoxia also leads to intrauterine growth retardation and suboptimal response of thrombopoitin system (TPO) to thrombocytopenia in DS during the neonatal period. Few cases of alloimmune thrombocytopenia with DS due to anti-HPA antibody were reported.<br />Methods: Data from multihospital healthcare systems shows large two case series of infants with cytogenetically confirmed DS and a reference group infants without birth defects all born during the period 2009-2015. During this period, 145,522 live births were recorded at 18 hospitals. Down syndrome was recognized in 226 newborn (1 in 644). Data were analyzed using multivariate logistic regression analysis expressed as adjusted odds ratio (aORs) with 95% confidence intervals (95% CIs).<br />Results & Conclusion: Infants with DS had a significantly higher risk for thrombocytopenia (aOR = 32.4). Platelet counts in DS averaged 104600 per microliter. The mean platelet volume did not correlate with the platelet count, but tended to run slightly large (9.2 +/- 1.3 fl). Persistence of thrombocytopenia beyond 8 to 12 weeks after birth should warrant a hematology consult. Thrombocytopenia can be seen associated with some types of congenital heart defects. Karyotype testing should be done in all obviously dysmorphic infants with thrombocytopenia. It seems reasonable to recommend that one or more CBCs be obtained on all neonates with Down syndrome.
Down syndrome,Thrombocytopenia,neonate,CBC
https://ijn.mums.ac.ir/article_13086.html
https://ijn.mums.ac.ir/article_13086_abbd1ef6f93e4622d9f6d64501e0b1ce.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Umbilical Cord Arterial Blood Gas and Apgar Score: Who Is at Higher Risk?
50
54
EN
Elham
Mobasheri
0000-0002-5903-0410
Department of Obstetrics and Gynecology, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
em5md@gmail.com
Marzieh
Savarrakhsh
0000-0001-6640-2983
Department of Obstetrics and Gynecology, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran
hosseininejad.s.mohsen@gmail.com
Seyyed Mohsen
Hosseininejad
Children’s and Neonatal Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
hosseininead.s.n@gmail.com
Ehsan
Alaee
0000-0002-6505-4451
Children’s and Neonatal Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
ealaee@yahoo.com
10.22038/ijn.2019.33155.1474
<strong><em>Background:</em></strong> Fetal asphyxia and the consequent neurological damages could be avoided if the risk factors are controlled at earlier stages. Umbilical cord arterial blood gas (UCABG) seems to be related to the Apgar scores, as well as the neonatal morbidity and mortality rates. Therefore, we designed this study to assess the correlation between the Apgar score and UCABG in Northeast of Iran.<br /> <strong><em>Methods:</em></strong> This case-control study evaluated 438 term newborns and 62 preterm infants born during 2012-2013. Peripartum asphyxia, admission in the neonatal intensive care unit, and death were recorded as outcome measures. All the data were analyzed using the t-test and logistic regression analysis.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> Mild to moderate acidemia (pH=7-7.2) was reported in 9.6% and severe acidemia (PH<7) was observed in 1% of the participants. Multivariate analysis showed that aspiration of amniotic fluid, umbilical cord pH ≤ 7.2, umbilical cord base excess, and being preterm could be considered as the predictors of lower first-minute Apgar score.<br /> <strong><em>Conclusion:</em></strong> Umbilical cord blood gas measurement is a useful tool to detect the neonates who are at higher risk of low Apgar.
Apgar score,Neonates,Umbilical cord blood gas
https://ijn.mums.ac.ir/article_13091.html
https://ijn.mums.ac.ir/article_13091_a4042682e6cd2cacda22dbb4f91cd34a.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Comparison of Effect of Prone and Right Lateral Positions on Gastric Residual Volume in Preterm Newborns
55
60
EN
Mahbobeh
Sajadi
0000-0001-6770-2072
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
m.sajadi@arakmu.ac.ir
Mehran
Akbari
0000-0002-1699-1051
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
m.akbari@arakmu.ac.ir
Saeed
Alinejad
0000-0002-7861-4155
Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
s.alinejad@arakmu.ac.ir
Sharareh
Khosravi
0000-0002-9506-3500
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
khosravi@arakmu.ac.ir
10.22038/ijn.2019.34332.1501
<strong><em>Background:</em></strong> Nutritional problems in premature newborns are of great importance for their development. In this regard, the neonatal positioning during and after feeding can have a significant effect on their nutritional tolerance. Therefore, the present study was conducted to compare the effect of two positions (i.e., prone and right lateral) on gastric residual volume in preterm newborns after gavage feeding.<br /> <strong><em>Methods:</em></strong> This crossover clinical trial was performed on 52 eligible premature newborns who were selected using purposive sampling. They were randomly assigned into two groups, namely A and B. After gavage feeding, the newborns in group A were placed in the prone position and their gastric residual volume was measured 3 times. Subsequently, after gavage feeding, they were put in the right lateral position and subjected to the same measurement. On the other hand, the newborns in group B were first put in the right lateral and then a prone position. The other procedures and measurements were performed the same as those in group A. The data were analyzed using repeated measure ANOVA.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> The results indicated a significant difference regarding the mean value of gastric residual volume (P=0.001). Moreover, the mean gastric residual volume in the prone position (2.152±0.299) was significantly (P=0.001) lower than that in the lateral position (2.618±0.403).<br /> <strong><em>Conclusion:</em></strong> According to the results, The prone position can reduce the mean gastric residual. Therefore, it can be recommended as a suitable position after gavage feeding in premature newborns.
Gastric,Newborn,Premature,Prone position,Residual volume,Right lateral position
https://ijn.mums.ac.ir/article_13093.html
https://ijn.mums.ac.ir/article_13093_56c35c22aadde65991bd6dc3aefeb747.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Relationship between Neonatal Skin Bilirubin Level and Severe Jaundice with Maternal, Childbirth, and Neonatal Characteristics
61
67
EN
Mojgan
Mirghafourvand
0000-0001-8360-4309
Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
mirghafourvand@gmail.com
Robabe
Seyedi
0000-0001-8664-3776
Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
r1seyedi@gmail.com
Abdollah
Jannat Dost
Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
jannatda@yahoo.com
Sakineh
Mohammad-Alizadeh-Charandabi
Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
alizades@tbzmed.ac.ir
Mohammad
Asghari Jafarabadi
0000-0003-3284-9749
Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
m.asghari862@gmail.com
10.22038/ijn.2019.33282.1478
<strong><em>Background:</em></strong> Neonatal jaundice is the most common cause of newborns' hospitalization. This study aimed to examine various maternal, childbirth, and neonatal factors affecting the neonatal skin bilirubin level and severe jaundice.<br /> <strong><em>Methods:</em></strong> This cross-sectional study was conducted on 1066 healthy neonates with a gestational age of 35 weeks or over and birth weight of ≥2000 g at teaching hospitals of Alzahra and Taleghani in Tabriz, Iran, during 2016-2017. The participants were selected using convenience sampling. Data were collected using a three-part researcher-made questionnaire assessing maternal, childbirth, and neonatal characteristics based on the medical histories of mothers and newborns as well as interviews with mothers. Neonatal jaundice was measured utilizing the Kj-8000 device on days 3-6 after birth by measuring the skin bilirubin level. Moreover, the need to phototherapy (severe jaundice) was determined based on the American Academy of Pediatrics guideline. The generalized linear model and multivariate logistic regression were employed for data analysis.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> Out of the followed-up neonates, 94 (9.96%) cases developed severe jaundice and 850 (90.04%) newborns did not show any symptoms of this complication. The results of the adjusted generalized linear model showed that infant’s bilirubin level correlated significantly with a history of jaundice in previous children, infant’s age at first meconium excretion, frequency of feeding, gestational age, mother’s blood type, and a number of maternal ultrasound during pregnancy. Moreover, the results of adjusted logistic regression revealed an association between severe jaundice and variables, such as the place of residence, history of jaundice in previous children, feeding the infant with water or sugar water during breastfeeding intervals, frequency of feeding the infant, gestational age, mother’s blood type, time of discharge from the hospital, and number of pregnancies.<br /> <strong><em>Conclusion:</em></strong> Some factors related to neonatal jaundice were identified to raise the awareness of healthcare personnel for the early identification and treatment of neonatal jaundice in order to prevent its complications.
Jaundice,Risk Factor,Transcutaneous bilirubin
https://ijn.mums.ac.ir/article_13092.html
https://ijn.mums.ac.ir/article_13092_2f6c3aacac842b1554ff45edb9dc03d6.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Validation of the Early Feeding Skills Assessment Scale for the Evaluation of Oral Feeding in Premature Infants
68
75
EN
Batul
Bahrami
0000000266598477
Student Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan , Iran
bbahrami1258@gmail.com
maryam
marofi
0000-0002-0993-2774
Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
marofi@nm.mui.ac.ir
Ziba
Farajzadegan
Community Medicine Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
faragzadegan@med.mui.ac.ir
Behzad
Barekatain
0000-0002-7370-5525
Department of Pediatrics, Division of Neonatology, Child Growth and Development Research center, Isfahan University of Medical Sciences, Isfahan, Iran
b_barekatain@med.mui.ac.ir
10.22038/ijn.2018.32322.1451
<strong><em>Background:</em></strong> Feeding difficulties are common and important in premature infants. In order to identify neonatal feeding difficulties, clinicians and nurses require assessment tools to conduct an objective evaluation of infant oral feeding (breast/bottle-feeding). Early identification of infants with feeding difficulty is critical to implement appropriate therapies and optimize the infant’s nutrition and oral feeding skill development. The aim of this study was to validate the Early Feeding Skills (EFS) Instrument for the Evaluation of Oral Feeding in Premature Infants.<br /> <strong><em>Methods:</em></strong> In this descriptive cross-sectional study, the researcher initially got permission from the designer of the tool through email. Then, the main version of this tool was translated into Persian using the standard backward/forward method. Subsequently, the formal and content validity of the questionnaire was confirmed. After visiting a neonatal specialist, the assessment of preterm infants' oral feeding skills was performed using the EFS Instrument by observing the infants (n=180) during feeding. The exploratory factor analysis and Cronbach’s alpha were utilized to determine the construct validity and assess the reliability of the instrument, respectively.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> All items of the EFS Instrument had formal validity. Two items were removed from the instrument, based on content validity. On the basis of factor analysis, the items with a minimum factor load of 0.4 were evaluated and according to the factor load of all items (above 0.4), EFS Instrument had the appropriate construct validity. The Cronbach's coefficient of the instrument was obtained 0.88.<br /> <strong><em>Conclusion:</em></strong> The EFS Instrument obtained the required reliability and validity for the evaluation of preterm infants oral feeding.
Infant,oral feeding,Premature,Validity
https://ijn.mums.ac.ir/article_11940.html
https://ijn.mums.ac.ir/article_11940_a88a01b0939ec8f6ffdc335a00eab092.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Periventricular Hemorrhage in Term and Late Preterm Neonates: Risk Factors and Outcomes
76
83
EN
Ashraf
Abou-Taleb
0000-0002-0955-1680
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
ashmaabu@yahoo.com
Hisham
A. Alghany Algahlan
0000-0002-4948-323X
Departments of Radiology, Faculty of Medicine, Sohag University, Sohag, Egypt
hishamaa78@yahoo.com
10.22038/ijn.2019.37743.1584
<strong><em>Background:</em></strong> Periventricular hemorrhage (PVH) is common in early preterm neonates but much less common in term and late preterm neonates. The aim of this study was to identify the risk factors and outcomes of PVH in term and late preterm neonates in a tertiary care center in Upper Egypt.<br /> <strong><em>Methods:</em></strong> A total of 33 term and late preterm (≥ 34 weeks of gestation) neonates (18 females and 15 males) admitted at the neonatal intensive care unit (NICU) of Sohag University Hospital and diagnosed with PVH from January 2016 to October 2018 were included in this prospective study. The neonates with major congenital malformation of the nervous system were excluded. The risk factors for PVH were ascertained, and the diagnosis was confirmed by transcranial ultrasound, computed tomography or magnetic resonance imaging. The outcomes were assessed at discharge time and the age of 6 months.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> ThePVH was diagnosed in 5.9% of the neonates. The median of age was 12 days (age range: 2-28 days) at presentation, and convulsions were the most frequent presentations followed by poor suckling and pallor. The risk factors for PVH included prolonged prothrombin time, thrombocytopenia, non-administration of vitamin K, and prolonged labor in 54.5%, 30 %, 30 %, and 27.3% of the cases, respectively. Moreover, 26 (78.7 %) cases were discharged with good conditions, and 7 (21.2 %) subjects died in the NICU. The investigation of the patients’ follow-up at the age of 6 months revealed neurological impairments in 36 % of the survivors. Grade IV and III PVH had mortality rates of 66.67% and 18.75%, respectively (P=0.009). Neurodevelopmental impairments were more frequent in Grade III and IV (P=0.002).<br /> <strong><em>Conclusion:</em></strong> The incidence of PVH was 5.9% among term and late preterm neonates admitted to our NICU. Coagulation disorders and prolonged labor were the leading risk factors. Most patients had favorable outcomes, and one-third of the cases had neurodevelopmental impairments. In addition, mortality was reported in one-fifth of the neonates. Severe grades of PVH had the worst outcomes.
Late preterm,Outcome,Periventricular hemorrhage,Risk factors,Term neonates
https://ijn.mums.ac.ir/article_13095.html
https://ijn.mums.ac.ir/article_13095_086d0c509024a0839740f5c436dbe12f.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
Correlation of Maternal Obesity and Exclusive Breastfeeding
84
88
EN
Reza
Saeidi
0000-0002-0075-5732
Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
saeedir@mums.ac.ir
Mahboobe
Gholami
0000-0002-7930-6218
Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of
Medical Sciences, Neyshabur, Iran
gholamim1@nums.ac.ir
10.22038/ijn.2019.28838.1385
<strong><em>Background:</em></strong> Many factors affect exclusive breastfeeding, include method of delivery, parity, maternal age and education, smoking, ethnicity, pregnancy complications, infant health, and environmental factors such as hospital practices, and social support.<br /> Recently, maternal obesity has been suggested as a risk factor for poor breast-feeding practices whose role has not yet been completely determined. This study was conducted to evaluate the effect of maternal obesity on exclusive breastfeeding.<br /> <strong><em>Methods:</em></strong> This Cross sectional study was carried out among women receiving prenatal care by midwives at the health center of Neyshabur University of Medical Sciences during 2014-2016. Data regarding maternal and neonatal variables were gathered. To analyze the data, Chi-squared test was run to determine the association between categorical variables.<br /> <strong><em>Results</em></strong><strong><em>:</em></strong> Planned feeding method, educational level, employment status, and gestational age were the four strongest predictors for poor breast-feeding practices at discharge. Method of delivery, gestational diabetes, and maternal hypertension and maternal obesity were significantly associated with exclusive breastfeeding at discharge (p<0.05).<br /> There was not any significant relationship between neonatal weight and gestational age with exclusive breastfeeding at discharge (p<0.05), but there was a significant association between gestational age and exclusive breastfeeding at discharge (p=0.042).<br /> <strong><em>Conclusion:</em></strong> This study indicated that maternal obesity is an important predictor of exclusive breastfeeding at discharge.
Exclusive breast-feeding,Maternal obesity,Newborn
https://ijn.mums.ac.ir/article_13226.html
https://ijn.mums.ac.ir/article_13226_119cb5c2f10294771951c00de40ea5c7.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
A Rare Occurrence of Ambiguous Genitalia in Meckel-Gruber Syndrome (MGS): A Case Report
89
91
EN
Bansal
Sharad
0000-0002-0660-4433
Departments of Pediatrics, Sir Padampat Mother and Child Health Institute, JK Lon Hospital, SMS Medical College, Jaipur, Rajasthan, India
sharadpeds@gmail.com
Jangir
Narendra
0000-0003-3445-3203
Departments of Pediatrics, Sir Padampat Mother and Child Health Institute, JK Lon Hospital, SMS Medical College, Jaipur, Rajasthan, India
nanysdmh2015@gmail.com
Sharma
Rambabu
Departments of Pediatrics, Sir Padampat Mother and Child Health Institute, JK Lon Hospital, SMS Medical College, Jaipur, Rajasthan, India
sharmarambabu905@gmail.com
10.22038/ijn.2019.37012.1573
<strong><em>Background:</em></strong> Meckel-Gruber Syndrome (MGS) is a rare autosomal recessive congenital syndrome with triad of encephalocele, polydactyly, and polycystic kidneys. The worldwide incidence of the MGS is 1 in 1.3-1 in 140,000 live births. The highest incidence of 1 per 1,300 live births (carrier rate of 1 in 18) was reported in Gujarati Indians. MGS is caused by mutation in the meckelin transmembrane receptor (MKS3) located in the interior of the cells in the ciliary transition zone. Therefore, MGS as a fatal congenital syndrome belongs to a group of diseases known as ciliopathies. Most of the fetuses affected by this syndrome die before birth or soon after birth due to oligohydramnios, respiratory failure, and renal failure. There are few case reports of this syndrome associated with cleft lip and palate, inguinal hernia, congenital heart disease, micrognathia, microcephaly, and other abnormalities.<br /> <strong><em>Case report:</em></strong> We report a case of unusual and interesting occurrenceof ambiguous genitalia in the MGS syndrome.<br /> <strong><em>Conclusion:</em></strong> The MGS is a rare fatal syndrome and can be diagnosed prenatally. In the current case, we observed that ambiguous genitalia should be taken into consideration, in addition to the cardinal features. Parents should be counselled about the outcomes of a child, as well as the chance of recurrence (25%) in the subsequent pregnancies.
Ambiguous genitalia,Encephalocele,Polycystic kidneys
https://ijn.mums.ac.ir/article_13094.html
https://ijn.mums.ac.ir/article_13094_ed63870a8ddafa5b15d6658d93dcfa22.pdf
Mashhad University of Medical Sciences
Iranian Journal of Neonatology
2251-7510
2322-2158
10
2
2019
06
01
A Rare Association of Right-sided Congenital Diaphragmatic Hernia and Encephalocele: A Case Report
92
95
EN
Gholamreza
Faal
0000000160708164
Pediatrics Ward, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
faalgh1@bums.ac.ir
Elham
Nokandi
Pediatrics Ward, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
elhamnokandi74@gmail.com
Elham
Noferesti
Pediatrics Ward, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
elham.noferesti@gmail.com
Fatemeh
Noferesti
Pediatrics Ward, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
eli97.noferesti@gmail.com
10.22038/ijn.2019.34858.1519
<strong><em>Background:</em></strong> This is a case report regarding a 2051-gram female newborn affected by right-sided congenital diaphragmatic hernia (CDH) presenting with encephalocele in the occipital region.<br /> <strong><em>Case report:</em></strong> The newborn was delivered by a 38-year-old mother from Darmian city, a rural district located in South Khorasan province, Iran.<br /> <strong><em>Conclusion:</em></strong> The CDH is an abnormality that rarely occurs with an approximate ratio of one in 3000 live births. It has been reported that 85% of the infants affected by this condition are left-sided and the classic posterolateral or Bochdalek hernia is the most common form. An incidence of 40%–50% has been reported regarding the other malformations associated with CDH, the most common of which are those involving the central nervous system. Some studies reported other rare associated abnormalities, including hepatopulmonary fusion, hypoplastic left heart syndrome, left heart hypoplasia, duodenal atresia, malrotation, and anorectal malformation. This case report aimed to mention encephalocele as another complication, which has not been reported for the CDH.
Congenital,Diaphragmatic,Encephalocele,Hernia,Newborn
https://ijn.mums.ac.ir/article_13097.html
https://ijn.mums.ac.ir/article_13097_5087aa5f7e3a13d8de47b70f0ff16013.pdf