A survey of the impact of proper breastfeeding education on blood sugar levels of healthy term infants in the public hospital of Shahid Rajai in Gachsaran in 1392

مقدمه و هدف: هیپوگلیسمی نوزادی به دلیل ایجاد عوارض مغزی در نوزاد نیاز به توجه جدی دارد .با توجه به احتمال افت قند خون در نوزادان ترم سالمی که تغذیه نا مناسب دارند،این مطالعه با هدف تعیین تأثیرآموزش روش صحیح شیردهی بر میزان قند خون نوزادان ترم سالم انجام شده است. روش مطالعه: این مطالعه یک کارآزمایی بالینی است که بر روی 85 زن باردار واجد شرایط انجام شد. نمونه ها به صورت تصادفی در دو گروه آزمایش وکنترل قرارگرفتند.برای گروه آزمایش3 جلسه‌ی 45 دقیقه‌ای کلاس آموزشی تئوری و عملی هفته‌ای یک بار در 1ماه آخربارداری برگزار شد. پس از زایمان میزان قند خون نوزادان در 3 زمان 1،3و 6 ساعت پس از تولد کنترل و ثبت گردید. داده های این مطالعه با نرم افزار spss و تست های آماری تی مستقل،کای‌اسکور، ضریب همبستگی پیرسون، فیشر وanova مورد تجزیه وتحلیل قرارگرفتند. یافته‌ها: یافته های پژوهش رابطه معنی داری را بین آموزش روش صحیح شیردهی ومیزان قند خون نوزادان درتمامی زمان های مورد پژوهش در دو‌گروه مورد مطالعه نشان داد. بیشترین میانگین قند خون در گروه آزمایش وکمترین میانگین قند خون درگروه کنترل بود. بیشترین میزان هیپوگلیسمی در ساعات اول و ششم پس از تولد و درگروه کنترل دیده شد. طبق تجزیه و تحلیل های آماری بین متغیّرهای کیفی و کمی جمعیت شناختی با میزان قند خون نوزادان رابطه معنی داری دیده نشد. متغیّرقد نوزاد در ساعت اول پس از تولد (با کنترل اثر سایر متغیّرها) در سطح خطای کوچکتر از 05/0 با هیپوگلیسمی رابطه معنی داری نشان داد(003/0 =pvalue) و این رابطه بصورت منفی می باشد به این معنی که افزایش یک سانتی متری قد نوزادان شانس ابتلا به هیپوگلیسمی را به اندازه 40 کاهش می دهد. نتیجه‌گیری: شیوه‌ی صحیح شیردهی به طورمعناداری سبب افزایش میزان قندخون نوزادان ترم سالم وکاهش شیوع هیپوگلیسمی در آنها می شود بنابراینبا وجود آموزش های جاری شیردهی، نیاز به آموزش های بیشتر و تبلیغات وسیعتر در مورد شیوه ی صحیح شیردهی در مادران باردار و نخست زا احساس می شود و پیشنهاد می گردد به افت قندخون متعاقب عدم تغذیه مناسب با شیر مادر، در نوزادان ترم سالم توجه بیشتری شود

QTc and QOTc intervals of neonatal electrocardiogram in prediction of hypocalcemia

Background: Hypocalcemia is one of important issues in pediatric domain and due to its high prevalence and important complications is a critical topic in neonatology. Measuring the total or ionized serum calcium takes time and can cause a delay in decision making and starting therapy. So it would be logical to find a noninvasive and fast method for diagnosing hypocalcemia. Methods: For assessing QTc and QOTc intervals in predicting hypocalcemia in neonates, 96 newborns were serially selected, whose clinical status or disease made them prone to hypocalcemia. From these, in 31 patients hypocalcemia was documented in serum (group1), 65 patients had normal serum calcium (group 2) and 29 normal neonates were selected in a 3rd group as a control group. Results: QTc prolongation in the first and second group was 61.3 % and 7.7 %, respectively and QOTc prolongation was 45.2% and 10.8%, respectively. None of neonates in the 3rd group had QTc or QOTc prolongation (P>0.001). Sensitivity and specificity for QTc was 61.3% and 92% respectively and for QOTc was 45% and 89.5% respectively. Conclusion: QTc and QOTc intervals could be used as a noninvasive fast and precise method for detecting hypocalcemia and starting treatment until the results of biochemical calcium measurement could be availabl

The Effects of Low and High Dose Oral Calcium and Phosphor Supplementation on Nephrocalcinosis Diagnosed by Sonography in Premature and Low Birth Weight Neonates

Nephrocalcinosis is defined as calcium deposition in the renal interstitium. One of the major causes of neonatal nephrocalcinosis is the use of calcium and phosphor supplements for premature neonates. This study aims at assessing the effects of calcium and phosphor supplementation in neonatal nephrocalcinosis by renal ultrasonography. In this randomized controlled trial, 37 premature neonates with birth weights <1500 g or a gestational age of <34 weeks were considered. Two different doses of calcium 75 vs. 230 mg/kg/day and phosphor 50 vs. 110 mg/kg/day were prescribed and laboratory and sonographic data were then documented and evaluated. The incidence of nephrocalcinosis was 47.8% in group 1 and 28.6% in group 2. There was a significant association between NC and positive family history of renal stones, shorter duration of TPN and NICU stay. The amount of calcium dosage, gestational age, birth weight, sex, use of surfactants, and mechanical ventilation did not have any significant association with NC. In this study, the neonates with NC were mostly the white flake type (8 cases) and the majority of the lesions were 1-2 mm. All the lesions were located in the pyramid and papilla areas, acoustic shadows were not prevalent and stones were not observed in any of the patients. Trial Registration Number: IRCT2013060810441N

Pharmacokinetic Evaluation of Two Doses of Aminophylline/Theophylline Administered as Multiple Intermittent Infusions to Iranian Apneic Premature Neonates: Pharmacokinetic of multiple intermittent infusions aminophylline/theophylline

Many premature neonates suffer from apnea, and aminophylline is administrated for them. The objective of this study was to reveal pharmacokinetic (PK) parameters of theophylline in Iranian premature neonates. Premature neonates (68) who were admitted in the Neonatal Intensive Care Unit (NICU) of Namazi, Hafez, and Zeinabieh Hospitals were included in the study. All of them received 5 mg/kg aminophylline. One group received 1 mg/kg/8 h and the other group received 2 mg/kg/8 h as maintenance dose. One blood sample was taken in steady-state on just before eleventh dose. Theophylline level was determined with immunoassay kit. There was a significant difference in average serum concentration (Cave ss ) between two dosing levels (7.69±2.92 µg/ml vs. 11.44±3.80 µg/ml). Furthermore, the total clearance and volume of distribution were significantly different in two groups. No significant correlation could be found between the gender and Cave ss in different dosing levels. Postnatal age and postconceptional age have significant relationship with Cave ss just in the second group. According to theophylline serum concentrations, these two dosages produce therapeutically safe and effective blood levels. Pharmacokinetic parameters in these patients–in two dosing groups–approximately are correlated with other reported and recommended amounts

A study of the effect of training pregnant women about attachment skills on infants’ motor development indices at birth to four months

Background. During pregnancy fetus-maternal attachment can improve maternal-fetal attachment, and have positive effects on the infant’s growth and development. Objectives. This study aimed to investigate the effect of training pregnant mothers about attachment skills on infants’ motor development indices at birth to four months. Material and methods. This study is a clinical trial with convenient sampling on 190 pregnant women in Hafez hospital. They were randomly divided into two groups: intervention and control. There were 94 and 96 patients in the control and intervention groups, respectively. In the intervention group, 6 sessions of 90-minute educational classes were held. After birth, the infants were compared, in both groups, in terms of motor status using the Denver questionnaire at birth to the age of 4 months. Results . In the intervention group, educating the women on fetal-maternal attachment skills was associated with infants’ earlier achievement age in terms of some gross motor, all fields of speech-language, and one item of fine-adaptive motor realms. In addition, the infants’ age was significantly reduced in achieving some personal-social items, as well as gross-fine scope at one and three months. Conclusions . Training the mothers in attachment skills increased fetal-maternal attachment and improved the motor development indicators in infants aged up to four months. Therefore, training in attachment skills is recommended to be given as a component of routine pregnancy care

The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study

Introduction: Communication is one of the key principles in Family-Centered Care (FCC). Studies have shown some drawbacks in communication between families and nurses. Therefore, the present study aimed to recognize the obstacles against nurse-family communication in FCC in Neonatal Intensive Care Unit (NICU). Methods: This qualitative study was conducted on 8 staff nurses in 2 NICUs affiliated to Shiraz University of Medical Sciences selected through purposive sampling. The data were collected using 8 deep semi-structured interviews and 3 observations. Then, they were analyzed through inductive content analysis. Results: Data analysis resulted in identification of 3 main categories and 7 subcategories. The first category was organizational factors with 2 subcategories of educational domain (inadequate education, lack of a system for nursing student selection, and poor professionalization) and clinical domain (difficult working conditions, lack of an efficient system for ongoing education and evaluation, and authoritarian management). The second category was familial factors with socio-cultural, psychological, and economic subcategories. The last category was the factors related to nurses with socio-cultural and psycho-physical subcategories.Conclusion: Identification of the obstacles against nurse-family communication helps managers of healthcare systems to plan and eliminate the challenges of effective communication. Besides, elimination of these factors leads to appropriate strategies in NICUs for effective application of FCC

Incidence and Risk Factors of Retinopathy of Prematurity among Preterm Infants in Shiraz/Iran

Objective: Retinopathy of prematurity (ROP) is a serious complication in preterm infants. To avoid this complication the risk factors leading to the disabling disease should be evaluated and prevented. Methods: This is a descriptive study. All preterm infants with birth weight under 1500 g and preterm infants with birth weight between 1500-2000 g who had unstable clinical condition and admitted in neonatal intensive care unit from February 2006-March 2007 at tertiary hospitals of Shiraz University, Iran, were introduced into the study. All infants are examined by indirect ophthalmoscopy. Risk factors analysis was performed in two groups. Group 1 consisted of infants with no ROP or ROP that regressed spontaneously, and Group 2 of those with severe ROP that needed laser therapy. Findings: Of 199 preterms, ROP that needed laser therapy was detected in 19 (9.5%); 65 (32.6%) had ROP that regressed spontaneously and 115(57.8%) had no ROP. Risk factor analysis showed significant P-values for gestational age, birth weight, Apgar score of first minute, mean duration of mechanical ventilation, mean duration of oxygen therapy, eclampsia-preeclampsia, hypoxia, hyperoxia, Pa CO2 >60 mmHg, pH>7.45 and frequent blood transfusions. Using stepwise logistic forward regression showed the three factors mean duration of oxygen therapy, birth weight and mechanical ventilation to be independently significant variables for increasing the rate of ROP. Conclusion: The main risk factors for development of threshold ROP are low birth weight, mechanical ventilation and duration of oxygen therapy. So it seems that prevention of premature delivery and judicious oxygen therapy is the main step for prophylaxis of ROP

Intraventricular Hemorrhage in Premature Infants and Its Association with Pneumothorax

Intraventricular hemorrhage (IVH) is one of the major causes of the cerebral palsy and mental retardation. Prevention and early management of these neurologic developmental problems will require determining the perinatal risk factors associated with this clinical entity. Pneumothorax increase the risk of IVH, and cause of pneumothorax has an important effect in severity of IVH. This is a prospective cross sectional study in 2010. This study includes 150 preterm neonates. Cranial ultrasound was performed in all neonates in age 3, 7, 30, 60, just after pneumothorax and every 2 week until chest tube discontinuation. Then prevalence of IVH and pneumothorax was calculated in preterm infant and severity of IVH was investigated before and after development of pneumothorax, and this comparison was divided by different causes of pneumothorax with SPSS version 11.5. Prevalence of IVH and pneumothorax in preterm infants were 30% and 10% respectively. Pneumothorax was not a risk factor of IVH (P>0.05), but prevalence of pneumothorax caused by RDS was a risk factor of development of IVH (P=0.01). Also pneumothorax in patients with birth weight less than 1000 g and gestational age less than 28 week was a risk factor of IVH pneumothorax (P=0.008, P=0.01 respectively). Our study discusses the differences in previous studies about association of pneumothorax and IVH. Also we suggest the hypothesis that lack of cerebral autoregulation in neonates with gestational age less than 28 week can cause IVH development after hypotension induces by pneumothorax

Lived experiences of the caregivers of infants about family-centered care in the neonatal intensive care unit: A phenomenological study

Background: Family-centered care (FCC) has recently been recognized as the most effective approach in pediatric and family care. Despite the emphasis of healthcare systems on commitment to the philosophy and application of FCC, the nature of this method remains unknown in the related studies. The present study aimed to describe and interpret the experiences of professional and familial caregivers about FCC in the neonatal intensive care unit (NICU) to reveal its structure and essence. Methods: The study was conducted using Van Manen’s phenomenological approach on 18 participants, including 10 professional and eight familial caregivers, who were interviewed. In addition, the interactions between the caregivers during the FCC practice were observed closely. Data were collected from the interviews, and the field notes were transcribed. Data analysis was performed using Van Manen’s thematic analysis. Results: Four main themes and 12 subthemes emerged in the study. Experiences of the caregivers about FCC were manifested through the themes of ‘restoring stability’ (subthemes: ‘reconstituted family’, ‘comprehensive advocacy’, and ‘meta-family interaction’), ‘oriented coalition’ (subthemes: ‘family as a care partner’, ‘professional group action’, ‘unity of action in caregivers’, and ‘collaborative space governance’), ‘dynamics of care’ (subthemes: ‘family as an agent for the advancement of professional caregivers’, ‘perceived status of problem-solving’, and ‘confrontation of caregivers’), and ‘empowering the family caregivers’ (subthemes: ‘accompanying to learn’ and ‘functional evolution’). Conclusion: According the results, FCC is a dynamic care intervention, which is established through purposeful interactions between heterogeneous group members (professional and familial caregivers) in order to achieve care goals and create balance in all caregivers. Moreover, the approach enables familial caregivers to play their role efficiently. Application of this comprehensive care requires the attention of healthcare policymakers and managers to provide the proper context for optimal care provision in the NICU

Olfactory Stimulation by Vanillin Prevents Apnea in Premature Newborn Infants

Objective: Apnea is one of the most common problems in premature newborns. The present study aimed to determine the effect of olfactory stimulation by vanillin on prevention of apnea in premature newborns. Methods: In this randomized controlled trial, 36 premature newborns with the postnatal age of 2 days and weight under 2500 grams referred to the hospitals affiliated to Shiraz University of Medical Sciences, were selected through simple random sampling and allocated into control and experimental groups. The experimental group received olfactory stimulation by saturated vanillin solution, while the control group received no interventions. The newborns of both groups were continuously monitored for presence/absence of apnea and number of episodes of apnea as well as arterial blood oxygen saturation and heart rate for 5 days. The data were analyzed by independent Student t-test and repeat measure ANCOVA. Findings: The presence of apnea revealed to be significantly different between the two groups in the first, second, and fourth day of the study (P<0.05). The number of episodes of apnea during five days was also significantly different between the study groups (t=8.32, P<0.05). Using olfactory stimulation by vanillin caused a 3.1-fold decrease in apnea and the effect size was 0.72. Moreover, the two groups were significantly different regarding the arterial blood oxygen and heart rate during the study period (P<0.05). Conclusion: This study indicated the beneficial effect of saturated vanillin solution on apnea; therefore, it may be used for prevention and treatment of apnea in premature infants. Further studies are needed to improve evidence-based practice in this regard