Umbilical cord serum procalcitonin, as an early diagnostic marker of early neonatal sepsis

Background and Objective: The prognosis of early neonatal sepsis is significantly associated with rapid diagnosis and appropriate antibiotic therapy. Since blood culture has been reported positive in less than 16 of neonatal sepsis cases, various biochemical markers have been evaluated. This study was performed to evaluate the umbilical cord blood procalcitonin (PCT) as an early diagnostic marker of early neonatal sepsis. Methods: This cross-sectional study included 100 neonates in two groups of case and control. The case group consisted of three separate groups, including proven, suspected and clinical sepsis groups. The PCT level of umbilical cord blood was measured by immunoluminoassay method, and PCT 0.5-2ng/ml, 2-10 ng/ml and >10ng/ml were considered weakly positive, positive and strongly positive, respectively. Sepsis screening tests and a culture taken from blood or other sterile fluids were studied in the case group. Findings: The PCT mean was 1.39±1.52 and 0.17±0.05ng/ml in the case (sepsis) and control groups, respectively. Finally, the PCT level was significantly higher in all cases in the proven sepsis group than in other sepsis groups. Conclusion: The result of this study showed that the mean value of PCT level in umbilical cord blood was higher in the sepsis group, and it was higher in the proven sepsis group than in the other two groups of sepsis

Audit nursing reports in intubated neonates admitted in neonatal intensive care unit of Ayatollah Rouhani Hospital, Babol, Iran

Background: Accurate and complete documentation of nursing records is one of the preconditions of the evidence-based cares and is considered as one of the most important professional tasks in nursing. The aim of the present study was to audit the nursing reports in intubated neonates admitted in neonatal intensive care unit of Ayatollah Rouhani hospital, Babol. Methods: In this cross-sectional study, 100 nursing reports were randomly selected from the neonatal intensive care unit. Data were collected by a researcher using a checklist which was developed in accordance with the standard and indicators of nursing documentation in national and international reliable sources and then compared after determining the content validity and reliability (observers' agreement coefficient). Data were analyzed using SPSS20, and statistical methods of Man-Whitney and Kruskal-Wallis were used at a significant level of p<0.05. Results: The quality of 93%, 1% and 6% of nursing records was good, moderate and poor, respectively. Overall, the quality of nursing records was desirable in terms of content and structure and there was no significant difference in nursing documentation record in dimensions of structure and content according to overtime (P=0.92 and P=0.11), work experience (P=0.61 and P=0.16) and age group (P=0.09 and P=0.76). Conclusions: The quality of nursing records in neonatal intensive care unit of Ayatollah Rouhani Hospital of Babol has been improved according to the Accreditation of Health Care Centers. In addition, the increase of nurses' knowledge about legal and professional issues has also been effective on improving the quality of the documentation

Effects of Restrictive Fluid Management in Transient Tachypnea in Neonates

Background: The transient tachypnea is a common respiratory problem in the neonate. One of the significant issues in pathophysiology of this disorder is the delayed reabsorption of the fluid by the neonate’s lungs and the effusion of fluid in the lungs. The purpose of this study is to evaluate the effects of restrictive fluid management in transient tachypnea of the neonate. Methods: The present study was conducted on the neonates with the gestational age ≥ 34 weeks suffering from transient tachypnea during the first 6 h after birth. The amounts of total fluid in experimental and control groups were 50, 65 mL/kg and 65, 80 mL /kg for term and preterm neonates, respectively. In each group, a daily amount of 20 mL/kg fluid was added until 150 and 170 mL/kg for term and preterm newborns. Results: This study was carried out on 70 neonates, including 34 cases and 36 controls. The mean of hospitalization period in the experimental group was less than that of the control group. The mean period of respiratory support in the experimental group was less than that in the control group. Conclusion: The results of the present study revealed that the restrictive fluid management in the neonates with transient tachypnea might decrease the hospitalization period and the respiratory support period. Furthermore, it is a safe and effective method in treating transient tachypnea in neonates

Early Surgical Intervention for Diaphragmatic Paralysis in a Neonate; Report of a Case and Literature Review

Background: Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. Case Presentation: We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. Conclusion: Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis

The effect of instructing mothers in attachment behaviors on short-term health outcomes of premature infants in NICU

BACKGROUND: The birth of a pre-mature infant and subsequent hospitalization and separation from the family can impair maternal and neonatal attachment and quality of maternal care. This study aimed to assess the effect of instructing mothers in attachment behaviors on short-term health outcomes of pre-mature infants admitted to neonatal intensive care units (NICUs). MATERIAL AND METHODS: In this quasi experimental study, 80 mothers of pre-mature infants who were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in 2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions. Mother–infant attachment behaviors were evaluated at both the beginning and the end of this study using a checklist derived from Avant's Maternal Attachment Assessment Strategy. Moreover, infants' short-term health consequences were investigated in two groups. SPSS 18 statistical software was used for data analysis. RESULTS: On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in the control and the intervention group to reach full oral feeding and 38/5 (38/4–42/11) and 37 (31/85–42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days, respectively (P > 0/05). CONCLUSION: Instructing mothers in attachment behaviors clinically improved short-term health-related outcomes. Hence, this intervention is recommended to be incorporated in the care program for mothers with pre-mature infants

Maternal Recto-Vaginal Organisms and Surface Skin Colonization in Infants

Background: Early-onset sepsis is a common cause of neonatal mortality and mainly occurs due to the colonized microorganisms in the maternal recto-vaginal area. The present study aimed to evaluate the effects of maternal risk factors on recto-vaginal colonization and transmission rate of micro-flora from mothers to infants. Methods: Upon admission, two samples were obtained from the distal third of vagina and rectum of mothers using sterile cotton swabs. Six hours after birth, sterile swab samples were collected from the external ear canal, nose, groin, and umbilicus of the infants. The samples were transferred to the laboratory on Stuart transport medium. Afterwards, the samples were transferred to standard culture media within 24 hours. Transmission rate of organisms was calculated based on the maternal and neonatal findings. Results: In total, 13 bacterial and fungal species were detected in the samples. Escherichia coli was the most frequent gram-negative organism in the rectal and vaginal cultures (29.34%) with the transmission rate of 49.4% to the infants. Infants of the mothers with premature rupture of membranes (PROM) had significant Enterobacter cloacaecolonization. In addition, frequency of Candida albicans was higher in the mothers with gestational hypertension (21.4%) compared to non-hypertensive women (4.9%). Infants requiring advanced cardiopulmonary resuscitation (CPR) had significantly higher E. coli colonization (45.1%) compared to those not needing CPR (27.6%). Conclusion: According to the results, gram-negative bacteria (E. coli and Enterobacteriaceae ) were the most frequent organisms in the maternal recto-vaginal area and body surface of the neonates in our clinical setting. Therefore, chemoprophylaxis is recommended for these organisms in prolonged PROM

Maternal recto vaginal colonization in term and preterm deliveries

Background and aim: Maternal recto-vaginal organisms are the main cause of early-onset sepsis in neonates. The aim of this study was to determine the most common organisms and compare maternal recto-vaginal colonization in term and preterm delivery. Methods: This cross-sectional study was done from October 2014 through October 2016 among participants referred to Ayatollah Rouhani Hospital in Babol, Northern Iran. All pregnant women within gestational age (GA) ≥ 26 weeks and labor pain were included in this study. By a cotton applicator, culture from the lower third of the vagina and another one from the rectum were taken and transported by Stuart media to the laboratory, and were cultured on main Medias within 24 hours. Then microorganisms in preterm and term delivery were compared together. Data were analyzed using SPSS 16. The variables were compared between two groups by chi-squared test, Fisher′s exact test and logistic regression. P<0.05 was statistically considered significant. Results: Among 511 mothers with successful culturing, 417 delivered at term and 94 fewer than 37 weeks. Staphylococcus epidermidis and Escherichia coli (E. coli) were the most abundant organisms. The frequency of E. coli in term and preterm delivery was 52.5% and 68.1% respectively (p=0.006). Group B strep was more frequent in term delivery (13.7% vs. 3.2%, p=0.004). Conclusion: Based on our findings, the frequency E. coli and other gram-negative bacteria were higher in preterm delivery groups which indicates the need to assess the efficacy of chemoprophylaxis in situations such as prolonged rupture of membrane, and preterm delivery

Duration of kangaroo mother care and weight gain in very low birth weight preterm infant

Background: One of the important effects of kangaroo mother care (KMC) in preterm baby is improvement in weight gain and so shortening in hospitalization, but it is not clear that how long of kangaroo mother care is effective in weight gain. The aim of this study was to determine the least effective duration of kangaroo mother care in weight gain in very low birth weights. Methods: Preterm babies with birth weight less than 1500 gr, without chronic cardiopulmonary disease, congenital anomaly and other medical problem when receiving to 140 ml/kg/d enteral feeding enrolled the study. KMC was started when the baby has been stabled, on the mother&rsquo;s appetency and ability at bedside. The mean daily weight gain in KMC period was compared with expected that (15 mg/kg/d) for the same baby. The babies with KMC&ge; 7 days were divided in three groups on the basis of mean daily KMC duration ( 60). Statistical study performed by using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and P values of less than 0.05 were considered to be significant. Results: In this study, 103 preterm baby (47 boys, 56 girls) less than 1500 gr were enrolled, with mean birth weight 1107.85&plusmn;190.87 gr. Mean weight gain of boys in KMC period and expected that were 324.78&plusmn;162.66 gr Vs. 127.46&plusmn;54.66 gr (P< 0.001). In eighty-seven babies who received KMC (7-40 days) mean daily weight gain was 26.69&plusmn;15.55 gr (P< 0.001). Mean weight gain in KMC period for group with< 30 min (n=19), 402.63&plusmn;126.29 gr Vs. 167.21&plusmn;74.20 (P< 0.001), group with 30-60 min (n=54) were 338.79&plusmn;182.60 gr Vs. 220.36&plusmn;66.98 (P< 0.001) and group with 60< (n=14) 352.14&plusmn;236.02 gr Vs. 259.96&plusmn;112.23 (P= 0.09). Conclusion: On the basis of this study KMC less than 1 hour per day is effective in weight gain of very low birth weight preterm babies

Factors Affecting Stillbirth Rate in the Hospitals Affiliated to Babol University of Medical Sciences

Background: Stillbirth is a sensitive indicator for health care quality, living conditions and equity in a society. The aim of this study was to determine the rate and contributing factors of stillbirth at Babol hospitals. Methods: This cross-sectional, descriptive, analytical study was designed as an applied research, using census sampling in 2012-2013. A questionnaire was applied for data collection. The study samples included all fetal mortalities occurring between 22 weeks of gestation and birth. Data were analyzed using SPSS version 18 at the significance level of 0.05. Results: Stillbirth rate was estimated to be 11.7 per 1000 cases. The age of mothers of stillborn babies ranged between 15 and 35 years with a mean of 26.94±5.995 years. Gestational age ranged between 22 and 41 weeks with a mean of 28.9±5.941 weeks. The range of weight at birth was 250-5500 g, with a mean weight of 1331.553±1068.468 g. Stillbirth had a significant correlation with gender, the number of babies in multiple gestations, congenital abnormalities, underlying maternal diseases and maternal conditions during pregnancy. Conclusion: Stillbirth can be effectively prevented through screening high-risk women and referring them to appropriate care centers. Moreover, training and counseling these women and proper follow-up before, during and after pregnancy can aid with early detection and termination of high-risk pregnancies

A Pilot Study of Developing an Infant Sucking Tester Instrument

Objectives: Most preterm infants experience oral feeding disorder. Sucking is the most appropriate way for oral feeding, but it may be immature in preterm infants. Regarding the increased risk of feeding problems in preterm infants, investigating and monitoring their sucking patterns to present appropriate and timely intervention is recommended The current research aimed to report the design of an instrument for measuring the suction pressure in preterm infants through a pilot study. We also checked the validity and reliability of the instrument. Methods: A pilot study was conducted to measure the validity and reliability of this instrument. First, the instrument was developed, and in the next step, discriminant validity, test-retest reliability, and comparison in terms of sex were investigated by measuring the suction pressure of 20 full-term and 15 preterm infants. The Mann-Whitney U test and Wilcoxon test were used to establish the discriminant validity, comparison in terms of sex, and test-retest reliability in SPSS v. 23 software. Results: Two groups showed a significant difference in the suction pressure (P<0.001) to support the discriminant validity of the instrument. We obtained satisfactory values for the test-retest reliability in two groups (r=0.97, P<0.001). Boys and girls did not significantly differ between full-term (P=0.9) and preterm infants groups (P=0.5). Discussion: Performing the pilot study on 35 infants through an infant sucker tester proved the instrument’s discriminant validity and test-retest reliability. However, conducting the studies with a larger sample size is essential to make this instrument available commercially