Effects of position on oxygen saturation and heart rate in very low birth weight neonates

Background: Optimal oxygenation in preterm neonates is very important, therefore different measures are recommended to improve their oxygenation. One of these measures is the position of these infants. The studies on the effects of prone and left lateral positions showed conflicting results. So, the aim of this study was to determine the effect of position on arterial oxygen saturation (SaO2) and heart rate (HR) in very low birth weight (VLBW) neonates. Methods: This non-randomized simple convenient interventional study was conducted on 40 VLBW 7-28-day infants with 29-35-weeks gestational age using in 2014-2015. The infants were hospitalized in the neonatal intensive care unit of Rouhani Hospital in Babol. Based on the inclusion criteria, each of them was initially kept in supine position for 120 minutes and then in prone and finally left lateral position for 120-min after 10-min rest. During this period, SaO2 and HR parameters were recorded every 15-min and data were analyzed. Results: The mean of SaO2 was 97.41±1.91%, 96.74±2.09% and 96.14±2.36% in prone, supine and left lateral positions, respectively and this difference was statistically significant (P=0.032). The mean of HR was 146.09±9.65, 148.15±11.46 and 146.02±10.54 (beat/min) in prone, supine and left lateral positions, respectively. HR was normal in all three positions but the HR variability in prone position was slightly less than other positions (P=0.596). Conclusions: The results of the current study indicated that in preterm newborns, the prone position made more desirable oxygenation and HR variability compared to the supine and left lateral positions

The Effect of mode of delivery on the umbilical artery pH

Background: Abnormal umbilical cord pH can be indicated a distress imposed of newborn and can also be useful in determining the prognosis of the newborn. There are different views about the effect of the neonatal delivery method on the blood gas analysis of the umbilical artery. This study aimed to determine the effect of the method of delivery on umbilical artery pH. Methods: In this Cross-Sectional study, 150 singleton newborns of 37 to 42 weeks, with birth weight 2500 to 4000 g, were allocated. The samples were calculated for values, based on similar studies, and were divided into two groups, including vaginal delivery and caesarian section under spinal anesthesia which have the least difference in pH. Umbilical artery blood gas analysis of both groups were studied. Finally, using statistical T-test for the quantitative data and chi-square for the qualitative data, hypotheses were answered. P-value less than 0.05 was considered statistically significant. Results: Average gestational age was between 39±0.9 weeks and 76 (50.6%) and 74 (49.4%) of neonates were male and female respectively. The average birth weight was 3368.7±473.5 g. In this study, average umbilical artery pH at birth by vaginal delivery and by cesarean section was 7.25±0.06, 7.26 ±0.06 respectively (P>0.05). In this study, in both groups significant differences were seen in all the blood gas values except the umbilical cord artery pH. Conclusions: Our study showed that the pH level of umbilical artery blood was in normal range among newborns of both groups, but Po2 and Pco2 were more appropriate in vaginal deliveries. Due to the prognostic value of umbilical artery PH and the essentiality of prognosis in the newborns under stress, we recommend that this study should be done in the emergency situation, too

Prophylactic oral probiotic on prevention of feeding intolerance in Very Low Birth Weight (VLBW) neonates: Randomized Clinical Trial

Background: Feeding intolerance is prevalent in very low birth weight (VLBW) neonates and is a barrier for better and faster growth in these neonates. Some studies have supported the administration of oral probiotic to decrease feeding intolerance. The aim of this study was to evaluate the effect of probiotic on feeding intolerance in VLBW neonates. Methods: This randomized clinical trial study was conducted on 60 VLBW neonates who were randomly divided into two equal groups. In the case group, the infants received probiotic in addition to routine therapy. Duration of hospitalization, time to reach to full enteral feeding and birth weight, the numbers of vomiting and defecation, c-reactive protein rising, daily weight gain were compared between two groups. Results: No significant differences were observed between two groups in regard with gender, birth weight, method of delivery and gestational age. Mean of duration of hospitalization was 42.27 and 31.6 days in control and drug groups, respectively and there was significant difference (P-value=0.005). There was no significant difference between two groups in terms of reaching full enteral feeding, the numbers of vomiting and defecation, time to reach to birth weight, CRP rising and daily weight gain but these results were better in probiotic group. Conclusions: This study showed that prophylactic administration of probiotic had significant role in reducing the duration of hospitalization of VLBW neonates and was effective in reaching full enteral feeding. It is suggested that the administration of probiotic can be helpful for feeding tolerance in VLBW neonates

Colonization of rectovaginal Escherichia coli and group B streptococci in mothers and on infants' body surface and their related risk factors

Background: Microorganisms that cause early neonatal sepsis are usually already colonized rectovaginal area in mothers. The most common of these organisms is group B streptococci (GBS) and intestinal gram-negative bacteria mostly Escherichia coli (E.coli). The use of prophylactic antibiotics against GBS has increased in recent years. This study aimed to determine the current situation and frequency of E.coli and GBS colonization in mothers and their infant. Methods: All pregnant women with gestational age≥26 weeks, progressive labor pain and no history of using antibiotic were entered into the current study. A sterile cotton swab culturing from distal third of vaginal and rectum of mothers, and six hours after delivery from external ear canal, nose, groin and umbilicus of infant has been taken. All samples were transferred to the laboratory in Stuart’s media, and then cultured to standard media within 24 hours and the main two organisms in neonatal sepsis (E.coli and GBS) were isolated from mothers' and infants' cultures. Results: E.coli and GBS were 56.3% and 11.2% respectively in rectovaginal culture, and 29.8% and 8.8% in infants’ body surface culture. There was a significant difference in rectovaginal GBS colonization between term (13.6%) and preterm (3.2%) (P=0.005), while the frequency of positive E.coli culture was 52.8% in term deliveries and 68.1% in preterm ones, showing a significant difference (P=0.009). Conclusions: Since E.coli is more common in preterm delivery in this geographical region, in cases of amniotic membrane rupture, mothers should be adequately protected with prophylactic antibiotics against neonatal sepsis