The Etiology of Acute Renal Failure in the Newborn Infants Admitted to the NICU at Afzalipour Medical Centre, Kerman, IRAN

Abstract: Introduction: Despite the countless benefits of breast milk, each year many infants are admitted to NICU's with clinical symptoms and laboratory indicators of dehydration and renal failure due to the lack of a national program to monitor post discharge breastfeeding over the first few days of life. In addition to identifying the role of inadequate breast milk intake as a cause of renal failure, the purpose of this study was to assess causes, clinical presentations and laboratory tests in acute renal failure and to identify the most available and practical laboratory test to differentiate prerenal from renal azotemia. Methods: A cross-sectional prospective study was performed between April 2005 and May 2006 (14 months) at Afzalipour Medical Centre in Kerman, Iran. All neonates with high serum blood urea and creatinine were included in the study. The percentage of weight loss, breast feeding, mode of delivery, and clinical presentations were recorded. Laboratory tests such as blood urea, serum and urine sodium and creatinine and, urine specific gravity were done. Data were analyzed by SPSS software, chi- square test and t- test. Results: Among 36 neonates, who were eligible for the study, 29 cases (80%) had dehydration (group I) and 7 cases (20%) had intrinsic renal failure (group II). In the first group, mean weight loss was 14% and mean age at admission was 10 days. Reasons for admission were poor feeding (69%), lethargy (58%), fever (30%), jaundice, vomiting and seizure. The mode of delivery in 69% of cases were vaginal route and 82% of cases were breast-fed. Decreased urine frequency in the previous day (<6 times per day) was considered more significant than decreased stool frequency (< 3 times per day). Serum sodium and urine specific gravity in group I was significantly higher than group II (P< 0.05). Conclusion: This study confirms that an excessive weight loss over the first few days of life and decreased urine and stool frequency might be considered as a warning for failure of receiving enough milk. Serum sodium and urine specific gravity are the most sensitive laboratory parameters, for the assessment of dehydration. Keywords: Acute renal failure, Newborn infant, Dehydration, Azotemia, Breastfeedin

Nasal Colonization Rate of Community and Hospital Acquired Methicillin Resistant Staphylococcus Aureus in Hospitalized Children

Background & Aims: Prevalence of community and hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. The primary reservoir is the anterior nares; and nasal carriage is a risk factor for infection in a variety of populations. Infection due to hospital-acquired colonization is different from community acquired in clinical manifestations and antibiotics susceptibility. In this study, we investigated nasal colonization rate and antimicrobial susceptibility of community and hospital acquired staphylococcus aureus nasal colonization at childhood. Methods: This cross-sectional study was conducted in children admitted at Kerman Afzalipour hospital, Iran, during June to November 2011. Sample was taken from nostrils of 180 patients in the beginning and after 48 hours of admission for staphylococcus aureus nasal colonization and antibiotics susceptibility test. Results: Of 180 samples at the beginning of hospitalization, 22 (12.2%) had staphylococcus aureus nasal colonization; from these, 18.1% were methicillin-resistant (2.2% of total population). Methicillih-resistant staphylococcus aurous colonized children had significantly greater mean age than non-colonized (P < 0.001). After 48 hours, 22 (12.2%) were colonized with staphylococcus aurous; from these, 11 (50%) were hospital acquired methicillih-resistant. All methicillih-resistant staphylococcus aurous isolates were sensitive to vancomycin. The rate of resistance to the other current in-use antibiotics was more common in hospital acquired staphylococcus aureus. Conclusion: Community acquired methicillih-resistant staphylococcus aurous is sensitive to many anti- staphylococcus agents in our region. Methicillin-resistant Staphylococcus aureus (MRSA) colonization in admitted patients can occur. Empirical antibiotics recommendation in nosocomial infection should be on the base of periodic culture and antibiotics susceptibility test. Keywords: Nasal colonization, Community acquired, Methicillih-resistant staphylococcus aurous, Hospital acquired, Childre

Predictive Value of Nucleated Red Blood Cell Counts in Cord and Peripheral Blood of Asphyxiated Term Neonates in the First Week of Life

Introduction: Increased numbers of nucleated red blood cells (NRBC) circulating in the blood of neonates can be associated with relative hypoxia and adverse outcomes. Thus, the aim of this study was to assess the NRBC count during the first week of life in neonates diagnosed with asphyxia as compared to healthy neonates and to determine the short-term morbidity and mortality for the affected babies. Methods: The cross-sectional study compared 15 healthy neonates with 15 neonates diagnosed with asphyxia confirmed by pH of cord blood or Apgar scores. The nucleated red blood cell (NRBC) counts were calculated right after birth, and on days 3 and 7, and the hematological parameters of umbilical cord blood were also evaluated. The infants were followed for mortality and associated morbidity. Statistical analysis was conducted using the Mann-Whitney U test, analysis of variance, chi-square tests, and Pearson’s correlation coefficient. A p-value < 0.05 was considered as statistically significant. Results: The initial NRBC counts were significantly higher in the asphyxiated group than in the control group and the difference remained significant through the end of first week. All of the umbilical cord blood parameters were significantly lower in the study group and were negatively correlated with the NRBC count. At birth, higher NRBC count correlated with higher mortality. conclution: Results show that NRBC count is a useful predictive factor for neonatal asphyxia through the end of the first week of life, although a larger study population and a longer follow up period seems to be necessary

The role of education methods, on knowledge and skills of neonatal resuscitation in nursing students

Background: Birth is probably considered as the most highly dangerous event in every one’s life. Although a few percent of newborns may require resuscitation in this stage, wrong methods or failures would lead to death or leave some irreversible complications. That is why it is of great importance to learn the proper methods and become skilful in resuscitation. This study was conducted to compare the effectiveness of conventional and recommended methods of teaching resuscitation to nursery students.Methods: The research is an interventional–semi experimental study. The samples were 46 nursery students of the third semester who were divided into two groups of 23 according to their place of residence. The resuscitation was taught through the conventional and recommended methods. The conventional method consists of teaching all the theoretical subjects by different instructors and performing the related team work. In recommended method the time specified to theoretical subjects is less, and most of the subjects are somehow included in practical work. A pretest was given in the two groups and after the training a final theoretical and practical test was held through the OSCE methods. The findings were analysed by using the SPSS software and some statistical tests as: Mann Whitney U-test, Independent sample t-test, Pearson correlation, paired t-test.Findings: The findings of this study show that there is no significant difference between the primary knowledge of the students in the two groups. The post-test scores are higher in both groups and the difference is significant which suggests that training has been efficient in both groups. Comparing the post-test scores (practical and theoretical) shows no significant difference. There is no significant difference between the increase in practical and theoretical scores of both groups either. Conclusions: considering less time (1/2) and lower costs (1/4) spent on training in the recommended method, there was no change in efficiency

Can we Replace Arterial Blood Gas Analysis by Pulse Oximetry in Neonates with Respiratory Distress Syndrome, who are Treated According to INSURE Protocol?

Neonates with respiratory distress syndrome (RDS), who are treated according to INSURE protocol; require arterial blood gas (ABG) analysis to decide on appropriate management. We conducted this study to investigate the validity of pulse oximetry instead of frequent ABG analysis in the evaluation of these patients. From a total of 193 blood samples obtained from 30 neonates <1500 grams with RDS, 7.2% were found to have one or more of the followings: acidosis, hypercapnia, or hypoxemia. We found that pulse oximetry in the detection of hyperoxemia had a good validity to appropriately manage patients without blood gas analysis. However, the validity of pulse oximetry was not good enough to detect acidosis, hypercapnia, and hypoxemia

Comparison of breast and formula feeding on the stool characteristics of 1-3 months old infants

Abstract: The aim of this study was to compare the effects of breast-feeding and formula-feeding on the characteristics of stool in infants, 1 to 3 months of age. In this investigation, 651 infants (338 girls (51.9%) and 313 boys (48.1%)) with a mean age of 2.18±0.84 months were studied. This population included of infants presenting to four different Health and Medical centers in Kerman for routine vaccination. They were exclusively fed with either breast milk or Nan, Nini, My boy. There was significant difference between the breast-fed and formula-fed infants (P<0.05). Infants fed Nan formula had more defecation per day than infants fed Nini formula, and this difference was statistically significant (P<0.05). The frequency of colic attacks per day was significantly higher in infants fed Nini formula than those fed Biomil formula or breast milk (P<0.05). The number of defecations or colic attacks per day was not statistically correlated with the sex of infants. There were more loose stools among breast-fed infants, and the frequency of firm stools was significantly higher in infants fed Nini formula than infants fed with other formulas or breast milk (P<0.05). The color of stool was similar in all studied groups. We concluded that minute differences in the composition of different formulas can cause various gastrointestinal symptoms, which may alleviate with replacing that formula with another one. Keywords: Breast feeding, Formula, Infant, Stoo

Effects of Yakson Therapeutic Touch on the Behavioral Response of ‎Premature Infants

BACKGROUND AND OBJECTIVE: Due to incomplete physical development, premature infants are susceptible to various sources of stress. Therapeutic touch is considered as an effective method to reduce stress in neonates. This study aimed to compare the effects of Yakson therapeutic touch and routine nursing care on the behavioral response of premature infants. METHODS: This quasi-experimental study was conducted on 60 premature infants aged 26-34 weeks, admitted at the neonatal intensive care unit (NICU) of Afzalipour Hospital of Kerman, Iran. Subjects were randomly selected by minimization and equally divided into two groups of intervention and control (N=30). Infants in the intervention group received Yakson massage therapy for 5 days, twice daily for 15 minutes, and infants in the control group received routine care. Behavioral responses of infants, including the status of sleep, waking and restlessness, were evaluated using Anderson Behavioral State Scale (ABSS) before and after intervention. FINDINGS: In this study, mean scores of ABSS in preterm infants of the intervention and control groups was 4.83±0.14 and 10.63±0.14, respectively. Moreover, there was a significant difference between the scores of behavioral response after the intervention between the groups (p=0.001). CONCLUSION: According to the results of this study, increased scores of sleep status in the infants of the Yakson therapy group indicated that this method could be effective in the provision of nursing care for premature infants admitted at the NICU