A Study on the Risk Factors for Obstetrical Brachial Plexus Palsy

ObjectiveConsiderable medical and legal debates have surrounded the prognosis and outcome of obstetrical brachial plexus injuries and obstetricians are oftenconsidered responsible for the injury. In this study, we assessed the factors related to the outcome of brachial plexus palsy.Material & MethodsDuring 24 months, 21 neonates with obstetrical brachial plexus injuries were enrolled.Electrophysiology studies were done at the age of three weeks. They received physiotherapy and occupational therapy. They were examined every 3 monthsfor one year and limbs function was assessed according to Mallet scores; also, maternal and neonatal factors were collected by a questionnaire.Results There were 10 boys and 11 girls.Of all, 76.2% had Erb's palsy, 19% had total brachial palsy and 4.8% hadklumpke paralysis.Risk factors including primiparity, high birth weight, shoulder dystocia, andprolonged second stage of labor were assessed.Electrophysiology studies showed neuropraxia in 52.4% and axonal injuries in42.9% of the patients.At the end of the first year, 81% of the patients had functioned recovery aroundgrade III or IV of Mallet scores.There were only significant relationships between functional improvement andneurophysiologic findings.ConclusionOutcome of obstetrical brachial injuries has a close relationship toneurophysiologic study results than other risk factors

Evaluation of urinary tract infections following

زمینه و هدف: عفونت ادراری یک مشکل شایع و جدی در نوزادان است. مطالعات نشان داده اند که زردی می تواند یک علامت زودرس عفونت ادراری باشد. هدف از این مطالعه بررسی شیوع عفونت ادراری در نوزادان مبتلا به زردی، سن بروز، شدت زردی، علایم و عوارض هیپربیلی روبینمی غیر مستقیم ناشی از عفونت ادراری در این نوزادان می باشد. روش بررسی: در این مطالعه توصیفی- تحلیلی در سالهای 1382 الی 1388، کلیه نوزادان مراجعه کننده به بیمارستان قائم مشهد بعلت زردی بدون علامت از نظر عفونت ادراری بررسی شدند. از نوزادان مورد مطالعه آزمایش بیلی روبین مستقیم و غیر مستقیم، کامل ادرار و کشت ادرار و سایر آزمایشات لازم انجام گردید. در اغلب نوزادان با عفونت ادراری سونوگرافی کلیه ها انجام گردید. اطلاعات مربوط به حاملگی، زایمان و حوادث پس از تولد ثبت شد. داده ها با استفاده از تست دقیق فیشر، کای دو و t دانشجویی مورد تجزیه و تحلیل قرار گرفت. یافته ها: از 1487 نوزاد دچار زردی ، 1061 نوزاد از نظر عفونت ادراری بررسی گردیدند که 74 مورد (97/6) عفونت گزارش گردید. سن بروز زردی، سن مراجعه و سن بهبودی نوزادان دچار عفونت ادراری بطور قابل ملاحظه ای دیرتر از نوزادان فاقد عفونت بود (05/0

Evaluation of acute renal failure in neonates bedridden in Neonatal Intensive Care Unite (NICU) in Ghaem hospital

چکیده: زمینه و هدف: نارسایی حاد کلیه بصورت یک کاهش ناگهانی شدید در GFR (Glomerular Filtration Rate) تعریف شده است و در بخش نوزادان شایع می باشد. این مطالعه با هدف بررسی انسیدانس، اتیولوژی، شیوه افتراق انواع نارسایی کلیه در نوزادان انجام شد. روش بررسی: در یک مطالعه توصیفی، 750 نوزاد بستری شده در بخش مراقبت های ویژه نوزادان بیمارستان قائم(عج) مشهد، از دی ماه 1384 تا دی ماه 1385، با تشخیص نارسایی کلیوی و بر اساس سونوگرافی و پاسخ به مایع درمانی به دو گروه رنال و پره نال تقسیم بندی شدند. این نوزادان از نظر ریسک فاکتورهای پره ناتال، پری ناتال، پست ناتال ریسک فاکتورهای مادری و محیطی و اندکس های مختلف سرمی و ادراری بررسی و داده ها به کمک آمار توصیفی تحلیل شدند. یافته ها: از 750 بیمار پذیرش شده 38 نوزاد (5) تشخیص نارسایی کلیوی داشتند، که 29 نفر (4/76) نارسایی پره رنال و 9 نفر (6/23) نارسایی رنال داشتند. فاکتورهای مستعد کننده همراه با نارسایی کلیوی شامل آسفیکسی (42)، سندرم غشا هیالن مامبران ((RDS (7/26)، سپسیس (13)، دهیدراتاسیون شدید (13) و بیماری مادرزادی قلبی (2/5) بودند. نتیجه گیری: نارسایی حاد کلیه یک علت مهم مرگ در نوزادان می باشد. شناسایی فاکتورهای مستعد کننده مثل نارس بودن، آسفیکسی، RDS، ونتیلاسیون و کنترل دقیق وضعیت کلیه های نوزادان در این شرایط ضروری است. پیش آگهی نوع پره رنال در صورت مایع درمانی مناسب، خوب بوده ولی در نوع رنال پیش آگهی وابسته به بیمار زمینه‌ای می باشد و مرگ و میر بالاست

Effects of Yakson Therapeutic Touch and Heel Warming on Pain Caused by Heel Stick Procedure, Vital Signs, and Cry Duration in Full-term Neonates

Background: Neonates are more sensitive to pain and likely to suffer from its long-term complications. Therefore, various methods including non-nutritive sucking, sensory stimulations, and various supportive interventions are employed to relieve pain in newborns. Aim: This study aimed to compare the effects of Yakson therapeutic touch and heel warming on pain caused by heel stick procedure, vital signs, and cry duration in full-term neonates. Method: This randomized clinical trial was conducted among 78 full-term newborns referred to healthcare centers in Mashhad, Iran, 2017. They were assigned into three groups of Yakson theraputic touch, heel warming using a hot-water bottle with the temperature of 40°C, and control receiving routine care, through randomized block method. Then, vital signs before and after and pain intensity after heel-stick procedure were measured using Neonatal Infant Pain Scale (NIPS). Data analysis was performed using Kruskal-Wallis and Wilcoxon tests in SPSS software, version 16. Results: The study groups were homogeneous considering demographic characteristics. The results of Kruskal-Wallis test showed a significant difference between the groups regarding the mean scores of the NIPS at the post-intervention phase (P=0.02). However, no significant difference was observed between pre- and post-intervention phases in the groups considering respiratory and heart rates. Additionally, cry duration significantly reduced in the group that received Yakson therapeutic touch (P=0.03). Implications for Practice: The use of Yakson therapeutic touch could relieve pain, soothe the neonates, and shorten cry duration in newborns after heel stick procedure. Nevertheless, heel warming only increased up blood flow for easier blood sampling

The Effects of Field Massage Technique on Bilirubin Level and the Number of Defecations in Preterm Infants

Background: Hyperbilirubinemia is a common physiological problem in approximately 80% of preterm infants during the first week after birth. Increase in bowel movements reduces enterohepatic circulation and increases bilirubin excretion. Aim: This study aimed to evaluate the effects of Field massage technique on bilirubin level and the number of defecations in preterm infants Method: This clinical trial was performed on 80 preterm infants aged 30-36 weeks, who were hospitalized in neonatal intensive care units of Qaem, Imam Reza, and Ommolbanin hospitals of Mashhad, Iran, in 2011. The enrolled infants were randomized into intervention and control groups. The control group received the routine care, and the intervention group received a 15-minute massage twice a day (morning and evening), for five consecutive days. Field massage technique was applied by the researcher. The number of defecations and cutaneous bilirubin level were recorded on a daily basis until the sixth day after birth. Independent t-test and Mann-Whitney U test were performed to analyze the data, using SPSS version 14. Results: The mean age of the intervention and control groups was 17.2±4.5 and 17.1±4.5 hours, respectively. The mean level of cutaneous bilirubin in the intervention and control groups on the first and sixth days were not significantly different (10.7±1.5, 10.8±1.4, 13.4±2.0, and 13.4±2.6, respectively; the first day: P=0.67, the sixth day: P=0.98). The number of defecations on the fourth (P=0.01), fifth (

The Acute Temporary Peritoneal Dialysis in Neonates: A Five-Year Experience

Background: The aim of this prospective study was to evaluate the characteristics of patients, treated by acute peritoneal dialysis (PD). We also assessed the indications for PD, PD-associated complications and neonatal outcomes in our patients. Methods: During five years, 30 term newborns underwent temporary cycling PD. The procedure was performed by applying the manual technique. A straight and relatively rigid peritocat catheter (Germany) was percutaneously inserted in neonates. Statistical analysis was performed, using Chi-square and student's t-test. Results: All subjects were term newborns, including 16 females (52%) and 14 males (48%). In total, 16 cases (52%) were born via cesarean section. The average age and weight of neonates at catheter insertion were 15 days (range of 5-26 days) and 2800 g (range of 2300-4060 g), respectively. The mean PD duration was two days. There was no significant difference between gender, weight, mode of delivery and associated complications. In total, 74% of patients needed assisted ventilation. No case of death was reported due to catheter insertion; however, 12 patients (40%) died during PD. PD-related complications were reported in 70% of patients, and the most common complication was catheter outflow failure (14 cases, 46%). The underlying causes included inborn errors of metabolism (16 cases, 52%) and acute renal failure (14 cases, 48%). Urea cycle enzyme defect, along with hyperammonemia, was the most common etiologic disease (9 cases). Conclusion: PD is an effective treatment for seriously ill newborns with life-threatening conditions such as acute renal failure or certain inborn errors of metabolism. However, mortality rate remains high due to the severity of underlying diseases and comorbidities

Evaluation of the Effect of Nest Posture on the Sleep-wake State of Premature Infants

Background: Premature birth is a major cause of infant mortality in developed countries. Newborns confined to neonatal intensive care units (NICUs) are in a rapid stage of brain development. As such, sleep plays a pivotal role in the proper brain development of newborns. However, this developmental aspect is often disregarded due to the lack of information. Aim: This study aimed to evaluate the effect of nest posture on the sleep-wake state of premature infants. Method: This cross-over clinical trial was conducted on 60 premature infants admitted in the NICU of Ghaem Hospital in Mashhad, Iran in 2015. Infants were divided into two groups of experimental and control. Data were collected using the Assessment of Premature Infants' Behavior (APIB). Neonates in the control group were placed in an incubator, and neonates in the experimental group were positioned in a nest. Between-group comparison was performed using paired-samples T-test for normal variables and Wilcoxon test for non-normal variables. Results: In this study, no statistically significant differences were observed between the two groups in terms of the scores of deep sleep state before (P=0.50) and after the intervention (P=0.59). However, during the intervention, mean score of deep sleep was higher in the experimental group (P=0.08). Moreover, mean score of slow wake state had no significant difference between the study groups before (P=0.67), after (P=0.86), and during the intervention (P=0.81). Implications for Practice: According to the results of this study, nest posture increased the deep sleep hours of premature infants as the most imperative state of brain development. Therefore, it is recommended that nest posture be used to improve the deep sleep state of premature infants

The Impact of Oral Glutamine Supplementation on Prevention of Nosocomial Infections in Preterm Infants

Background: In the recent decades, the prevalence of nosocomial infections in neonates has grown and almost 21% of preterm neonates experience these kinds of infections. Some factors were proposed to have a protective effect against neonatal infections through promoting the development of the immune system of the newborn. This study aimed to evaluate the efficacy of oral glutamine supplementation in management of neonatal sepsis. Methods: Neonates were randomly allocated to case and control groups. The infants in the case group received 0.3 g/kg/day glutamine, every eight hours from three days of age to 28 days. Hospital stay duration and occurrence of necrotizing enterocolitis (NEC) as well as sepsis were recorded for each patient. Data were analyzed using SPSS version 16. Results: In general, 105 neonates were enrolled in the study, 52 of who were allocated to the glutamine group and 53 neonates assigned to the control group. The results showed that 52 (49.5%) cases were male and 53 (50.6%) were female with mean gestational age of 30±2 weeks. Life threatening infections occurred more commonly in the control group (P=0.036). Six neonates (11.5 %) in the glutamine group and eight (15.1 %) in the control group developed clinical sepsis (P=0.592). NEC occurred only in the control group (P=0.118). Mean durations of hospital stay in the glutamine and placebo groups were 20±12 days and 26±18 days (P=0.065), respectively. Mean durations of oxygen therapy were 6±5 days and 16±11 days for the glutamine and control groups, respectively (P=0.039). Conclusion: Oral glutamine administration reduced life threatening infections and duration of receiving supplemental oxygen

Thrombocytopenia during the First Week of Life among Neonates with Down Syndrome: Data from Multihospital Healthcare Systems

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.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).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

Comparing the Effect of Peer Support and Training by Healthcare Providers on Women’s Breastfeeding Self-Efficacy

Background & aim: Breastfeeding self-efficacy is an important factor affecting the success and duration of breastfeeding. Self-efficacy of people is influenced by four sources including performance accomplishments, vicarious experiences, verbal persuasion and the physiological responses which seem to be modified by breastfeeding intervention.  This study was conducted to compare the effect of providing peer support versus training women by health care providers on breastfeeding self-efficacy. Methods:This controlled clinical trial was conducted on 93 primiparous women in Mashhad health-care centres. Three centres were selected as clusters and subjects who attended each cluster were randomly allocated to three groups of peer support, training by health care providers and control. The peer support group received support from their peers four times. Subjects who were trained by health care providers participated in four training sessions by health care providers and the control group only received the routine care. At the end of the eighth postpartum week, data were collected using the breastfeeding self-efficacy scale. The data were analysed using ANOVA and paired t-test with SPSS, version 14. Results: The mean score of self-efficacy at the end of the eighth postpartum week, in the peer support, training by healthcare providers and control groups, were 54.4±9.75, 50.8±13.05 and 56.4±9.49, respectively. The three groups showed no significant differences in terms of breastfeeding self-efficacy score at the end of the eighth postpartum week (­P-value=0.125). Breastfeeding self-efficacy score at baseline and at the end of the eighth postpartum week were significantly different in peer support and training by health care providers groups (P=0.05). Conclusion: Peer support and training by healthcare providers have similar impact on breastfeeding self-efficacy in primiparous women. So they could be used interchangeably to promote breastfeeding behavior