Comparison of the Effect of Plastic Cover and Blanket on Body Temperature of Preterm Infants Hospitalized in NICU: Randomized Clinical Trial

Introduction: Preterm infants are unable to regulate their body temperature and there are insufficient research evidences on different kinds of covers for hospitalized preterm infants; therefore, the present study was conducted with the aim of comparing the effects of plastic and blanket covers on the body temperature of preterm infants under radiant warmer. Methods: This randomized cross-over clinical trial was carried out upon 80 infants with the gestational age of 28-30 weeks and birth weight of 800- 1250 gr who were in Neonatal Intensive Care Unit on the second day of their hospitalization. The study lasted for two days. In group 1, the plastic cover was used during the first day of the study while the blankets were used during the second day. Infants’ heads were kept out of the cover and coated with a hat. In group 2, the plastic cover was used during the first day of the study while the blanket was used during second day. Digital thermometer was used to measure infants’ axillary temperature. The data was analyzed using SPSS ver 13 and MiniTab software. Descriptive statistics, (Mean (SE), 95%CI) and inferential statistics (Repeated measurement and ANCOVA tests) were used. Results: The mean body temperature of the infants in the group covered with the plastic was calculated to be higher and the warmer was set on low temperature. Conclusion: Using plastic cover during the first few days of hospitalization in NICU resulted in regulation of preterm infants’ body temperature

Impact of Empirical Antibiotic Treatment Duration on Short-term Prognosis of Very Low Birth Weight Newborns

Objective: Probable early infection is one of the most important reasons to begin antibiotics treatment for very low birth weight (VLBW) infants. In most of the cases, antibiotics treatment continues as long as the venous line persist. Long-term empirical antibiotics therapy for premature infants (5 days) create even more danger than the infection itself, such as necrotizing enterocolitis (NEC) and death. In order to reduce the risks of these dangers, antimicrobial therapy must stop in clinical conditions in which the possibility of infection is low. This study makes an effort to evaluate the impact of empirical antibiotic treatment duration on early prognosis of premature infants with VLBW. Materials and Methods: A total of 209 premature infants with birth weight less than 1500 g who were suspicious of having infection, were evaluated in 2 groups of control (107 infants) and intervention (102 infants). All of the infants evaluated for sepsis according to the protocol of the unit. In the control group, antibiotics treatment continued as long as the venous line persist, in the intervention group after day 3 to 5 if the results of blood culture were negative, the infants were checked for C-reactive protein (CRP), and if it was negative too and the patient’s clinical status was good, antibiotic treatment was stopped. The outcome measures were short-term prognosis of with VLBW newborns. Results: The mean gestational age of the studied patients was 30.21 ± 2.69 and 29.57 ± 2.09 g in the control and intervention groups, respectively (P = 0.07). The average days of receiving antibiotics in the control group were 29.21 ± 1.57 while in the intervention group it was 8.11 ± 2.16 (P 0.05). Conclusion: Early discontinuing of antibiotics (5 days or less) had no impact on the mortality rate of VLBW infants and seemed it was safe

Comparing the Efficacy of High and Low Doses of Vitamin A in Prevention of Bronchopulmonary Dysplasia

Background Bronchopulmonary dysplasia (BPD) is one of the most common serious squeal of preterm infants. It involves approximately one quarter of infants with birth weight less than 1500 grams and 30% of less than 1000 grams. Vitamin A has been shown to reduce BPD rate. We compared efficacy of low and high doses of vitamin A for prevention of BPD in very low birth weight preterm infants. Materials and Methods In a randomized clinical trial, 120 preterm infants with gestation age 32 weeks or less and birth weight less than 1,500 grams were enrolled in the study. Group A (n=60) received 1,500 IU vitamin A intramuscularly three times per week and group B (n=60) received 5,000 IU vitamin A intramuscularly 3 times/week. Vitamin A was continued for 4 weeks in all patients. Oxygen dependency at age 28 days after birth and at 36 weeks’ postmenstrual age was determined in all studied infants. Results The mean gestation age and birth weight in group A was 29.2 ± 2.1 weeks and 1095 ± 211 gr and in group B 28.7 ± 2.1week and 1147 ± 218 grams (P>0.05). Moderate to severe bronchopulmonary dysplasia was detected in 6 (10%) neonates in group A and 13(21.6%) infants in group B, P= 0.09. Mortality rate was 4 (6.6%) infants in group A and 3 (5%) patients in group B (P>0.05). Conclusion In our study, high and low doses of vitamin A were similar with respect to the BPD, intra-ventricular hemorrhage, and retinopathy of prematurity and total number of days for hospital stay in very low birth weight preterm infants

The Effect of Plastic Cover on Regulation of Vital Signs in Preterm Infants: A Randomized Cross-over Clinical Trial

Background: Considering the susceptibility of preterm infants to disturbances of vital signs, this study was conducted to investigate the effects of using plastic covers on regulation of vital signs in preterm neonates.Methods: This randomized, cross-over, clinical trial was carried out on 80 preterm infants admitted to neonatal intensive care unit (NICU) of Taleghani Hospital, Tabriz, Iran. The study was conducted in two days (on the second and third days of the infants’ life). In group 1, plastic cover was used during the first day followed by the use of blanket on the second day, while the order was reversed in group 2. Digital thermometer was used to measure the infants’ axillary temperature. Heart rate and oxygen saturation were measured through monitoring. To analyze the data, descriptive (Mean and SE, 95%CI) and inferential statistics (repeated measurement and ANCOVA tests) were used in SPSS version 13 and MiniTab software.Results: Fourteen infants who were covered with blanket were found to suffer from hypothermia, while no infant with a plastic cover encountered this problem. The percentage of arterial blood oxygen saturation in the group with plastic covers was higher, and as a result, the infants received less oxygen supplements. However, no statistically significant differences were observed in heart rate between the groups.Conclusion: Use of plastic cover during NICU stay prevented hypothermia in premature infants, with the arterial blood oxygen saturation being within the normal limits. Yet, it did not seem to have a significant effect on other vital signs

Relationship between Ureaplasma urealyticum Colonization and Bronchopulmonary Dysplasia in Very Low Birth Weight Premature Infants: A Prospective Cohort Study

Background: Bronchopulmonary dysplasia (BPD) is the second prevalent lung disease and one of the care challenges of premature newborns. Different risk factors play an important role in the development of this disease. Therefore, the aim of the present study was to investigate the relationship between colonization with Ureaplasma urealyticum and BPD.Methods: This prospective cohort study was conducted in 2017 in the neonatal intensive care unit of Alzahra Hospital in Tabriz, Iran. The samples included newborns weighing less than 1500 g with the gestational age of less than 32 weeks who required intubation within 72 h after birth. Following recording the initial information, the secretions within the trachea were aspirated and Ureaplasma urealyticum was detected in reference laboratory by polymerase chain reaction. Afterwards, we completed a follow-up of 28 days after birth for BPD.Results: Our findings demonstrated that out of 82 infants, 21 cases (26.3%) were excluded from the study due to discharge from hospital or death before the age of 28 days. Among the rest (61 newborns), three cases (4.3%) were shown to have secretions infected with Ureaplasma and 33 cases (54.1%) suffered from BPD. All the three newborns infected with Ureaplasma had BPD. However, no significant relationship was observed between Ureaplasma infection and BPD (P=0.24).According to the analysis of data, the most important factors contributing to BPD among the patients were the gestational age and birth weight. In other words, for one week increase in the age of pregnancy and for each 100 g increase in birth weight, the likelihood of BPD is reduced by 55% and 1%, respectively. In the present study, no relationship was found between Ureaplasma infection and BPD, which might be due to the low prevalence of this infection. Nonetheless, prematurity and low birth weight could be regarded as the two considerable risk factors for BPD.Conclusion: In order to perfectly determine the role of bacterial colonization within the trachea in BPD, collecting and analyzing various samples for the existence of other bacteria are recommended

Effects of Gentle Human Touch and Field Massage on Urine Cortisol Level in Premature Infants: A Randomized, Controlled Clinical Trial

Introduction: Hospitalization in neonatal intensive care unit may leads to many stresses for premature infants. Since premature infants cannot properly process stressors, identifying interventions that reduce the stress level for them is seems necessary. The aim of present study was to compare the effects of Field massage and Gentle Human Touch (GHT) techniques on the urine level of cortisol, as an indicator of stress in preterm infants. Methods: This randomized, controlled clinical trial was carried out in Al-Zahra hospital, Tabriz. A total of 84 premature infants were randomly assigned into three groups. First groups were touched by their mothers three times a day (15 minutes in each session) for 5 days by GHT technique. The second group was received 15 minutes Field massage with sunflower oil three times a day by their mothers for 5 days. The third group received routine care. In all groups, 24-hours urine samples were collected in the first and sixth day after the intervention and analyzed for cortisol level. Data were analyzed by SPSS software. Results: There were significant differences between mean of changes in cortisol level between GHT and control groups and Field massage and control groups (0.026). Conclusion: Although the massage with Field technique resulted in a significant reduction in blood cortisol level, but the GHT technique have also a similar effect. So, both methods are recommended for decreasing of stress in preterm infants

Nurses’ Knowledge Regarding Hand Hygiene and Its Individual and Organizational Predictors

Introduction: Based on recommendations from World Health Organization, hand hygiene is the most important way to control the hospital infections. Due to the critical role of nurses in patient care, they should have essential and updated information regarding hand hygiene. So this study aims at determining the knowledge of hand hygiene and its individual and organizational predictors among nurses in neonatal units. Methods: This descriptive and cross-sectional study was conducted in neonatal units in the hospitals affiliated to Tabriz University of Medical Sciences. The participants surveyed in this study were 150 nurses who were invited by census sampling method. A researcher prepared questionnaire that investigated the knowledge of participants about hand hygiene and was used after approving its validity and reliability. The quantitative analysis of this study used Statistical Package for Social Sciences SPSS version 13 by descriptive statistics and pearson correlation test, independent samples t-test, One-way ANOVA. For multivariable explanation of nurses’ knowledge based on independent variables multiple linear regressions was used. Results: Most of participants have an acceptable level of knowledge regarding hand hygiene. The highest score was for infection control domain and the lowest score was for definition of hand hygiene domain. Multivariable analysis showed that work experience and history of previous training were the most important predictors of participants’ knowledge about hand hygiene. Conclusion: It is recommended that infection control committees should revise their educational methods and give more emphasis on update guidelines regarding hand hygiene. Also, more experienced nurses should be employed in neonatal units

The Efficacy of a Protocolized Nursing Care on Nasal Skin Breakdown in Preterm Neonates Receiving Nasal Continuous Positive Airway Pressure

Background: Nasal continuous positive airway pressure (NCPAP) is an effective method of ventilation in newborns with respiratory distress syndrome (RDS). Using an appropriate nasal skin care protocol is identical to prevention or reduction of nasal skin breakdown in those who receive NCPAP. This study aimed to investigate the effectiveness of an evidence-based clinical care protocol on nasal skin integrity in preterm newborns who receive NCPAP.Materials and Methods: A Randomized Controlled Trial was used to conduct the study. A cohort of 110 preterm newborns with a gestational age (GA) of 25 to 36 weeks, receiving nasal continuous positive airway pressure (NCPAP) for RDS in the neonatal intensive care unit of a university teaching hospital were selected to perform the study. They were randomly assigned to a protocolized nasal skin care (group A) or to a group receiving the routine care (group B). Nasal skin integrity of the preterm neonates, were measured on a daily basis for 10 days using the Neonatal Skin Condition Scale (NSCS) 24 hours after placement of NCPAPs in both groups.Results: Each intervention and control group included 55 neonates. 65.50% of neonates in the control group and 47.30% of neonates in the intervention group were male. Repeated measures analysis showed thatNSCS scores were significantly lower in intervention group receiving nasal skin care in accordance with the protocol than the control group receiving the routine nasal skin care (P=0.000). Conclusion: In this study, the protocolized care reduced nasal skin breakdown in the preterm newborns receiving NCPAP. Therefore, it can be used as an effective method in nasal skin care in neonates who are treated by NCPAP