Investigation of the effect of early and late breast milk enrichment on growth parameters in preterm infants: A randomized clinical trial

Background and aims: This study aimed to investigate and compare the effect of early and late breast milk fortification on growth parameters in preterm infants. Methods: In this clinical trial, 90 preterm infants (28-32 weeks) admitted to the neonatal intensive care unit (NICU) of Hajar Hospital in Shahrekord, Iran were randomly divided into three groups. The fortification was performed when the milk intake reached 30 (group A), 70 (group B), and 100 cc/kg (group C). The height, weight, and head circumference of newborns were measured at the beginning of birth and 4 weeks after the birth. The incidence of sepsis and necrotizing enterocolitis, and milk tolerance were investigated as well. All analyses were conducted with Stata software, and P valuesResults: The value changes in the height, weight, and head circumference in all three groups at 4 weeks were significant (PPPPP=0.264). Conclusion: The breast milk fortification when the milk intake reached 70 cc/kg had better efficiency on neonatal weight gain compared with the early and delayed fortification

Breastfeeding versus Formula Feeding: Main Reasons and Determinants

Background: It is critical to identify the factors that influence mothers' decision to discontinue breastfeeding and use formula. The purpose of this study is to compare the characteristics of breast-fed and formula-fed subgroups in order to identify the factors influencing the discontinuation of exclusive breastfeeding in a group of Iranian infants. Methods: The data of the two groups of women who fed their infants with breast milk (n = 275) or formula (n = 275) were gathered by the use of a questionnaire including questions regarding maternal demographics, breastfeeding-related problems, infant disorders, and factors that influence formula preference. Face-to-face interviews with the mothers of the children were used to obtain the questionnaire data by a trained interviewer. In SPSS version 22, descriptive and inferential statistics were used to analyze the data. Results: Lack of weight gain (32.8 %), inadequate breast milk (51.3 %), return to work (9.1%), teething (0.7%), mothers' disorders (3.6 %), and infants' disorders (2.5 %) were the most common reasons for starting formula feeding. Physicians (34.5 % versus 21.5 %), health providers (26.5 % versus 30.5 %), health assistants (26.9% versus 26.7 %), and books (12.0 % versus 16.7%) are the main sources of information about the types of infantile feeding in the groups of mothers who use formula or breast-feeding, indicating a significant difference between the sources used by the two groups (p = 0.001). Conclusion: Formula use is primarily motivated by two factors: apprehension over the insufficiency of breastfeeding and a lack of time to do so. As a result, comprehensive education for mothers about the necessary cases of formula feeding is critica

The effect of supportive care program based on Bandura self-efficacy on stress-exacerbating and stress-relieving factors of neonatal mothers admitted to neonatal intensive care unit

Objectives: The birth of a premature baby can change all the emotions of parents and replace stress. It is necessary to identify the factors that aggravate and relieve maternal stress and adopt strategies to reduce it. The aim of this study was to analyze the effect of supportive care program based on Bandura’s self-efficacy on aggravating and stress relieving factors of mothers of neonates admitted to the neonatal intensive care unit Methods: A quasi -experimental study was performed in 2020 on 90 mothers of premature infants admitted to the neonatal intensive care unit of a Hospital in Shahrekord by convenience sampling method. The experimental group has received an educational intervention based on the theory of self-efficacy in four two -hour sessions with the presentation of an educational booklet. Data were collected using a self-designed questionnaire before and after the intervention in both groups and were analyzed using SPSS software version 24 performing paired t -test, independent t -test, and Chi -square. Results: The results showed that the mean score of stressors in mothers of preterm infants in the control group decreased from 42.73 ± 6.26 to 42.62 ± 7.09, which was not statistically significant (P= 0.906) while in the experimental group it was decreased from 48.78 ± 4.36 to 25.33 ± 4.84, which was statistically significant (P <0.001). The mean score of soothing agents for mothers of preterm infants increased from 2.98 ± 2.61 to 3.07 ± 2.29 in the control group which was not statistically significant (P = 0.415) and in the experimental group it was increased from 4.51±1.72 to 7.29 ± 1.16, which was statistically significant (P <0.001). Conclusion: Based on the findings of the study, it is recommended to implement interventions to make parents of premature infants, especially mothers ready to face the baby in the intensive care unit. Key words: Stress, mother, newborn intensive care units, care progra

The effect of supportive care program based on Bandura self-efficacy on stress-exacerbating and stress-relieving factors of neonatal mothers admitted to neonatal intensive care unit

Objectives: The birth of a premature baby can change all the emotions of parents and replace stress. It is necessary to identify the factors that aggravate and relieve maternal stress and adopt strategies to reduce it. The aim of this study was to analyze the effect of supportive care program based on Bandura’s self-efficacy on aggravating and stress relieving factors of mothers of neonates admitted to the neonatal intensive care unit Methods: A quasi -experimental study was performed in 2020 on 90 mothers of premature infants admitted to the neonatal intensive care unit of a Hospital in Shahrekord by convenience sampling method. The experimental group has received an educational intervention based on the theory of self-efficacy in four two -hour sessions with the presentation of an educational booklet. Data were collected using a self-designed questionnaire before and after the intervention in both groups and were analyzed using SPSS software version 24 performing paired t -test, independent t -test, and Chi -square. Results: The results showed that the mean score of stressors in mothers of preterm infants in the control group decreased from 42.73 ± 6.26 to 42.62 ± 7.09, which was not statistically significant (P= 0.906) while in the experimental group it was decreased from 48.78 ± 4.36 to 25.33 ± 4.84, which was statistically significant (P <0.001). The mean score of soothing agents for mothers of preterm infants increased from 2.98 ± 2.61 to 3.07 ± 2.29 in the control group which was not statistically significant (P = 0.415) and in the experimental group it was increased from 4.51±1.72 to 7.29 ± 1.16, which was statistically significant (P <0.001). Conclusion: Based on the findings of the study, it is recommended to implement interventions to make parents of premature infants, especially mothers ready to face the baby in the intensive care unit. Key words: Stress, mother, newborn intensive care units, care progra

Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial

Background: Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns. Methods: This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO(2) and 5 cm H2O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay. Results: According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (P<0.001). Numbers of NCPAP weaning attempts, the need for mechanical ventilation, duration of oxygenation, and hospital stay in the two groups were not significantly different. Conclusion: There was no difference between sudden complete and gradual weaning from NCPAP in terms of treatment success and complications. The selection of the appropriate technique may depend on available equipment and treatment costs

Phytotherapy with silymarin: A clinical trial on infants with jaundice

Objective: In this study, we aim to investigate the effects of silymarin in terms of reducing bilirubinemia in infants with hypercholesterolemia and under phototherapy. Materials and Methods: In this study, 180 infants were randomly assigned to three groups. The intervention was performed with silymarin in the case group. The case, positive, and negative control groups underwent phytotherapy, while the negative control group did not have any treatment; meanwhile, the case group was orally administered with 4 mg/kg silymarin once every 12 h as well. The tests consisted of alanine aminotransferase (SGPT), alanine transaminase (SGOT), albumin levels at baseline and completion of the intervention, and TSB at baseline and then after 24-h intervals up to the infants' discharge. Results: As per our findings, a significant difference was noted in terms of the duration of hospital stay between the case and control groups (p0.05), a significant difference was observed between the case group and the positive control with the negative control group. Conclusion: Administering silymarin on infants with hypercholesterolemia (bilirubin factor) and under phytotherapy can be effective alongside the main therapies, as a significant difference was observed between the case and positive control groups in terms of length of hospital stay (but not with the control group), which indicates the effect of silymarin on hyperbilirubinuria. Keywords: Silymarinphototherapyicterusinfantsjaundic

Survey of effect of protein supplementation on body growth indices and immune system development in premature neonates with very low birth weight

Objective: Complications in very low birth weight (VLBW) infants include an increase in mortality, sepsis, failure to thrive, and immune system development disorder. However, breast milk is the preferred choice for premature infants. However, no useful nutrition support exists for well-being growth in preterm infants, especially in protein quantity. Thus, this study aims to add protein supplements to breast milk for increased growth criteria and the development of the immune system. Materials and Methods: This double-blind clinical trial included 30 VLBW infants whose weight was <1,500 g and with gestational age <32 weeks. The infants were divided into three equal groups (n=10). Groups A and B received 4.8 and 3.5 gm/ kg/day, respectively. However, group C was without supplement. Growth criteria (e.g., daily weight and head circumference) and weekly length were measured in all groups. Moreover, the blood sample was given pre (day 1) and post (day 21) study to analyze white blood cells, neutrophils, lymphocyte, immunoglobulin G, immunoglobulin M, and immunoglobulin A (IgA). Results: Based on the results of the current study, a dose of 4.8 g/kg/day of protein supplement caused a significant increase in weight and head circumference but did not affect length development. Furthermore, receiving high-dose protein supplements caused an increase in neutrophil and lymphocyte count and serum IgA concentration. Conclusion: Receiving high-dose protein supplement caused the development of growth criteria and the development and evolution of immune system criteria especially the innate immune system that caused decrease infectious diseases such as sepsis

The Effects of Zinc Sulfate on Sepsis Outcomes in Neonates: A Blind Clinical Trial

Background: The present study aimed at assessing the effects of zinc sulfate supplementation on sepsis outcomes in neonates. Methods: This randomized double-blind clinical trial was performed on neonates suffering neonatal sepsis. They were hospitalized in NICU ward at Hajar hospital in Shahrekord, Iran, in 2018. The patients were randomly assigned into two groups receiving a combined therapy of oral zinc sulfate (3mg/kg/day) and antibiotic for ten days (the intervention group, n=30) or routine anti-sepsis antibiotic therapy for the same time (the control group, n=30). The intervention and control groups were matched for baseline variables including gestational age, patients' age, time for beginning the first feeding and baseline anthropometric parameters. Height, weight, head circumference, feeding tolerance time, number of days of oxygenation, number of days hospitalized, NEC, duration of TPN reception, and time at feeding completion in the two groups were compared. Results: In total, 37 males and 23 females participated in this study, 21.7% of whom were born by natural vaginal delivery and others by cesarean section. There was a significant difference between the intervention and control groups in terms of neonates' weight and height, the rate of receiving TPN, Apgar score and nutrition tolerance. The use of zinc sulfate resulted in a significant increase in body weight and height, requiring less TPN use, and also shorter time to achieve nutritional tolerance (P<0.05). Conclusion: The use of oral zinc sulfate (3 mg/kg/day divided for 10 days) in neonates suffering from sepsis improves sepsis-related clinical outcomes, leading to improvements in linear growth and nutrition tolerance, along with shortening the time for TPN

Breastfeeding versus Formula Feeding: Main Reasons and Determinants

Background: It is critical to identify the factors that influence mothers' decision to discontinue breastfeeding and use formula. The purpose of this study is to compare the characteristics of breastfed and formula-fed subgroups in order to identify the factors influencing the discontinuation of exclusive breastfeeding in a group of Iranian infants. Methods: The data of the two groups of women who fed their infants with breast milk (n = 275) or formula (n = 275) were gathered by the use of a questionnaire including questions regarding maternal demographics, breastfeeding-related problems, infant disorders, and factors that influence formula preference. Face-to-face interviews with the mothers of the children were used to obtain the questionnaire data by a trained interviewer. In SPSS version 22, descriptive and inferential statistics were used to analyze the data. Results: Lack of weight gain (32.8 %), inadequate breast milk (51.3 %), return to work (9.1%), teething (0.7%), mothers' disorders (3.6 %), and infants' disorders (2.5 %) were the most common reasons for starting formula feeding. Physicians (34.5 % versus 21.5 %), health providers (26.5 % versus 30.5 %), health assistants (26.9% versus 26.7 %), and books (12.0 % versus 16.7%) are the main sources of information about the types of infantile feeding in the groups of mothers who use formula or breast-feeding, indicating a significant difference between the sources used by the two groups (p = 0.001). Conclusion: Formula use is primarily motivated by two factors: apprehension over the insufficiency of breastfeeding and a lack of time to do so. As a result, comprehensive education for mothers about the necessary cases of formula feeding is critical

Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial

Background: Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns. Methods: This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay. Results: According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (