Search

Background: Fetal and neonatal health is of particular importance in pregnant women. Secondhand smoke (SHS) can jeopardize the health of the mother, fetus, and neonate. The present study was conducted to determine the relationship between exposure to secondhand smoke during pregnancy and neonatal-related outcomes.Methods: This retrospective cohort study was conducted in 2022 on 270 mother-newborn pairs through convenience sampling in two equal groups (n=135), including exposure and non-exposure to SHS at Rohani Hospital, Babol, Children's Hospital, Amirkola, and Imam Ali Hospital, Amol. In order to collect the data, a checklist including the demographic characteristics, medical variables, questions related to the exposure of mothers to cigarette smoke, the neonatal outcomes questionnaire, and the SNAPPE-II scale were used. Data analysis was performed using STATA statistical software (version 17), and the significance level of all tests was considered less than 0.05.Results: The mean age of mothers was 28.30±5.83 years, and 61% of births were by cesarean section. The SNAPPE-II score was 8.23​±5.29 in the non-exposure group and 20.68±13.53 in the exposure group (P=0.005). The prevalence of neonates with a birth weight of less than 2500gr was higher in mothers exposed to SHS (P=0.033). Considering confounding variables, the neonates in the non-exposure group were, on average, 1.46 cm taller than those in the exposure group (P=0.005). Exposure to smoking increases the risk of premature birth by 1.65 times (P=0.032). Conclusion: Exposure of pregnant mothers to SHS is associated with adverse neonatal outcomes. Therefore, it is recommended to train families to avoid exposure to cigarette smoke, especially during pregnancy, and also for health centers to pay special attention to this matter in the care of pregnant mothers.

Background: Fetal and neonatal health is of particular importance in pregnant women. Secondhand smoke (SHS) can jeopardize the health of the mother, fetus, and neonate. The present study was conducted to determine the relationship between exposure to secondhand smoke during pregnancy and neonatal-related outcomes. Methods: This retrospective cohort study was conducted in 2022 on 270 mother-newborn pairs through convenience sampling in two equal groups (n=135), including exposure and non-exposure to SHS at Rohani Hospital, Babol, Children's Hospital, Amirkola, and Imam Ali Hospital, Amol. In order to collect the data, a checklist including the demographic characteristics, medical variables, questions related to the exposure of mothers to cigarette smoke, the neonatal outcomes questionnaire, and the SNAPPE-II scale were used. Data analysis was performed using STATA statistical software (version 17), and the significance level of all tests was considered less than 0.05. Results: The mean age of mothers was 28.30±5.83 years, and 61% of births were by cesarean section. The SNAPPE-II score was 8.23±5.29 in the non-exposure group and 20.68±13.53 in the exposure group (P=0.005). The prevalence of neonates with a birth weight of less than 2500gr was higher in mothers exposed to SHS (P=0.033). Considering confounding variables, the neonates in the non-exposure group were, on average, 1.46 cm taller than those in the exposure group (P=0.005). Exposure to smoking increases the risk of premature birth by 1.65 times (P=0.032). Conclusion: Exposure of pregnant mothers to SHS is associated with adverse neonatal outcomes. Therefore, it is recommended to train families to avoid exposure to cigarette smoke, especially during pregnancy, and also for health centers to pay special attention to this matter in the care of pregnant mothers. [ABSTRACT FROM AUTHOR]

Background: Respiratory disorders are recognized as a leading cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is used by pediatricians both for diagnostic and therapeutic indications in children. Nonetheless, there is a paucity of data regarding the diagnostic utility and safety of FOB in neonates, and it has remained relatively under-used in the care of neonates. The present study provided a practical overview of the wide diagnostic aspects of the FOB in newborns hospitalized in the Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to the quick management of neonates with respiratory disorders. Methods: This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over 5 years within 2013-2018. All subjects underwent FOB and bronchoalveolar Lavage (BAL) using a bronchoscope of 2.8 (EVIS EXERA III Olympus bronchoscope). Results: The greatest indications for performing FOB entailed hypersecretion in 138 (92%) cases, prolonged mechanical ventilation in 108 (72%) neonates, and persistent radiological finding in 97 (64.6%) subjects. Bronchoscopy detected various airways anomalies, such as Laryngomalacia (72%), Tracheobronchomalacia (64%), subglottic stenosis (26%), vocal cord paresis (18%), tracheoesophageal fistula (6.7%), laryngeal cleft (6%), and laryngeal web (4%). BAL results demonstrated that the cultures were positive in 20 (13.33%) neonates. Acinetobacter was the most commonly reported bacterial infection observed in 8% of neonates. Conclusion: As evidenced by the obtained results, when performed by an experienced and well-trained person and in an environment with appropriate facilities, FOB can be a safe and efficient tool for the early diagnosis of numerous airway disorders among neonates admitted to NICUs.

Background: Risk scoring systems evaluate neonatal outcomes using perinatal and neonatal status. The present study aimed to predict the mortality risk of preterm or low birth weight infants using the Clinical Risk Index for Babies (CRIB-II) and Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) scoring systems.Methods: This prospective cohort study investigated the preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Vali-e-Asr Hospital, Tehran, Iran, with the birth weight of ˂1500g or a gestational age˂32weeks using the CRIB-II and SNAPPE-II scoring systems within the first 12 h after birth. The area under the curve, sensitivity, specificity, positive and negative predictive values of the scoring systems, as well as the association between neonate factors and neonatal death were calculated in this study.Results: Out of 344 neonates under study, 253casessurvived after24hof birth and 91 newborns died. The total CRIB-II scores in survived and deceased infants were 6.12 and 10.28, respectively. The area under the receiver operating characteristic (ROC) curve with a cut-off point of 8.5 was obtained at 0.838. Moreover, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 74.4%, 78.65%, 55.37%, and 89.68%, respectively, for the CRIB-II system. Total scores of SNAPPE-II in survived and deceased infants were 16.9 and 51.6, respectively. The area under the ROC curve with a cut-off point of 27.5 was determined at 0.887. Sensitivity (84.44%) and specificity (79.05%) were calculated for the SNAPPE-II. Furthermore, positive and negative predictive values were 58.91% and 93.46%, respectively.Conclusion: This study demonstrated that the CRIB-II and SNAPPE-II scoring systems can be useful mortality predictors for at-risk neonates.

Background: Premature birth and hospitalization in Neonatal Intensive Care Units (NICUs) is a critical issue for parents, especially mothers. The present study aimed to investigate the effect of spiritual care on hope and self-transcendence in mothers with premature newborns hospitalized in the NICUs.Methods: This quasi-experimental, single-group study was conducted using time series analysis. The sample consisted of 30 mothers with premature neonates hospitalized in Shahid Beheshti Hospital, Maraqeh, Iran. The participants were selected through a convenience sampling method following the inclusion criteria. The data were collected using the demographic characteristic forms of mothers and the clinical status of infants, as well as the hope and self-transcendence scales of the mothers with premature neonates admitted to the NICU. The data were analyzed in SPSS software (version 19) through descriptive statistics (i.e., frequency distribution, mean and standard deviation) and repeated measures analysis of variance (ANOVA).Results: The findings show a significant difference among the pre-test, post-test, and follow-up stages in terms of the mean scores of hope and self-transcendence using repeated measure ANOVA (P

Background: Skin is the most important defense mechanism of the neonate's body. The admission to the Neonatal Intensive Care Unit (NICU) is a risk factor for neonatal skin injuries. Therefore, to prevent these complications, it is essential to identify the risk factors. The present study aimed to investigate the incidence of skin injuries and its related factors in neonates admitted to the NICU.Methods: This cohort study was conducted in two NICUs in one perinatal hospital in Tehran, Iran, from January 2018 to June 2018. The sampling was performed using the census method. The data were collected through a demographic characteristics form, a risk factor assessment checklist, and the European Pressure Ulcer Advisory Panel (EPUAP) tool. The data were analyzed in SPSS software (version 19) through Fisher's exact test and chi-square test.Results: Out of 368 neonates, 126 cases had skin injuries, and the others were healthy. The mean values of weight and age of the neonates with skin injuries were 796.68±1606.82 g and 5.18±30.82 days, which was significantly lower than those of the infants without skin injury (p

Background: Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).Methods: This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.Results: The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.Conclusion: Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains.

Background: Infections are one of the most important causes of death in infants, especially in developing countries. Inappropriate use and administration of antibiotics can contribute to the resistance and spread of infection. In this study, we determined the antibiotic resistance pattern of the bacteria isolated from clinical samples of blood, cerebrospinal fluid, and urine in the neonatal intensive care unit (NICU) of Ali Asghar Hospital, Iran during 2013-2015.Methods: For the purposes of the study, clinical samples of blood, cerebrospinal fluid, and urine were collected from the NICU of Ali Asghar Hospital during 2013-15. The type of bacterial strain and antibiotic susceptibility pattern was determined by routine microbiological tests. The collected data were analysed in SPSS software (version 19), using χ2, Student’s t-test, and ANOVA test for comparison.Results: In total, 240 positive culture samples (118 blood, 117 urine, and 5 cerebrospinal fluid samples) were collected for this research. The most common isolates in the blood, urine, and cerebrospinal fluid samples were Staphylococcus epidermidis (63.6%), Klebsiella (35%), and Acinetobacter Baumannii (40%), respectively. The highest antibiotic resistance in S. epidermidis isolated from blood samples was found against amikacin and cefotaxime, while linezolid and vancomycin were the most effective antibiotics against S. epidermidis. Moreover, ciprofloxacin and nitrofurantoin were the most effective antibiotics against Klebsiella isolated from urine samples, while this bacterial strain had the highest resistance to imipenem and ampicillin. Despite the fact that A. Baumannii strains were resistant to most studied antibiotics, ceftazidime and ceftriaxone had an acceptable antibacterial effect against these isolates.Conclusion: Continuous surveillance for antibiotic susceptibility, rational use of antibiotics, and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.

Background: The present study aimed to determine the mean blood glucose during the first 24 h post-surgery and its relation with the source of calorie intake.Methods: The data of the current observational retrospective study was collected from hospital medical records. A total of 45 neonates suffering from atresia in different parts of the gastrointestinal tract, who were candidates for open abdominal surgery from September to October 2016 were selected. Blood glucose within 24 h after the surgery were taken four times using a glucometer. Moreover, the mean blood glucose during this period was calculated. Independent Student's t-test, chi-square test, and logistic regression model were performed to assess the association of post-operative blood glucose with calorie and macronutrient intakes.Results: In one third of neonates, the mean blood glucose of the samples during the first day after the surgery was ≥180 mg/dl and the rest of them had mean blood glucose of 40-179 mg/dl. There was a significant relationship between blood glucose BG≥180 mg/dl and calorie (P=0.001), macronutrient (carbohydrate (PConclusion: The present study revealed that there was a significant relationship between mean blood glucose during the first 24 h after the surgery and intake of macronutrients (carbohydrate and fat).

Background: Considering the importance of job satisfaction and occupational burnout among nurses, the present study aimed to determine the prevalence of occupational burnout and the degree of job satisfaction among neonatal intensive care unit (NICU) nurses.Methods: The current research was a cross-sectional study in which the Job Descriptive Index and Maslach Burnout Inventory were distributed among the NICU nurses. The collected data were analyzed using SPSS software.Results: A total of 30 NICU nurses working in two public and private hospitals participated in the present study. The mean age of the participants was measured at 37.46±6.93 years, most of them (73.3%) held a Bachelor’s degree and more than 60% were married. No significant relationship between job satisfaction and burnout was observed among the nurses. Both variables were moderate among the NICU nurses as representatives of the staff working in special units.Conclusion: It is widely believed that people who are exposed to extreme stress for a long time are more likely to suffer from occupational burnout. Moreover, considering the importance of this issue in healthcare environments for the provision of services that physically and mentally affect patients, it is recommended to pay greater attention to employee satisfaction and burnout process in hospital settings.

Background: Among the most common causes of death in preterm infants are neonatal infections, which remain high despite antibiotic therapy and preservative measures. The control of hospital infections is now a global priority, and many factors contribute to the spread of these infections. This study aimed to determine the frequency of bacterial infections in neonates and identify the common causes of infection in neonates admitted to the neonatal intensive care unit (NICU) of Alzahra Hospital in Isfahan, Iran. Methods: In this cross-sectional study, the population consisted of all neonates who were admitted to the NICU of Al-Zahra Hospital in Isfahan, Iran, from April 2017 to March 2018. Neonates who had a positive culture (blood, cerebrospinal fluid, urine, eye discharge, and tracheal tube secretions) were enrolled. The data were collected by a structured questionnaire, including maternal and neonatal information. Results: In this study, 56 newborns admitted to the NICU of Alzahra Hospital in Isfahan were studied. Their age range was within 5-28 days (18.88±8.41). Thirty-two (57.1%) neonates were male, and 24 (42.9%) newborns were female. In total, 26 (46.4%) neonates had prematurity that was the most common reason for hospitalization. The most isolated microorganisms were Staphylococcus epidermidis, Enterococcus, Klebsiella, Enterobacteriaceae, Candida spp., Acinetobacter, Streptococcus pneumoniae, E. coli, and Streptococcus viridans, respectively. Conclusion: According to the results of this study, the frequency of nosocomial infections in the NICU of Alzahra Hospital in Isfahan was 7.4%. The findings of this study highlighted the importance of paying more attention to controlling and preventing hospital infections in NICUs.

Background: Oral feeding problems are among the most common issues in preterm infants. Various methods and feeding support tools are used in this regard, such as cup feeding and feeding nozzle. The present study aimed to determine the preferred method between cup feeding and feeding nozzle to support oral feeding in premature neonates. Methods: This clinical trial was conducted on 70 preterm infants with the gestational age of 30-33 weeks in Isfahan, Iran. Infants were divided into two groups of cup feeding and feeding nozzle application. The studied variables were the duration needed to reach the time of full oral feeding, weight changes since birth until full oral feeding, and length of hospital stay. Results: Mean duration to start full oral feeding was 4.03 and 5.1 days in the cup feeding and feeding nozzle groups, respectively (P0.05). Mean length of hospital stay was 23.1 and 21.9 days in the cup feeding and feeding nozzle groups, respectively (P>0.05). Conclusion: According to the results, the time needed to reach full oral feeding was shorter in the cup feeding group compared to the feeding nozzle group. However, the mean length of hospital stay was two days shorter in the feeding nozzle group compared to the cup feeding group. Therefore, feeding nozzle could be utilized as a supportive method in the feeding of preterm infants.

Background: Respiratory disorders are recognized as a leading cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is used by pediatricians both for diagnostic and therapeutic indications in children. Nonetheless, there is a paucity of data regarding the diagnostic utility and safety of FOB in neonates, and it has remained relatively under-used in the care of neonates. The present study provided a practical overview of the wide diagnostic aspects of the FOB in newborns hospitalized in the Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to the quick management of neonates with respiratory disorders. Methods: This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over 5 years within 2013-2018. All subjects underwent FOB and bronchoalveolar Lavage (BAL) using a bronchoscope of 2.8 (EVIS EXERA III Olympus bronchoscope). Results: The greatest indications for performing FOB entailed hypersecretion in 138 (92%) cases, prolonged mechanical ventilation in 108 (72%) neonates, and persistent radiological finding in 97 (64.6%) subjects. Bronchoscopy detected various airways anomalies, such as Laryngomalacia (72%), Tracheobronchomalacia (64%), subglottic stenosis (26%), vocal cord paresis (18%), tracheoesophageal fistula (6.7%), laryngeal cleft (6%), and laryngeal web (4%). BAL results demonstrated that the cultures were positive in 20 (13.33%) neonates. Acinetobacter was the most commonly reported bacterial infection observed in 8% of neonates. Conclusion: As evidenced by the obtained results, when performed by an experienced and well-trained person and in an environment with appropriate facilities, FOB can be a safe and efficient tool for the early diagnosis of numerous airway disorders among neonates admitted to NICUs. [ABSTRACT FROM AUTHOR]

Background: Skin is the most important defense mechanism of the neonate's body. The admission to the Neonatal Intensive Care Unit (NICU) is a risk factor for neonatal skin injuries. Therefore, to prevent these complications, it is essential to identify the risk factors. The present study aimed to investigate the incidence of skin injuries and its related factors in neonates admitted to the NICU. Methods: This cohort study was conducted in two NICUs in one perinatal hospital in Tehran, Iran, from January 2018 to June 2018. The sampling was performed using the census method. The data were collected through a demographic characteristics form, a risk factor assessment checklist, and the European Pressure Ulcer Advisory Panel (EPUAP) tool. The data were analyzed in SPSS software (version 19) through Fisher's exact test and chi-square test. Results: Out of 368 neonates, 126 cases had skin injuries, and the others were healthy. The mean values of weight and age of the neonates with skin injuries were 796.68±1606.82 g and 5.18±30.82 days, which was significantly lower than those of the infants without skin injury (P<0.05). The results of the risk factors analysis also showed that the second-grade injuries were the most frequent. Moreover, the drug leakage (14.2%, n=33) and nasal continuous positive airway pressure (12.06%, n=28) had the highest prevalence. The results of the effect of risk factors on the wound grade also showed that drug leakage, diaper rash, and surgical injuries had a significant effect on the wound grade. Conclusion: The results showed that in addition to neonatal conditions, equipment, and neonatal care play a significant role in the incidence of skin injuries. Skin is the most important defense barrier of the neonate's body and it is vitally important to take care of it. Therefore, it is necessary to identify and prevent such injuries. [ABSTRACT FROM AUTHOR]

Background: Preterm deliveries and premature babies are among challenges for families and communities. A familycentered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs). Methods: This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests. Results: The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75- 34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning. Conclusion: Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains. [ABSTRACT FROM AUTHOR]

Background: Premature birth and hospitalization in Neonatal Intensive Care Units (NICUs) is a critical issue for parents, especially mothers. The present study aimed to investigate the effect of spiritual care on hope and selftranscendence in mothers with premature newborns hospitalized in the NICUs. Methods: This quasi-experimental, single-group study was conducted using time series analysis. The sample consisted of 30 mothers with premature neonates hospitalized in Shahid Beheshti Hospital, Maraqeh, Iran. The participants were selected through a convenience sampling method following the inclusion criteria. The data were collected using the demographic characteristic forms of mothers and the clinical status of infants, as well as the hope and self-transcendence scales of the mothers with premature neonates admitted to the NICU. The data were analyzed in SPSS software (version 19) through descriptive statistics (i.e., frequency distribution, mean and standard deviation) and repeated measures analysis of variance (ANOVA). Results: The findings show a significant difference among the pre-test, post-test, and follow-up stages in terms of the mean scores of hope and self-transcendence using repeated measure ANOVA (P<0.001). Moreover, in examining the effect of spiritual care on hope and self-transcendence in mothers, the results of repeated measures ANOVA showed that there was a difference among the pre-test, post-test and follow-up stages in terms of the mean scores of mothers’ hope, (P<0.001, F=53.133, and Eta-squared=0.639). Moreover, a significant difference was observed among the pretest, post-test, and follow-up phases regarding the mean scores of self-transcendence (P<0.001, F=131.239, and Etasquared=0.814). Conclusion: Since spirituality can lead to an increase in hope and self-transcendence of mothers with premature infants hospitalized in the NICUs, this approach can be used as an appropriate intervention method to help improve their adaptation and peace of mind. Therefore, barriers to providing these types of care and managing them must be identified so that nurses in the NICUs can use them. [ABSTRACT FROM AUTHOR]

Background: Risk scoring systems evaluate neonatal outcomes using perinatal and neonatal status. The present study aimed to predict the mortality risk of preterm or low birth weight infants using the Clinical Risk Index for Babies (CRIB-II) and Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) scoring systems. Methods: This prospective cohort study investigated the preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Vali-e-Asr Hospital, Tehran, Iran, with the birth weight of ˂1500g or a gestational age˂32weeks using the CRIB-II and SNAPPE-II scoring systems within the first 12 h after birth. The area under the curve, sensitivity, specificity, positive and negative predictive values of the scoring systems, as well as the association between neonate factors and neonatal death were calculated in this study. Results: Out of 344 neonates under study, 253 casessurvived after 24hof birth and 91 newborns died. The total CRIB-II scores in survived and deceased infants were 6.12 and 10.28, respectively. The area under the receiver operating characteristic (ROC) curve with a cut-off point of 8.5 was obtained at 0.838. Moreover, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 74.4%, 78.65%, 55.37%, and 89.68%, respectively, for the CRIB-II system. Total scores of SNAPPE-II in survived and deceased infants were 16.9 and 51.6, respectively. The area under the ROC curve with a cut-off point of 27.5 was determined at 0.887. Sensitivity (84.44%) and specificity (79.05%) were calculated for the SNAPPE-II. Furthermore, positive and negative predictive values were 58.91% and 93.46%, respectively. Conclusion: This study demonstrated that the CRIB-II and SNAPPE-II scoring systems can be useful mortality predictors for at-risk neonates. [ABSTRACT FROM AUTHOR]

Background: Infections are one of the most important causes of death in infants, especially in developing countries. Inappropriate use and administration of antibiotics can contribute to the resistance and spread of infection. In this study, we determined the antibiotic resistance pattern of the bacteria isolated from clinical samples of blood, cerebrospinal fluid, and urine in the neonatal intensive care unit (NICU) of Ali Asghar Hospital, Iran during 2013-2015. Methods: For the purposes of the study, clinical samples of blood, cerebrospinal fluid, and urine were collected from the NICU of Ali Asghar Hospital during 2013-15. The type of bacterial strain and antibiotic susceptibility pattern was determined by routine microbiological tests. The collected data were analysed in SPSS software (version 19), using χ2, Student's t-test, and ANOVA test for comparison. Results: In total, 240 positive culture samples (118 blood, 117 urine, and 5 cerebrospinal fluid samples) were collected for this research. The most common isolates in the blood, urine, and cerebrospinal fluid samples were Staphylococcus epidermidis (63.6%), Klebsiella (35%), and Acinetobacter Baumannii (40%), respectively. The highest antibiotic resistance in S. epidermidis isolated from blood samples was found against amikacin and cefotaxime, while linezolid and vancomycin were the most effective antibiotics against S. epidermidis. Moreover, ciprofloxacin and nitrofurantoin were the most effective antibiotics against Klebsiella isolated from urine samples, while this bacterial strain had the highest resistance to imipenem and ampicillin. Despite the fact that A. Baumannii strains were resistant to most studied antibiotics, ceftazidime and ceftriaxone had an acceptable antibacterial effect against these isolates. Conclusion: Continuous surveillance for antibiotic susceptibility, rational use of antibiotics, and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU). This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions.

Background: Prematurity could result in the long admission of the neonate to the Neonatal Intensive Care Unit (NICU) and development of some complications for both mother and newborn. The early discharge programs make the neonatal transference to home much easier and are beneficial to both parents and newborns. However,there are limited studies investigating the real needs of the preterm neonates discharged early. Therefore, the identification of the post-discharge needs of these newborns could help the nurses, as the most important health care members, to consider these needs and mitigate the complications affecting the neonates. This study aimed to describe the care needs of the preterm infants with early discharge from the NICU. Methods: The present study was conducted on 25 participants (i.e., 10 mothers, 3 physicians, and 12 nurses) selected by purposive sampling technique. Data collection was performed by Observer as participant and in-depth interviews by qualitative content analysis for analysis. Results: Data analysis led to the emergence of four categories, namely need to follow nasogastric tube feeding, need for oxygen level monitoring, need to obtain sufficient information about medication, and need to acquire skill for daily care delivery. Conclusion: The enhancement of the nurses' knowledge about the needs of the preterm neonates with early discharge would result in the improvement of their abilities in the relevant domain. Accordingly, these nurses could help the mothers to prevent the incidence of several complications in the neonates, such as readmissions to the NICU. More importantly, these measures could prevent from the consequences of failure to fulfil these needs emerging in the later stages of life.

Background: Hospitalization of infants in the neonatal intensive care unit (NICU) may disrupt the proper interaction with infants and lead to anxiety and depression, while adversely affecting the role of families. Therefore, it is necessary for healthcare teams to be familiar with the principles of parental mental health in the NICU. The present study aimed to codify the principles of parental mental health in the NICU. Methods: This study was conducted with a triangulation methodology in two steps. In the first step, the principles of mental health care for parents in the NICU were compiled and translated. In the second step, the principles were edited using the Delphi method based on the opinion of experts (physicians, faculty members, and health policymakers). Final principles of parental mental health in the NICU were codified. Results: In total, four general principles of holistic care, relationship with parents in the NICU, special care for establishing communication with families in the NICU, and principles of infants and family care were obtained.Conclusion: Since healthcare teams may not be familiar with the principles of parental mental health in the NICU, the results of the present study could lay the groundwork for promoting the knowledge of healthcare team members in interaction with parents

ABSTRACTBackground: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant's condition and care for it after discharge from neonatal intensive care unit (NICU).Methods: A qualitative design was used to explain mothers' challenges after their infant's discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant's discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis.Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers.Conclusion: Mothers have difficulty in meeting their infants' basic needs after discharge. Supporting these mothers can enable them promote their infant's health.

ABSTRACTBackground: The survival rate of preterm and low-birth-weight (LBW) infants depends on various factors such as birth weight, gestational age, and quality of care. The present study aimed at evaluating the survival rate of preterm and LBW infants, predictive factors, and the risk of mortality in three training hospitals of Mashhad and Tabriz cities.Methods: This prospective, cohort study was conducted during six months from 2013 to 2014. Infants with birth weight ≤1500 g or gestational age ≤32 weeks were enrolled. Their information was gathered by using data collection forms and clinical risk index for infants (CRIB II) was calculated for each participant. Infants were followed up until discharge from the hospital and their outcomes were determined. Kaplan-Meier and Log rock tests were used for survival analysis. Cox regression was also applied in order to find out the factors associated with infants’ survival.Results: Among the 338 followed up infants, 97 (28.7%) died and 241 (71.3%) remained alive. The median of preterm and LBW infants’ overall survival rate was 76 days (CI: 60.4-91.5). Multivariate Cox regression analysis indicated that three factors of birth weight, base excess, and fifth minute Apgar score had a significant relationship with the survival rate of infants (P

Background: Considering the importance of job satisfaction and occupational burnout among nurses, the present study aimed to determine the prevalence of occupational burnout and the degree of job satisfaction among neonatal intensive care unit (NICU) nurses. Methods: The current research was a cross-sectional study in which the Job Descriptive Index and Maslach Burnout Inventory were distributed among the NICU nurses. The collected data were analyzed using SPSS software. Results: A total of 30 NICU nurses working in two public and private hospitals participated in the present study. The mean age of the participants was measured at 37.46±6.93 years, most of them (73.3%) held a Bachelor's degree and more than 60% were married. No significant relationship between job satisfaction and burnout was observed among the nurses. Both variables were moderate among the NICU nurses as representatives of the staff working in special units. Conclusion: It is widely believed that people who are exposed to extreme stress for a long time are more likely to suffer from occupational burnout. Moreover, considering the importance of this issue in healthcare environments for the provision of services that physically and mentally affect patients, it is recommended to pay greater attention to employee satisfaction and burnout process in hospital settings. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to determine the mean blood glucose during the first 24 h post-surgery and its relation with the source of calorie intake. Methods: The data of the current observational retrospective study was collected from hospital medical records. A total of 45 neonates suffering from atresia in different parts of the gastrointestinal tract, who were candidates for open abdominal surgery from September to October 2016 were selected. Blood glucose within 24 h after the surgery were taken four times using a glucometer. Moreover, the mean blood glucose during this period was calculated. Independent Student's t-test, chi-square test, and logistic regression model were performed to assess the association of postoperative blood glucose with calorie and macronutrient intakes. Results: In one third of neonates, the mean blood glucose of the samples during the first day after the surgery was ≥180 mg/dl and the rest of them had mean blood glucose of 40-179 mg/dl. There was a significant relationship between blood glucose BG≥180 mg/dl and calorie (P=0.001), macronutrient (carbohydrate (P<0.001), and fat (P=0.04)) intakes. After adjustment of confounding variables, carbohydrate intake was found as an independent factor in increasing BG≥180 mg/dl during the first 24 h after the surgery (P=0.01). In addition, fat intake was observed as an effective factor in decreasing BG≥180 mg/dl during this time (P=0.04). Conclusion: The present study revealed that there was a significant relationship between mean blood glucose during the first 24 h after the surgery and intake of macronutrients (carbohydrate and fat). [ABSTRACT FROM AUTHOR]

Background: Among the most common causes of death in preterm infants are neonatal infections, which remain high despite antibiotic therapy and preservative measures. The control of hospital infections is now a global priority, and many factors contribute to the spread of these infections. This study aimed to determine the frequency of bacterial infections in neonates and identify the common causes of infection in neonates admitted to the neonatal intensive care unit (NICU) of Alzahra Hospital in Isfahan, Iran. Methods: In this cross-sectional study, the population consisted of all neonates who were admitted to the NICU of Al- Zahra Hospital in Isfahan, Iran, from April 2017 to March 2018. Neonates who had a positive culture (blood, cerebrospinal fluid, urine, eye discharge, and tracheal tube secretions) were enrolled. The data were collected by a structured questionnaire, including maternal and neonatal information. Results: In this study, 56 newborns admitted to the NICU of Alzahra Hospital in Isfahan were studied. Their age range was within 5-28 days (18.88+8.41). Thirty-two (57.1%) neonates were male, and 24 (42.9%) newborns were female. In total, 26 (46.4%) neonates had prematurity that was the most common reason for hospitalization. The most isolated microorganisms were Staphylococcus epidermidis, Enterococcus, Klebsiella, Enterobacteriaceae, Candida spp., Acinetobacter, Streptococcus pneumoniae, E. coli, and Streptococcus viridans, respectively. Conclusion: According to the results of this study, the frequency of nosocomial infections in the NICU of Alzahra Hospital in Isfahan was 7.4%. The indings of this study highlighted the importance of paying more attention to controlling and preventing hospital infections in NICUs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units. Methods: A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013), including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.Results: Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%). Less than half felt that the pain tool used in their unit was an accurate measure (44.2%). Fewer than half reported that pain was well managed (28.3%) , that their pain protocols were research evidence based (34.2%) and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%). Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.Conclusions: proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision.

Background: Infants are regarded as a vulnerable group in need of nursing care, particularly during NICU admission. Parents of these infants often experience emotional, psychological and physical upheavals. Therefore, nurses can be of great help to the parents and facilitate a healthy transition from this period. Improper communication with parents, who seek information on their infant’s condition, intensifies their stress, fear and misunderstanding. In fact, inadequate communication with healthcare providers and lack of family support are major issues for the parents of NICU-admitted infants. Methods: In this qualitative study, via content analysis, we objectively selected and collected data from parents, physicians and nurses, residing in Isfahan, Iran in 2012. Data saturation was reached after conducting 25 in-depth, semi-structured interviews. Results: Based on the findings, five major categories were extracted: 1) care provision in NICUs; 2) diagnostic difficulties; 3) NICU admission process; 4) challenges of hospitalization; and 5) maintenance of infant viability. Conclusion: Nurses’ proper response to parents’ questions about the infant's condition reduced stress among parents. Based on the findings, training is essential to healthy family dynamics and infant’s well-being, particularly for younger parents who support their infants at home. Also, regular updates on infant’s condition could help reduce parents’ stress and discomfort.

Background: Mothers are highly vulnerable to depression within the first year after childbirth. Approximately 10-20% of mothers suffer from depression during this period, and half of these women with symptoms of prominent postpartum depression (PPD) remain undiagnosed. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely applied screening instrument for PPD evaluation. In this study, we evaluated EPDS scores (score ≥12) at discharge and 2, 28 and 42 days following delivery to determine the risk factors and prevalence of PPD in mothers of infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: A sample of 682 women completed the EPDS scale upon admission and hospital discharge. PPD assessment was performed at days 28 and 42 following delivery via phone interviews. Results: Upon admission, the average EPDS score was 9.72 (SD=4.4) and 27.4% of women (n=187) had EPDS scores ≥ 12. At discharge and 28 and 42 days following delivery, the average scores were normal as follows: 9.34 (SD=3.8), 9.12 (SD=3.7) and 8.52 (SD=3.36), respectively. Within the mentioned intervals, 25.4% (n=173), 23.3% (n=141) and 15.3% (n=88) of women presented with PPD. A positive correlation was shown between EPDS scores on admission and D42 (P = 0.001) that all PPD cases at D42 had EPDS score ≥ 12 on admission The analysis showed that multiple gestation (P=0.001) and advanced age (P=0.001) were significantly associated with PPD. Conclusion: As the results indicated, women with EPDS scores ≥ 12 should benefit from close follow-ups during the postpartum period and be provided with psychological support.

Background: Premature infants are among high-risk groups in community who need to be hospitalized at intensive care units for survival and receiving basic or special care. Hospitalization at neonatal intensive care units (NICUs) unsettles the family and leads to the separation of parents from their infants. This study aimed to determine the effects of maternal attachment behaviors on the behavioral responses of premature infants, hospitalized at NICUs. Methods: In this randomized clinical trial, 64 premature infants, who were hospitalized at NICUs and were eligible for the study, were randomly allocated to study and control groups. Attachment behaviors including touching, massage and kangaroo care were applied for the study group, while the conventional attachment method was adopted for the control group. Behavioral responses were evaluated two hours before and two hours after training attachment behaviors. Data were analyzed, using Chi-square and student’s t-test. Results: The mean difference in the duration of deep sleep and consciousness was more significant in the study group, compared to the control group. Furthermore, the duration of drowsiness was significantly less in the study group, compared to the control group. Conclusion: The implementation of attachment training at NICUs decreased the time of drowsiness and improved behavioral responses, deep sleep time and consciousness.

Background:Extrauterine growth restriction remains a common and serious problem in newborns especially who are small, immature, and critically ill. Very low birth weight infants (VLBW) had 97% and 40% growth failure at 36 weeks and 18-22 months post-conceptual age respectively. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may cause significant growth delay or morbidity in VLBW infants. The purpose of this study was to evaluate current nutritional status in the neonatal intensive care unit in a teaching hospital.Methods:During this prospective observational study, the nutritional status of 100 consecutive critically ill neonates were evaluated by anthropometric and biochemical parameters in a tertiary neonatal intensive care unit. Their demographic characteristics (weight, height and head circumference), energy source (dextrose and lipid) and protein were recorded in the first, 5th, 10th, 15th and 20th days of admission and blood samples were obtained to measure serum albumin and prealbumin. The amount of calorie and protein were calculated for all of preterm and term neonates and compared to standard means separately. Results: The calorie and amino acids did not meet in the majority of the preterm and term neonates and mean daily parenteral calorie intake was 30% or lower than daily requirements based on neonates’ weight. Mortality rate was significantly higher in neonates with lower serum albumin and severity of malnutrition but not with serum prealbumin concentration. Conclusion: Infants were studied did not receive their whole of daily calorie and protein requirements and it is recommended early and enough administration of calorie source (dextrose, lipids) and amino acids. Prealbumin was a more benefit biochemical parameter than albumin to evaluate short term nutrition especially in critically ill patients.

Background: Oral feeding problems are among the most common issues in preterm infants. Various methods and feeding support tools are used in this regard, such as cup feeding and feeding nozzle. The present study aimed to determine the preferred method between cup feeding and feeding nozzle to support oral feeding in premature neonates. Methods: This clinical trial was conducted on 70 preterm infants with the gestational age of 30-33 weeks in Isfahan, Iran. Infants were divided into two groups of cup feeding and feeding nozzle application. The studied variables were the duration needed to reach the time of full oral feeding, weight changes since birth until full oral feeding, and length of hospital stay. Results: Mean duration to start full oral feeding was 4.03 and 5.1 days in the cup feeding and feeding nozzle groups, respectively (P<0.05). Mean changes in the weight of the neonates since the initiation of oral feeding until full oral feeding was 49.5 grams in the cup feeding group and 89 grams in the feeding nozzle group. Analysis of covariance was performed by adjusting the duration since initiating the intervention until starting full oral feeding, and no significant difference was observed between the groups in this regard (P>0.05). Mean length of hospital stay was 23.1 and 21.9 days in the cup feeding and feeding nozzle groups, respectively (P>0.05) . Conclusion: According to the results, the time needed to reach full oral feeding was shorter in the cup feeding group compared to the feeding nozzle group. However, the mean length of hospital stay was two days shorter in the feeding nozzle group compared to the cup feeding group. Therefore, feeding nozzle could be utilized as a supportive method in the feeding of preterm infants. [ABSTRACT FROM AUTHOR]

Background: Prematurity could result in the long admission of the neonate to the Neonatal Intensive Care Unit (NICU) and development of some complications for both mother and newborn. The early discharge programs make the neonatal transference to home much easier and are beneficial to both parents and newborns. However, there are limited studies investigating the real needs of the preterm neonates discharged early. Therefore, the identification of the post-discharge needs of these newborns could help the nurses, as the most important health care members, to consider these needs and mitigate the complications affecting the neonates. This study aimed to describe the care needs of the preterm infants with early discharge from the NICU. Methods: The present study was conducted on 25 participants (i.e., 10 mothers, 3 physicians, and 12 nurses) selected by purposive sampling technique. Data collection was performed by Observer as participant and in-depth interviews by qualitative content analysis for analysis. Results: Data analysis led to the emergence of four categories, namely need to follow nasogastric tube feeding, need for oxygen level monitoring, need to obtain sufficient information about medication, and need to acquire skill for daily care delivery. Conclusion: The enhancement of the nurses' knowledge about the needs of the preterm neonates with early discharge would result in the improvement of their abilities in the relevant domain. Accordingly, these nurses could help the mothers to prevent the incidence of several complications in the neonates, such as readmissions to the NICU. More importantly, these measures could prevent from the consequences of failure to fulfil these needs emerging in the later stages of life. [ABSTRACT FROM AUTHOR]

Background: Globally, it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU). This study aimed to evaluate the physical environment of hospital and nursery in Iran's tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants' bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants' beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions. [ABSTRACT FROM AUTHOR]

Background: Neonatal survival is one of the most important challenges today. Over 99% of neonatal mortalities occur in the developing countries, and epidemiologic studies emphasize on this issue in the developed countries, as well. In this study, we attempted to investigate the causes of neonatal mortality in Taleghani Hospital, Tabriz, Iran. Methods: In this cross-sectional study, we studied causes of neonatal mortality in neonatal intensive care unit (NICU) of Taleghani Hospital, Tabriz, Iran, during 2013-2014. Data collection was performed by the head nurse and treating physician using a pre-designed questionnaire. Most of the data were extracted from the neonatal records. Information regarding maternal underlying diseases and health care during pregnancy was extracted from mothers' records. Results: A total of 891 neonates were admitted to NICU of Taleghani Hospital of Tabriz, Iran, during 2013-2014, 68 (7.5%) of whom died. Among these cases, 37 (%54.4) were male, 29 (29.4%) were extremely low birth weight, and 16 (23.5%) weighed more than 2.5 kg. The main causes of mortality were congenital anomalies (35.3%), prematurity (26.5%), and sepsis (10.3%), respectively. Conclusion: Congenital anomaly is the most common cause of mortality, and the pattern of death is changing from preventable diseases to unavoidable mortalities. [ABSTRACT FROM AUTHOR]

Background: Hospitalization of infants in the neonatal intensive care unit (NICU) may disrupt the proper interaction with infants and lead to anxiety and depression, while adversely affecting the role of families. Therefore, it is necessary for healthcare teams to be familiar with the principles of parental mental health in the NICU. The present study aimed to codify the principles of parental mental health in the NICU. Methods: This study was conducted with a triangulation methodology in two steps. In the first step, the principles of mental health care for parents in the NICU were compiled and translated. In the second step, the principles were edited using the Delphi method based on the opinion of experts (physicians, faculty members, and health policymakers). Final principles of parental mental health in the NICU were codified. Results: In total, four general principles of holistic care, relationship with parents in the NICU, special care for establishing communication with families in the NICU, and principles of infants and family care were obtained. Conclusion: Since healthcare teams may not be familiar with the principles of parental mental health in the NICU, the results of the present study could lay the groundwork for promoting the knowledge of healthcare team members in interaction with parents. [ABSTRACT FROM AUTHOR]

Background: The survival rate of preterm and low-birth-weight (LBW) infants depends on various factors such as birth weight, gestational age, and quality of care. The present study aimed at evaluating the survival rate of preterm and LBW infants, predictive factors, and the risk of mortality in three training hospitals of Mashhad and Tabriz cities. Methods: This prospective, cohort study was conducted during six months from 2013 to 2014. Infants with birth weight ≤1500 g or gestational age ≤32 weeks were enrolled. Their information was gathered by using data collection forms and clinical risk index for infants (CRIB II) was calculated for each participant. Infants were followed up until discharge from the hospital and their outcomes were determined. Kaplan-Meier and Log rock tests were used for survival analysis. Cox regression was also applied in order to find out the factors associated with infants' survival. Results: Among the 338 followed up infants, 97 (28.7%) died and 241 (71.3%) remained alive. The median of preterm and LBW infants' overall survival rate was 76 days (CI: 60.4-91.5). Multivariate Cox regression analysis indicated that three factors of birth weight, base excess, and fifth minute Apgar score had a significant relationship with the survival rate of infants (P<0.05). Conclusion: The survival rate of preterm and low-weight infants was acceptable in this study (71%). Birth weight, fifth minute Apgar score, and base excess were important items that affected infants' survival and could be considered in predicting it in neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Background: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant's condition and care for it after discharge from neonatal intensive care unit (NICU). Methods: A qualitative design was used to explain mothers' challenges after their infant's discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant's discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis. Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers. Conclusion: Mothers have difficulty in meeting their infants' basic needs after discharge. Supporting these mothers can enable them promote their infant's health. [ABSTRACT FROM AUTHOR]

Background: Despite the growing knowledge on pain assessment and intervention, neonatal pain remains unrecognized and under-treated. This study aimed to determine the knowledge and practice of the neonatal nurses in pain assessment and management. Methods: This cross-sectional descriptive study was conducted on 120 neonatal nurses working in the Neonatal Intensive Care Units (NICUs) and neonatal units in Ardebil, Iran, using the census method. For data collection, Nurses' Perceptions of Neonatal Pain questionnaire developed by Cong was employed, which includes two open ended and 36 Likert scale questions. The collected data were analyzed, using descriptive statistics (frequency and percentage) and qualitative content analysis method. Results: As the results of the study indicated, the nurses had adequate level of knowledge about the neonatal pain. However, less than 50% of them believed receiving suitable training on this issue. The majority of the participants reported that they did not use any pain assessment tools (65%). Less than half of them expressed that the pain assessment tools used in their units were accurate measures (44.2%). Likewise, less than half of the nurses reported that pain was well managed in their institution (28.3%) with evidence-based protocols (34.2%). In addition, more than half of the subjects reported that parents should be involved with the care and comfort of their infants during the painful procedures (71.6%). Conclusion: Nurses' perceptions of well-managed pain had a significant relationship with adequate training, use of appropriate and accurate pain tools, clear and evidence-based protocols, and parent involvement. [ABSTRACT FROM AUTHOR]

Background: Infants are regarded as a vulnerable group in need of nursing care, particularly during NICU admission. Parents of these infants often experience emotional, psychological and physical upheavals. Therefore, nurses can be of great help to the parents and facilitate a healthy transition from this period. Improper communication with parents, who seek information on their infant's condition, intensifies their stress, fear and misunderstanding. In fact, inadequate communication with healthcare providers and lack of family support are major issues for the parents of NICU-admitted infants. Methods: In this qualitative study, via content analysis, we objectively selected and collected data from parents, physicians and nurses, residing in Isfahan, Iran in 2012. Data saturation was reached after conducting 25 in-depth, semi-structured interviews. Results: Based on the findings, five major categories were extracted: 1) care provision in NICUs; 2) diagnostic difficulties; 3) NICU admission process; 4) challenges of hospitalization; and 5) maintenance of infant viability. Conclusion: Nurses' proper response to parents' questions about the infant's condition reduced stress among parents. Based on the findings, training is essential to healthy family dynamics and infant's well-being, particularly for younger parents who support their infants at home. Also, regular updates on infant's condition could help reduce parents' stress and discomfort. [ABSTRACT FROM AUTHOR]

Background: Mothers are highly vulnerable to depression within the first year after childbirth. Approximately 10-20% of mothers suffer from depression during this period, and half of these women with symptoms of prominent postpartum depression (PPD) remain undiagnosed. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely applied screening instrument for PPD evaluation. In this study, we evaluated EPDS scores (score =12) at discharge and 2, 28 and 42 days following delivery to determine the risk factors and prevalence of PPD in mothers of infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: A sample of 682 women completed the EPDS scale upon admission and hospital discharge. PPD assessment was performed at days 28 and 42 following delivery via phone interviews. Results: Upon admission, the average EPDS score was 9.72 (SD=4.4) and 27.4% of women (n=187) had EPDS scores = 12. At discharge and 28 and 42 days following delivery, the average scores were normal as follows: 9.34 (SD=3.8), 9.12 (SD=3.7) and 8.52 (SD=3.36), respectively. Within the mentioned intervals, 25.4% (n=173), 23.3% (n=141) and 15.3% (n=88) of women presented with PPD. A positive correlation was shown between EPDS scores on admission and D42 (P = 0.001) that all PPD cases at D42 had EPDS score = 12 on admission The analysis showed that multiple gestation (P=0.001) and advanced age (P=0.001) were significantly associated with PPD. Conclusion: As the results indicated, women with EPDS scores = 12 should benefit from close follow-ups during the postpartum period and be provided with psychological support. [ABSTRACT FROM AUTHOR]

Background: Premature infants are among high-risk groups in community who need to be hospitalized at intensive care units for survival and receiving basic or special care. Hospitalization at neonatal intensive care units (NICUs) unsettles the family and leads to the separation of parents from their infants. This study aimed to determine the effects of maternal attachment behaviors on the behavioral responses of premature infants, hospitalized at NICUs. Methods: In this randomized clinical trial, 64 premature infants, who were hospitalized at NICUs and were eligible for the study, were randomly allocated to study and control groups. Attachment behaviors including touching, massage and kangaroo care were applied for the study group, while the conventional attachment method was adopted for the control group. Behavioral responses were evaluated two hours before and two hours after training attachment behaviors. Data were analyzed, using Chi-square and student's t-test. Results: The mean difference in the duration of deep sleep and consciousness was more significant in the study group, compared to the control group. Furthermore, the duration of drowsiness was significantly less in the study group, compared to the control group. Conclusion: The implementation of attachment training at NICUs decreased the time of drowsiness and improved behavioral responses, deep sleep time and consciousness. [ABSTRACT FROM AUTHOR]

Background: Extrauterine growth restriction remains a common and serious condition in neonates, particularly small,immature, and critically ill infants. Overall, 97% and 40% of very low birth weight (VLBW) infants experience growth failure at 36 weeks and 18-22 months post-conceptual age, respectively. The postnatal development of premature infants is highly dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may lead to significant growth delays or morbidity in VLBW infants. The purpose of this study was to evaluate the nutritional status of infants in a neonatal intensive care unit (NICU) at a teaching hospital.Methods: In this prospective observational study, the nutritional status of 100 consecutive critically ill neonates was evaluated, using anthropometric and biochemical parameters in a tertiary NICU. Infantṥ demographic characteristics (weight, height, and head circumference), energy source (dextrose and lipids), and protein level were recorded on the 1st, 5th, 10th, 15th, and 20th days of admission. Blood samples were obtained to measure serum albumin and prealbumin.Calorie and protein levels were calculated for all preterm and term neonates and were separately compared with the standard mean values. Results: Calorie and amino acid level were not similar among the majority of preterm and term neonates, and the mean daily parenteral calorie intake was≤ 30% less than the daily requirements, based on neonatal weight. Mortality rate was significantly higher in neonates with lower serum albumin level and severe malnutrition; however, no association was found between mortality rate and serum prealbumin concentration. Conclusion: In the evaluated infants, the whole daily calorie and protein requirements were not met. Therefore, timely and adequate administration of calorie sources (dextrose and lipids) and amino acids is highly recommended. Compared to albumin, prealbumin was a more effective biochemical parameter for valuating neonate' short-term nutritional status, particularly in critically ill patients. [ABSTRACT FROM AUTHOR]