Shiraz Emedical Journal
Volume:16 Issue: 11, Dec 2015

Prematurity is the most common cause of neonatal death, resulting in approximately 80% of the deaths of infants without congenital abnormalities.. This study aimed to determine the survival of low birth weight infants and to investigate the effect of birth weight, gestational age, and Apgar score on mortality rate..Patients and We retrospectively studied the mortality and survival of 798 newborns with birth weight of < 2500 g during a 4-year period in the neonatal intensive care unit of a referral hospital in Qom, Iran.. The survival-to-discharge rate was 50% for infants weighing < 1000 g and 84.2% for those weighing 1000 – 1499 g. Survival rates at 26, 27, and 28 weeks’ gestation were 54.1%, 63.6%, and 70.2%, respectively. An Apgar score of more than 5 at the first minute and more than 7 at the fifth minute were associated with better survival after hospital discharge.. Our study showed that even with modern perinatal technology and care, early deaths of extremely low birth weight infants are common in our hospitals..

Premature rupture of membranes (PROM) and preterm PROM (PPROM) are the rupture of the fetal chorioamniotic membranes before the onset of labor contractions.. To evaluate whether detection of thyroid hormones in vaginal washouts can be used to diagnose premature rupture of membranes (PROM)..Patients and Total T4 (thyroxin), total T3 (triiodothyronine), and free T4 concentrations in vaginal washouts were analyzed in 45 women with the diagnosis of PROM and compared with 45 normal pregnancies (controls). A Student's t-test was used for comparison of thyroid hormone values and a ROC curve was used for analyzing the diagnostic accuracy.. There were no differences between the patients with PROM and the control women regarding maternal age, gestational age, and parity. The mean concentration of total T4 in the PROM group and the control subjects were 2.1 ± 1.3 µg/mL and 1.55 ± 0.58 µg/, respectively (P = 0.01). Total T3 concentration in the PROM group was significantly higher compared to the controls (1.28 ± 0.42 ng/ vs. 0.8 ± 0.26 ng/, P < 0.0001). Also, free T4 concentration was significantly higher in the PROM group as compared with the controls (0.026 ± 0.034 ng/ vs.0.007 ± 0.004 ng/, P < 0.0001). The ROC curve analysis showed that total T4 = 1.685 µg/ had a sensitivity of 62%, specificity of 76%, positive predictive value (PPV) of 71.8%, and negative predictive value (NPV) of 66.7%. Total T3 = 0.82 ng/ gave a sensitivity of 91%, specificity of 64%, PPV of 72%, and NPV of 87.8%. Free T4 = 0.01 ng/ gave a sensitivity of 51%, specificity of 82%, PPV of 74.2%, and NPV of 62.7%. The best cutoff values were total T4 = 1.685 ng/, total T3 = 0.82 ng/, and free T4 = 0.01 ng/.. Detecting total T4, total T3, and free T4 in vaginal washouts of patients suspected of PROM suspected is a simple, available, rapid, and inexpensive method for the diagnosis of PROM. However, a combination of three tests is recommended..

One of the most serious complications of pregnancy is preterm labor (PTL) and delivery. Further, there are different tocolytic agents available to enhance the time of delivery.. The aim of this study was to compare the effectiveness of transdermal nitroglycerin (glyceryl trinitrate, GTN) and oral nifedipine for managing preterm labor..Patients and This was a randomized clinical trial involving women who were admitted to our hospital with a diagnosis of PTL. Group one received transdermal GTN, whereas group two received oral nifedipine. All vital signs, fetal heart rate (FHR), contractions, dilation, and effacement, as well as gestation age at the time of delivery, have been monitored and evaluated in both groups of patients. Our main goal was the postponement of delivery so as to secure the most beneficial effect of primary corticosteroid administration for the fetus.. Both groups were matched regarding age, gestational age at the time of tocolytic therapy, height of fundus, history of pregnancy, abortion, delivery, and stillbirth, primary body temperature, and systolic and diastolic blood pressure. Those who received GTN had a more prolonged delay of delivery. Also, the GTN group had infants with better one- and five-minute Apgar scores. Although both groups reported minimal side effects, tachycardia and nausea were reported more frequently in GTN patients.. Transdermal GTN was shown to be more effective in controlling PTL compared to oral nifedipine in terms of both maternal and neonatal effects..

Neonatal jaundice is the most common cause of hospitalization in the first month of life. Factors that reportedly affect the severity of neonatal jaundice include: maternal, prenatal and neonatal factors as well as environmental factors (such as zinc). Animal study demonstrated a decrease in serum bilirubin level after zinc treatment in hyperbilirubinemic rats.. The current study aimed to investigate serum zinc level in the neonates with idiopatic jaundice..Patients and A case-control study was undertaken from 2008 to 2010 on 263 neonates in a neonatal intensive care unit and obstetrics department in Ghaem hospital, Mashhad, Iran. Of the 263 infants, 114 and 149 neonates were in the control and the case groups, respectively. Infants with a gestational age of > 35 weeks or with idiopathic jaundice were included in the study. Exclusion criteria were as follows: neonates with sepsis or any congenital abnormalities or with glucose-6-phosphate dehydrogenase (G-6PD) deficiency, ABO and RH incompatibility. Serum levels of zinc and bilirubin were compared between the control (114 neonates without jaundice) and case (149 neonates with jaundice) groups using atomic absorption spectrometry. The maternal and neonatal information were recorded. Spearman correlation coefficient, chi-square and Mann-Whitney tests were employed to analyze the data by SPSS software.. The mean value of the zinc serum level was 1024.74 ± 245.17 μmol/L in the control group and 841.42 ± 211.99 μmol/L in the case group (P < 0.001). There was no significant correlation between zinc level and factors such as maternal age, multi parity, mode of delivery, hospitalization and gender of infants (P > 0.05). Also, no significant correlation was observed between serum levels of Na, blood urea nitrogen (BUN), creatinine (Cr), white blood cell (WBC), platelet, hematocrit (Hct) and zinc (P > 0.05).. The level of serum zinc in the neonates with hyperbilirubinemia jaundice was lower than that of the ones without jaundice. It seems that zinc has a protective effect. However, more studies are needed for better decision making..

One of the main challenges of all health systems is achieving equity in healthcare financing. The Kakwani index is an equity index used to show how distant a financing source is from the proportional status.. The present study aimed to measure the equity of Iran’s health system financing in rural and urban areas between 2001 and 2010 using the Kakwani index.. This study analyzed secondary data for the years 2001 through 2010 in Iran. The data of annual household expenditures and an income survey conducted by the statistical center of Iran (SCI) were used in this study. In addition, out of pocket payments and health insurance premiums, as two sources of healthcare financing, were investigated regarding vertical equity. The T-test was used to test the dominance of the curves.. The Kakwani index was negative (regressive) for out of pocket payments among both rural and urban households (-0.168 in 2001 to -0.197 to 2010, and 0.104 in 2001 to 0.156 in 2010, respectively), it but did not follow a regular trend during the study period. On the other hand, the Kakwani index was positive (progressive) for health insurance premium payments in rural areas (0.065 in 2001 to 0.095 in 2010). In urban areas, this index was negative for health insurance between 2001 and 2006 (-0.04 and -0.004), respectively), but positive between 2007 and 2010 (0.003 and 0.016, respectively). The dominance test (T-test) showed the concentration curves of out of pocket payments in both areas dominated the Lorenz curve in all years, but the dominance test (T-test) for health insurance premium payments did not follow a regular trend during the study period.. Due to the negativity of the Kakwani index for out-of-pocket payments, a great burden on the households can be predicted, and the progressivity of health insurance premium payments implies that expanding insurance coverage may lead to more equitable financing. Thus, the government should take the responsibility to expand the service and cost coverage of insurance plans and to develop policies that protect poor people..